8 days to go

It is now only 8 days until my last Chemo session and 9 till my last radiation.   

I'm planning a party to celebrate on the weekend following the end of the treatment.  While it may be a self-serving excuse for a party, I think getting through the treatments deserves some special celebration.

Within two weeks after the end of treatment I shall be scheduled for a battery of follow-up  scans, and then onwards into surgery!  Excelsior!

The last week has been a little rough as the combined effects of treatment take their toll.  It occurred to me that my current pharmacology assortment is actually designed to treat me for the effects of chemo as opposed to actually being anti-cancer.  It's a sobering reflection on the toxicity and efficacy of the treatment itself. 

Chemo is essentially applied poison directed at the cancer: the trick is to do more damage to the cancer than to healthy cells, i.e. me.  

I once wrote I was eager to feel the "damage" being done to the cancer.  I can now say I'm achieving success in that regard.  The moral of that is to be careful what you wish for.

With all that said, however, I will add that I'm doing very well so long as I remember to keep on top of my meds.  

I'll type more tomorrow after I return from chemo.  

Here's a photo of my current drugs.  

 

The Most Astounding Fact: a video by Dr. Neil deGrasse Tyson

Misadventure, video, and unexpected grace.

Today was a day of misadventure, covert video, and unexpected grace.

I decided to get some video of my radiation treatment and smuggled my camera into the therapy session. As I reported earlier this week, the staff often plays music during the procedure and I wanted to show my blog readers what it was like when a certain song started playing. The loud "buzz" sounds you hear are the actual radiation emitters, and as I also said earlier in my blog, there's a static electric charge that plays ticklish over my chest hair as it zaps me. The radiation itself is starting to really do its job, and I'm glad there's at last some pain to feel that I'm doing some damage back at the cancer.

Here's my video.

 But my adventure today didn't end with my video. I was hustling to reach my appointment in time and had thought my jeep would have enough gas to skip refueling until afterwards. I was wrong. Jenny (that's my jeep's name) got me to the appointment in time, but alas she must have been running on fumes because I returned to discover her gas tank as empty as I felt. So there was in inevitable calling of friends, then approaching strangers to borrow a gas can, and then a walk to a gas station, return with a gallon, drive to gas station, drive to return the gas can, and then home to rest.

But something happened this morning that transformed everything.

When I arrived at my appointment I discovered the same volunteer playing piano who had been playing last week. It turns out he does this every Thursday. I decided to catch a bit of his performance on video, and accidentally got an exchange between a little girl present for her treatment along with her brother. Both looked to be around 8 or 9 years old.

 If you listen you can hear the brother talking about his sister. This little girl has an amazing brother, and although you can't see them in the video (just listen for their voices), he had shaved his head to help show support for his sister. That children should have to endure this ... it tests every foundation of faith from every perspective. At least it does mine. Those kids are the real heroes in this battle, and I found myself praying for them. The agnostic in me had no choice.

I got the volunteer to talk a bit during a break. He is doing something amazing just by being there and playing his music. There is grace and transcendence in music. I wish I could express it better.

A Very Special Piano Man

Phantom Tastes and Surreal Moments in Radiation

My apologies for the delay in updating. Last week was extremely hectic due to A: preparing for two mysteries performed over the weekend, and B: the mid-way point in Chemo and Radiation have begun to really kick in. My blood work from today indicates a drop in protein so I'm focusing on that. I'm including a scan of this week's lab work compared to last week's, and while most of the numbers are holding good, there is room for a little improvement.

Regarding chemotherapy, my doctors assure me these next two weeks will be the hardest, to which I say, "bring it on!"  No matter how bad it feels for me, I know it's worse for the cancer, and the one thing I dearly love is the idea of hurting it back.  Does this make me a masochist or a sadist?

Keeping a healthy diet is getting difficult.  I have no appetite.  I have no sense of taste or smell due to chemo, or when I do, it's distorted.   Throughout my life I've enjoyed a very keen sense of taste and smell.  These senses have often been more valuable to me than sight and hearing for picking up subliminal cues and details.  Now everything tastes and smells weird, or not at all.  Everything is blandly neutral or repulsive, or worst, a mixture of metallic flavors mixed with chemical smells.  So I am now treating food and drink as medicine, setting aside specific amounts to be consumed on a time-table like prescriptions. I can taste extreme spices like cayenne peppers, but I avoid these due to a possible reoccurrence of the acid reflux potential which caused the cancer in the first place.  I'm normally a very taste / scent oriented person but this is like I'm hallucinating with my mouth and nose.  Phantom odors and chemical tastes are a surreal experience I can't quite describe adequately. 

