What have I been doing lately? Reading, reading, reading (or at least trying to). So I can post reviews, reviews, reviews. Thanks for your patience! But that’s not the really important stuff that has been going on.

Here’s what we’ve been up to while I’m trying to do all that reading. Spending time at the awesome Duke Cancer Center. Mark just finished 168 pills of chemo (his “weapons of ass destruction”) and 28 days of almost daily radiation. Some folks are curious about how all this works. So here are some links to help you understand what has been going on in Mark’s body, and what “radiation” is all about. It’s really pretty cool.

So, the chemotherapy that Mark is using is an oral drug called Xeloda. The 3-step activation process of XELODA preferentially generates 5-fluorouracil (5-FU) through thymidine phosphorylase (TP) at the tumor site. Did you get that? Well, for you visual learners, here’s an animation of how the drug capecitabine works. Cool, huh?

click the image to see the video (not able to embed in my blog)

If you are really curious (and I know a few scientists in my family who are), you can download the 43-page PDF with all the details, including the detailed mechanism of action, a diagram of the molecular structure and the metabolic pathway of capecitabine to 5-FU (and the requisite mind-numbing list of potential side-effects). Come on, you know you want to read it. Download it here.

In addition to the chemo, Mark has had radiation treatment. Here’s an animation of how the Clinac linear accelerator works. If you are really interested in the physics, read here, here, and here or you can email me. But I think it is pretty cool that there is a linear accelerator in there! This first animation shows the target area as the head region. But it still gives you an idea of how the machine turns. You can’t actually see the rays, this animation just demonstrates how it works.
[youtube]http://www.youtube.com/watch?v=Zg-lWogEfcE[/youtube]

Here is an actual video of a machine (without a patient). The machine turns so easily, even though it is very large.
[youtube]http://www.youtube.com/watch?v=SJ2Unb-EwEE[/youtube]

Here’s Mark, waiting for positioning.

Here’s the “command central” for the technicians:

The software is programmed to open the multileaf collimater fingers in a pattern that allows the beam to leave the machine in a specific shape that the oncologist has programmed for Mark’s body and tumor. On the left you see the photo of the shape the machine is opening to (the gold sections are the collimator fingers that slide in and out, the white area is the open section which shapes the beam). On the right you see the shape of the beam superimposed on Mark’s radio-images (from the on-board imaging apparatus).

Note the cute little figure that reminds the technicians which way the image is facing. See the red nose? So, this setup is for the radiation to enter from the patient’s right side.
The technicians line up the image of Mark on the bed of the machine, with a CT scan (with contrast) taken at the beginning of the treatment, and which was used to set up the software. When everything is lined up, they give him the ol’ zap. Well, actually, he gets the radiation three times… once from each side, and once from above. The positioning actually takes longer than the dose of radiation.

Our machine was the “Green Machine” (there is are four machines, all different colors). The machines aren’t actually painted different colors, it’s just a way to keep everything organized and easy to identify. The Green Team of Eddie and Jen was awesome. Here we are with them on “graduation” day.

Duke’s Rad Onc department is really and truly RAD!!!!

Now, Mark gets 4 weeks off until a new round of CT/PET scans and consultation with the Medical Oncologist, Radiation Oncologist, and most importantly, the Surgical Oncologist. At this point they will decide when he will have his surgery to remove the cancer. After that surgery, he’ll have some more chemo. The type and duration will depend on how things go with the surgery. At least, that’s the plan for now! Stay tuned for updates.