SIRTainly, Madam

Yesterday afternoon, I had an appointment at the Hammersmith Hospital with a doctor specialising in SIRT. SIRT stands for selective internal radiotherapy. It is a specialised form of radiotherapy which has been developed to treat cancer that has spread to the liver. It involves putting special radioactive beads up inside the artery that lead to the liver. The beads are taken by the bloodstream to the tumours and hopefully kill them. This is a relatively novel procedure in the UK and is not available on the NHS for breast cancer patients. I am extremely lucky to have private medical insurance that is hopefully going to cover this and give me another option as regards treatment.

The appointment was extremely helpful. The doctor explained in detail not only what the procedure involves but what needs to be done in preparation, what happens afterwards and what the risks are. He was also very interested in my genetic position and in the drug regime that I am currently on. To cut a long story short, I am definitely a candidate for the procedure, but will need to stop my current chemo regime 6 to 8 weeks before I have SIRT.  The doctor and I agreed that if my next scan shows that this chemo regime is still continuing to work, we should not consider stopping it for the SIRT procedure yet.

I felt both lifted and depressed by the appointment at the same time. The doctor was extremely helpful and comprehensive, knowledgeable and interesting, and most importantly, he treated me like an adult. It was extremely good to know that I am a candidate for this procedure and that it has shown some successes in patients in my situation. However, the appointment also reinforced the fact that it is extremely unlikely that the disease will go away and stay away for a long time. It is possible to have the procedure repeated and it is possible that the procedure has some success in shrinking the tumours and killing some off altogether and so can be followed by other forms of radiotherapy or even surgery on the liver. But it is extremely unlikely that once the cancer has spread to the liver, it just goes away following SIRT or indeed any other form of treatment. 

Whilst we were in the waiting room, Elliot also mentioned two other things that brought home the fact that we are both coping with the idea that I will not be around for ever. The first was that we should probably amend our wills to make provision for the children if, for some reason, neither of us are here while they are still under the age of 18. The second thing he raised concerned genetic testing, and in particular whether our daughter’s DNA could be compared with mine to see if there is any shared genetic mutation. I repeated to him what my genetic counsellor had said – that when Natalie is old enough to be tested, probably aged 18, scientific knowledge will be much more advanced and therefore the testing will be much more accurate. Elliot told me I  had misunderstood – his concern was not to get Natalie tested now, but that some record should be kept of my DNA in the event that I’m not around when Natalie is 18. 

I think for the last few weeks, probably following the good news from the last scan, I have been living in a bit of a bubble. I have managed to stop thinking about having a shortened lifespan and allowed myself to imagine that the disease can be held at bay or even sent into remission entirely for quite some time. I don’t think I have ever imagined I will live to be a very old lady, but I have allowed myself to hope I might be around for a good little while yet. I suppose following yesterday, that now seems doubtful again. I know that no one knows what is going to happen, that science is advancing daily and that miracles occur. But I am realist. I know that people die from this disease every day. I know that the prognosis is still guarded. It is just nice to be able to forget that from time to time. And even though this procedure is a possibility for me, it will still be complex, it is likely to be uncomfortable and the results are not guaranteed. But then again, nothing in life is guaranteed. I must remember that.