Swallowing in general has become painful and difficult.  The radiation is burning away at the cancer inside my esophagus, which is most excellent, but it is also doing collateral damage to the surrounding tissue.  This has made my voice raspy and induces great pain whenever I take a deep breath or attempt to swallow.  Even swallowing a sip of liquid  is becoming a painful act of will.  I find myself increasingly reliant on pain medication.  My brain hates this reliance.  When using the pain meds I feel mentally dulled, slowed down, distracted.   So I find myself avoiding the pain meds until absolutely necessary.  It's a trade-off I'm willing to make.  For now.

Today's radiation therapy provided a very surreal moment all on its own.  The attending staff generally play music over the speakers as the giant mechanical donut machine zaps away at the cancer.  This can be relaxing and helpful while laying motionless as the machine rotates around you.

Today it took such a surreal turn that I almost fell laughing off the table.

To give you a better visual idea of the machine and process, see attached image below.  

The process is simple: I am placed shirtless on a narrow table with bars, and my head is fitted against a molded-depression as my arms are raised above my head to grip a steel bar above me.

The lights go down, laser guide-lines are projected against the crosses and ex.'s on my torso, and the Giant Mechanical Donut dances around me zapping radiation into my chest.

Well, if that isn't surreal enough, today's musical choice was a Johnny Cash Medley, including "Burning Ring of Fire."

I was deeply amused.

Please note these are stock images  used in this image, but this is the EXACT model series of the machine used in my treatments and are identical to what I experience every weekday.  They don't allow cameras in the actual radiation room so I pulled these images from the machine manufacturer's web page and other image sources.   The last two reflects more reflect my twisted imagination as to what they may actually be doing in the control booth and the unbridled affects of any unforseen radiation mutations.  :)

Wednesday Update

Third week of chemo and radiation and so far so good!  There have been some minor problems with pain but the new meds are doing wonders.  

I obtained a copy of my new blood tests Tuesday to compare with my test results from when I started chemo and am including a scan of them below.  Overall I am maintaining excellent levels and keeping my weight steady.  Go Todd Squad!

I've been working hard on my nutrition and lifestyle, and most importantly on me.  I've come to see  this is an opportunity for rebirth.  The first half of my life was been filled with so many mistakes, regrets, self-destructive and childish things.  This cancer represents change inexorable and inevitable.  I may not be able to control the inevitable.  The end comes for us all eventually,  But I am able to define me, and this I can do.

 I am determined to use this as a rebirth, a phoenix metaphor if I may.  Getting through the surgery is only the beginning.  There will be monthly tests at first, then sporadic as I begin the 5-year process to reach a quantified "cured".   

The changes I've been making are only the beginning of an entirely new lifestyle.  Better choices, a different perspective.  This is the start of the second half of my life, however long that may be, and it is a chance for me to try to be a better person in every way I can control.  This cancer is trying to kill the old me.  Let it.  That me was messed up in so many ways, a life of mistakes and bad decisions and good intentions failed..... Whatever "me" that emerges from this, however successful I am in fighting the cancer, the "me" that is to come is going to be a different me, and I'm embracing that in so many positive ways.  I may not be able to atone for my past mistakes, but I'm determined not to repeat them.  I may make all new mistakes, but they will be made from a better place, a different perspective.

 I'm visualizing this as a sort of birthing process, to become a better person.  This is my goal and the way of life I'm trying to live.  As I just told a very dear friend of mine, I intend to take the best part of me and distill it into a better future me, and the future is now.

Musical mood today

New prostate cancer treatment gives 'perfect results' for 9 in 10 men

New treatment for prostate cancer gives 'perfect results' for nine in ten men: research
A new treatment for prostate cancer can rid the disease from nine in ten men without debilitating side effects, a study has found, leading to new hope for tens of thousands of men.

Click here for the whole story

Monday's update: I'm a walking radioactive pharmacy

New meds today! Yippee!

