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Going back to external radiation, the exact type of cancer as determined by examination of a sample under the microscope is also important in determining the dose that would probably be needed and the chance that this would produce a cure. One reason is that some types of cancer are more sensitive to radiation than others. For example, a type which typically has a large proportion of actively dividing cells will be more sensitive than one with many dormant cells. The other reason is that some types of cancer are much more likely to spread through the bloodstream than others. Because radiation is a local form of treatment, it has less chance of curing cancers which tend to spread very early in the course of the disease.

As with every form of treatment which aims for cure, it is many years before you can be sure that treatment was completely successful. The initial aim is to achieve a complete remission, because of course only complete remissions can eventually prove to be complete cures. I have explained that an irradiated cancer can keep shrinking for some months after completion of treatment. This means that you may have to wait before even being sure that you are in complete remission. Ask your doctor how long you must wait before you can be fairly confident that recurrence will not occur. The time is different for different types of cancer.

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Certain types of thyroid cancer (well differentiated papillary and follicular types) can be cured by a unique radiotherapeutic method, even when they have spread through the bloodstream. It is not even necessary to know where the secondary deposits are! How is this done? The method relies on the fact that well differentiated thyroid cancers have not lost the ability to concentrate iodine in their cells. Normal thyroid tissue takes iodine out of the blood in order to make thyroid hormone. Although they can’t make thyroid hormone with it, the above-named well differentiated types of thyroid cancer also extract iodine from the blood. This ability is exploited by giving the patient a radioactive form of iodine. Provided all of the normal thyroid gland has been removed or destroyed by a previous dose of radioactive iodine, the radioactive iodine concentrates in the cancer cells. They therefore receive a very high dose of radiation, which has a very good chance of destroying them completely. The rest of the body receives very little radiation, so the side effects of this treatment are mild. There have been many attempts to find radioactive substances which would be concentrated in other types of cancer cells, so far with no real success.

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Cancer