Fighting Cancer, Together
Story by Will Morton | Photos by Gary Matoso
X-rays have come a long way. Today’s focused radiation beams obliterate cancer, improving outlooks for people throughout the Inland Northwest
In 1895, when Bertha Roentgen’s husband, Wilhelm, discovered that electromagnetic rays could pass through human tissue, he opened up a new world for modern medicine. Over the years, these “X-rays” were harnessed to give health care providers a look inside the body without surgery—to diagnose broken bones, arthritis, pneumonia, emphysema, ulcers, tumors, cancer and more.
Soon, medical researchers observed that X-rays were particularly eﬀective at killing cancer cells. This led to the development of external beam radiation therapy, which has steadily improved since the 1960s.
“It saved my life,” says Bobbi Jo Harding, 40, of Spokane.
How It Works
During external beam radiation therapy, high-energy X-rays are directed from a machine called a linear accelerator through the skin to the site of the cancer and the immediate surrounding area. The X-rays destroy cancer cells by disrupting their genetic ability to multiply.
When Harding underwent this treatment for her Stage III oral cancer ﬁve days a week for six weeks, the machine clicked away as it delivered precise doses of radiation to its multiple targets.
Evolving Radiation Technology
Radiation oncologist Jason Call, M.D., of Cancer Care Northwest in Spokane, says Harding’s treatment included the use of IMRT, short for intensity-modulated radiation therapy. This type of radiotherapy allows doctors to adjust the intensity of radiation beams across the treatment area and “shape” the beam so that it conforms to the 3-D shapes of tumors. This precision is crucial when tumors are near critical structures, as was true of Harding’s cancer near the tongue and neck. Higher radiation doses are focused on the tumor while minimizing potential damage to surrounding normal tissue, Dr. Call says. Treatment is carefully planned with a special computer program that uses 3-D images of the treatment area combined with precise radiation dose calculations.
During treatment, the patient lies on a movable couch in a predetermined, calculated position. The couch can be adjusted in many directions—up, down, left, right, in, out—during treatment, and the beam itself is delivered from a part of the accelerator that also can be rotated around the patient. Thus, radiation can be delivered to the tumor from any angle.
As with many innovations, “the technology is always evolving in radiation therapy,” Dr. Call says. Improved methods continually become available to meet the needs of individuals. Some people with lung cancer, for instance, may require just a single dose of radiation or a few sessions, while others with different cancers may require total body radiation for longer periods.
Efforts are also making the experience more comfortable for patients, Dr. Call adds. To that, Harding gives a thumbs up.
Much more than radiation therapy, a team of highly coordinated caregivers from different specialties in different locations had a hand in saving Harding’s life after her cancer diagnosis.
Harding first went to her primary care physician at Providence Holy Family Hospital with what she thought was a cold sore on her tongue. It was on the underside, near the base. She was given a course of antibiotics and then waited for the medicine to take effect. The sore didn’t go away. A biopsy taken later revealed the cause: stage III oral cancer.
Working together, Harding’s doctors, including Dr. Call and head and neck surgeon Brian Mitchell, D.O., of Providence Sacred Heart Medical Center in Spokane, developed a plan that included surgery, radiation and chemotherapy. Surgeons first removed the tumor and rebuilt her tongue with tissue from her forearm. Then, dental surgeons removed her bottom teeth—18 in total—a necessary step to lessen the potential for oral infections and future tooth loss. After that, technicians administered radiation therapy.
The chemotherapy perhaps was the most challenging, Harding says, because it made her sick. More than anything, that worried her daughters, then 4 and 16 years old, because they felt helpless. It was that same feeling that led Harding to take an empowering step and cut her own hair, rather than wait for it to fall out because of the chemotherapy. “It is the small victories that keep you positive,” she says.
After receiving radiation treatment and chemotherapy, Harding had another surgery to remove the lymph nodes in her neck in case any cancer lingered there.
Today, she is not only in remission from the cancer, but she also has had dental implants to restore her smile.
“I have everything back,” she says.
With her oral cancer in remission, Bobbi Jo Harding can focus on her home life - with daughters Cheri and Haily - and her job at Yoke's Fresh Market.
Collaboration Drives Innovation
Bobbi Jo Harding, who had stage III oral cancer, was among the first to benefit from the combination of oncology services of Cancer Care Northwest, Kootenai Health and Providence Health Care. The Alliance for Cancer Care formed in January 2015 to give people access to the most complete set of advanced radiation options in the region, plus other advantages.
- Improved access to care. The alliance covers a large geographic service area, including northern Idaho and eastern Washington. People like Harding can go anywhere within the area of the alliance to receive the latest treatments locally, says Jeff Collins, M.D., physician chief executive for Providence Eastern Washington and Montana and a board member of The Alliance for Cancer Care. Harding no longer needed to travel from Spokane to Seattle, for instance, for her advanced cancer care.
- More coordinated care. Because of the alliance, Brian Mitchell, D.O., a head and neck surgeon at Providence Sacred Heart Medical Center in Spokane, and Jason Call, M.D., a radiation oncologist at Cancer Care Northwest in Spokane, were connected in new ways. They had been talking weeks before Harding’s initial surgery to plan their approach to treating her cancer.
- Access to new technology. Forming the alliance makes it more efficient for the organizations to keep up with the latest technological advances in the field, Dr. Collins says. “For each one alone,” he says, “it would be more challenging.”
- Greater opportunities ahead. Having established the alliance to deliver radiotherapy, the collaborating members look to the future for new ways to optimize oncology services for patients throughout the greater Inland Northwest.