Sunday Update

Sunday Update

I've been amazed how quickly the radiation and chemo have become a routine occurrence and focus of my days .  Monday through Friday mornings I report in at 9:00 for radiation and Tuesdays are devoted to Chemo.  I've become a first-name basis regular at each office and am known as a scourge on the lollipop baskets.  I have developed a fondness for raspberry suckers.

Meanwhile my health has not been super great.  The radiation is doing its job at burning away at the cancer and as a result there's a bit of collateral pain growing in the surrounding esophagus.  

Swallowing is becoming increasingly harder, even just for normal liquids, and breathing is becoming more difficult.  Chemo side-effects have started to catch up with me with cramps and nausea, but the oddest effects have been sensory.  Everything now tastes like chalk to me and everything smells different, sour.  My mouth is constantly dry and sticky at the same time and it's as if I've been sucking on persimmons.  

It's basically an adventure in re-adjustment to the way my body handles the drugs and treatment. 

One interesting aspect has been coming to terms with the radiation treatment itself.  I've noticed a very subtle sensation at each treatment that I hadn't expected.  As the radiation machine rotates around me and the beam zaps at my chest from different angles, there is a ripple-like wave sensation through my chest hair like a soft electric breeze.  The sensation is oddly pleasant.  I imagine the instrument as the machine sings some radioactive melody to the cancer. 

Meanwhile I've been juggling things on a personal front fairly well.  Rent this month is paid and there is chocolate milk in the fridge and protein shake supplies in the pantry.  I'm online and there is the chance for a couple of design gigs that may help with the financial situation.  I received a letter Saturday that there is some sort of problem with the medical billing situation but won't know details until I can call them tomorrow.

Towards the end of this week I did take the initiative to radically shorten my hair.  I haven't started experiencing any hair loss yet from the chemo but wanted to take some kind of control over the situation before that happened.  My basic fear was to start losing it massively at a point when I may not be psychologically at my best, and rather than set myself up for that I decided to preemptively "cut my losses".  I didn't go for the full "shave" (yet), but am close enough so that my scalp can get some sun but at the same time prepared for the ultimate option if I chose to fully shave my head.

I've been thinking a lot about how much I've been changing my life, my hopes for the future, my fears about everything..... I'm not sure I can really write about any of that yet.

I have an odd day planned today with a friend that involves seeing the film "Cabin in the Woods" followed by some serious Buddhist discussion and meditation.  

Life is full of metaphors but they are only where you are prepared to find them.  

Friday and Weekend update

I meant to update my blog on Friday but found myself swept up in minor financial drama followed by an overwhelming need to sleep, sleep, and sleep some more.  Here it is Sunday night and I feel as if I just woke up from a nap started on Friday afternoon.  I know sleep is a process for healing but this is ridiculous! 

Due to my semi-comatose weekend there is little to report for the blog.  My Friday began with the (now customary) visit to the radiation lounge at J. Graham Brown.  All in all these sessions consist of a giant donut-shaped machine rotating and waltzing around the stationary axis of my body.  I'm reminded of my late teens when I did a work-study semester at the University of Louisville planetarium and the huge graceful projector there.  The radiation machine moves with the same slow precision as that projector, twisting with delicate precision amidst the stars and black holes.  It's like watching a space craft in some invisible orbit.   The only thing missing is the Blue Danube as the Pan Am space clipper hurtles towards its final rendezvous with the space station in 2001.

As to the financial drama mentioned earlier, I was unable to resolve it Friday but have a plan to attack it tomorrow morning after radiation.  I'm optimistic it can be reasonably straightened out.  If not, I'll certainly be commenting on it in future blog posts.

On a more positive front I am again online and connected to the internet.  Ta-dah!  For this I am indebted to a very dear friend whose heart knows no bounds.  One thing I am learning from this process is how absolutely essential friends and family are.  Most of my life has been a fight against compromise and hypocrisy.  I've made decisions, some bad, some good, all based on an attempt to be true to myself and the things I believe.  But as I've grown older I've been forced to face time and again how many of these decisions were in fact based in pride or stubbornness.  I survived by virtue of being smugly self-assured in my beliefs.  If these past few years have taught me anything, it's that everything I ever judged was only measured against my own ignorance.  The more I know, the less I'm certain of. 

Friday ended early for me with a nap-turned-weekend-hibernation.
______________________________________________________________________

My Google news feed did produce one interesting item that I'll include as food for thought.

 'Universal' cancer vaccine developedA vaccine that can train cancer patients' own bodies to seek out and destroy tumour cells has been developed by scientists.

The  company Vaxil Biotheraputics along with researchers at Tel Aviv University are testing an extremely hopeful lead in the war on Cancer.  Scientists have found that a molecule called MUC1, which is found in high amounts on the surface of cancer cells, can be used to help the immune system detect tumors.  They have produced a new drug that uses a small section of the molecule to prime the immune system so that it can identify and destroy cancer cells.

The catch: clinical trials are expected to last another 6 years at least before its available to the general public.  Darn!

' Click here to read the whole story.

Thursday, no internet, but it's only temporary

I'm currently writing today's blog from Highland Coffee on Bardstown Road.

 The day began with the discovery my internet had dissolved along with the client who had been covering it in exchange for periodic web updates on his web catalog.  Apparently he decided to engage a new web person who isn't facing some hospital time.  I can't say that I blame him.  I not exactly in the position to commit to long term maintenance agreements right now.

The morning only got better when my ride to radiation therapy was detoured for an emergency side-trip to help deliver another friend's kids to school due to a flat tire.  It all worked out when my ride pulled some amazing driving tricks and we managed to exit an expressway parking lot and sail through the side streets like greased lighting.  Jennifer's driving

We arrived at radiation on time in spite of traffic, detours, and drivers ahead of us who weaved like suicidal lemmings.

Once at the radiation center I was surprised to discover another patient had taken up a position at the piano in the waiting room.  He was playing something classical and mournful, and I realized that music is becoming a constant part of this process.  And I get it.  Music is the most transcendent experience one can find in moments of "aloneness", and that's what this process reduces all of us to.

I was called back to radiation before getting a chance to thank the gentleman for his amazing skill and bravery for performing .... so I hastily scrawled a thank you note and slipped it on the piano after taking the above photos with my phone.  I then ran back to the radiation rooms where I proceeded to reflect on the music as the tri-fold beams of energy quietly and softly danced through my chest.

The session was over quickly.  The radiation treatment almost seems anti-climatic.  I want it to hurt. I want to feel the energy burning away at the cancer in my chest.  I want to attack the cancer, damage the thing that's trying to kill me.  I want to give it as good a fight as possible, and that means wanting to feel the pain as I kick back at it.

Instead all I can do is take it laying down as the radiation whispers around me.

I want to fight back.  Hurt it.  I want to feel it hurting.  Instead I put my shirt on and slip out of the hospital quietly thinking about music.

Once home I start working on the Internet problem, and an angel in the form of another friend came to my rescue.   I should be back online by tomorrow afternoon.

Today's musical mood

Today is the 4th, a few updates and national news

Today was the second day since I started my chemotherapy consisting of cisplatin. No side effects yet, but as I'm only 2 days into the treatment that's not unusual.

Today also marked my second official day of radiation. It's odd how quickly the radiation treatments are compared to the severity of the attack on the cancer cells. The entire office visit takes less than 45 minutes and other than a sharpie marker used to place targeting crosses across my chest and an odd inked outline resembling the state of Illinois, so far I have no ill effects whatsoever. But I am assured the effect will build inexorably towards great distress, an experience I'm not really looking forward to.

Apart from the quick radiation session today my time was spent in getting my water services re-activated and then knuckling down to writing. I write murder mysteries and have a series premiering at a local community theatre on the 20th of this month soon, and am racing to get the scripts finished before the side effects of my medical treatments reduce my output. There's so much to do and so little time.

Meanwhile I've also done a bit more research and setting up relevant news alerts online. Two stories that caught my attention today involve a move by various medical associations to decrease testing and treatment of certain illnesses, including an end to five cancer tests and treatments.

I've included links to those stories below. 

Doctor Panels Recommend Fewer Tests for Patients
The American Gastroenterological Association is urging its physicians to prescribe the lowest doses of medication needed to control acid reflux disease. In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.
-- Read the whole story by clicking here

Also in the news:
Doctors call for end to five cancer tests, treatments  (Reuters)
 - In a move that threatens to further inflame concerns about the rationing of medical care, the nation's leading association of cancer physicians issued a list on Wednesday of five common tests and treatments that doctors should stop offering to cancer patients. The list emerged from a two-year effort, similar to a project other medical specialties are undertaking, to identify procedures that do not help patients live longer or better or that may even be harmful, yet are routinely prescribed. As much as 30 percent of health-care spending goes to procedures, tests, and hospital stays that do not improve a patient's health, according to a 2008 analysis by the nonpartisan Congressional Budget office.
-- Read the whole story by clicking here

Update: first session of chemotherapy and radiation

Tuesday, April 3rd marked the first day of my Chemotherapy and Radiation treatment at The James Graham Brown Cancer Center. The Center is part of the U of L Health Care system and places a huge focus on the collaboration between their oncologists, cancer researchers, and clinical trials.

 My appointment was for 12:30 noon, which allowed me to take care of some personal business first involving the transfer and license plates of a jeep recently acquired from a very good friend. After a long wait at the DMV, a quick lift from another friend (named Ed Hiemer whose amazing mechanic skills made this possible) I finally got the jeep to my place and hooked up with my new assistant Jennifer Shanklyn who was my ride and support to the chemo / rad session.

Jennifer and I arrived perfectly on time and had a short wait with others who were scheduled for their own sessions as well. Jennifer maintained an amazing wit and attitude that made the wait far less scary that it otherwise might have been.

My name was finally called and Jennifer went with me as I navigated through the routine weighing and check-up before at last being shown to The Chair where I'd spend the next 5 hours. Part of the prolonged time was due to this being my first visit and the additional blood tests as part of the RTOG control group trial.

 I took my designated chair and the nurse proceeded with the ritual of disclosure and then the process of inserting the IV needle through the skin into the port implanted in my chest.  Although I'd brought a fun little book to read (How to Man Up), Jennifer surprised me with a copy of The Girl With The Dragon Tattoo. 

 Actually reading material is available in copious amounts in the chemo clinic. Bookshelves abound with a variety of genres and there is even a small kitchen with a wide selection of juices, coffee, and snacks. Each Chair has its own TV mounted on an opposing wall and the environment is much more hospitable than I'd hoped it would be. But the mood of the clinic is what you'd expect from the seriousness of each patient's purpose and treatment. There is a somber quiet and even the patients with guests seem to take refuge in self-imposed solitude and silence.

I decided to save the books for later and busied myself reading all the labels and medical warnings on everything I could lay my hands on.

 As my attention focused on the drugs flowing into me I heard something that I couldn't believe at first. It was music, soft and low, the sound of a live performer on cello. My mind immediately went to my daughter Courtenay. She is amazingly talented musically and the cello is her instrument, and for a moment all the memories of her high school recitals and her late night rehearsals in her room came back to me. I looked around for the source of the cello and saw a man seated in the hall with a cello playing for the patients. I can't express how that simple music brought me strength as I thought about my daughter, my son, my family all so far away. At last the performer ended and moved on to another part of the clinic.

Jennifer sensed my change of mood and immediately began engaging me with wild and random topics about films, books, and murder mysteries. It was then that another friend arrived and suddenly our three-way conversation became a comedy improve as we debated coffee for chemo patients, the effects of drugs, and a hundred random things. The effect on the people in the other nearby chairs was amazing as we all joined in some pretty loud and weird conversations.

At last my friends had to leave due to their own schedules, and everyone around me expressed great disappointment when a somber silence filled the void. We all returned to whatever personal books or mp3 players or television programs that passed for our respective walls of privacy.

 At last my chemo injection came to an end and it was time for my radiation treatment. I was taken to the basement radiology center. It was a brief but fascinating experience as I lay in the center of a massive machine that moved around me like something out of a science fiction film.

At last my sessions were complete and yet another friend who happens to work nearby arrived to give me a lift home.

A nap later and here I am updating my blog. All in all today was an interesting start to this process.  The treatments were surprisingly non-painful, just psychologically exhausting.  There has been mild dizziness and nausea tonight, but I emphasize it has been very mild.  The most stressful thing today was returning home and discovering I'd forgotten to send in a utility bill last week and my water service has been shut off.   This is a minor thing and I intend to take care of it when I go downtown tomorrow for my next radiation treatment.

- Todd

Tuesday Morning: unexpected Chemo and Radiation

Yesterday afternoon I was informed that I would not be receiving the protocol drug RTOG-0436 but instead would be in the control group who does not.  The potential benefit of  RTOG-0436   included the possibility of reducing post-chemo / radiation surgery.  However my cancer will certainly require some degree of surgery so the efficacy of being included in the test group as opposed to the control group is debatable at best.  My primary goal in volunteering for the RTOG-0436 protocol test was to contribute in some tangible way to the advancement of the war on cancer, and in this my participation is a success whether I am on the protocol drug or not.

However I will be starting chemo and radiation a day early.  Inclusion in the protocol requires my treatment to begin on Tuesday, and if I miss tomorrow's group I shall be forced to wait until next week.  As speed is essential in fighting cancer, I pushed for earlier rather than later. 

It is just after midnight and the prospect of starting treatment tomorrow terrorfies me.  It is what I want and am eager to do, but it marks the beginning of an adventure whose journey and possible end that I can not control. 

Last Saturday I spent the night trying to escape from this reality and re-connect with the places in Louisville I love.  I visited the Speed Museum, Wild and Wooley video, Highland Coffee, cafe 360, Heine Brothers and Carmichael's Bookstore, Cave Hill and Eastern Star, and listened to music while wandering the highways. The morning brought with it a storm and grey wet skies, but I ignored this portent and embrace this moment, this perfect moment, of the here and now and all the good friends that I have. I am grateful for this life and the people who have shared theirs with me.  I'm ready for this adventure.

Diagnosed with esophageal cancer

Three weeks ago I was diagnosed with Stage 3 esophageal cancer.

My cancer appears to be the result of acid reflux I experienced for a few months 3 years ago. Acid Reflux is essentially when stomach acid comes up from the stomach into the esophagus, a condition called "gastro-esophageal reflux disease" (GERD). The most serious consequence of acid reflux is esophageal cancer or adenocarcinoma, a deadly cancer with a 5-year survival rate of less than fifteen percent.

I was completely unaware of this possible consequence from acid reflux and never realized the peril it presented. I'm not certain of anything I could have done to have actually prevented this as the acid damage to the esophagus occurred when the acid reflux occurred. However, if I'd been aware of the danger then perhaps I might have been motivated to seek treatment earlier and possibly catch the cancer at a much earlier stage. This begs the question as to why there isn't more public awareness of this form of cancer and encouragement for individuals with acid reflux to become vigilant for this cancer.

This is part of my motivation in creating this blog: to hopefully expand public awareness of esophageal cancer and to add to the public discussion on the subject. This blog is also my attempt to chronicle my experience and treatment and to document relevant research and news regarding esophageal cancer.

 It is Monday, April 2nd, 2012, and I begin chemotherapy and radiation this upcoming Wednesday.

Relevant links on esophageal cancer:
The James Graham Brown Cancer Center
Why Persistent Acid Reflux Sometimes Turns Into Cancer: New Clues
Esophageal Cancer

Causes, incidence, and risk factors 
Esophageal cancer occurs most often in men over 50 years old. Two main types of esophageal cancer exist: squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope.

• Squamous cell esophageal cancer is linked to smoking and alcohol consumption.
• Barrett's esophagus, a complication of gastroesophageal reflux disease (GERD), increases the risk for adenocarcinoma of the esophagus. This is the more common type of esophageal cancer. 

 Symptoms 

• Backwards movement of food through the esophagus and possibly mouth (regurgitation) Chest pain unrelated to eating Difficulty swallowing solids or liquids Heartburn Vomiting blood Weight loss 

Tests used to help diagnose esophageal cancer may include: 

• Barium swallow Chest MRI or thoracic CT (usually used to help determine the stage of the disease) 
• Endoscopic ultrasound (also sometimes used to determine the stage of disease) 
• Esophagogastroduodenoscopy (EGD) and biopsy PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible) 

 Treatment 
When esophageal cancer is only in the esophagus and has not spread, surgery is the treatment of choice. The goal of surgery is to remove the cancer. Sometimes chemotherapy, radiation, or a combination of the two may be used instead of surgery, or to make surgery easier to perform. If the patient is too ill to have major surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. This is called palliative therapy. In such cases, the disease is usually not curable.