On the Friday night before Christmas 2012, I spent six hours in an operating theatre with a dearly loved friend. The only time I’d ever been conscious in an operating theatre was during the caesarean births of my sons.
When someone tells you something like “I have cancer” it’s probably a fairly common response to feel both scared and helpless.
But if I was to write a list of ‘things I love about my job’, then being able to do stories like this and share them with others, maybe making a difference, would be right up there. I call it ‘using my evil powers for good’.
Brad and his wife felt that in doing this story it would help others in the future who might be faced with the terrible decision he had to make. It’s a story with a bit of a twist, too.
As for me, if just one boy gets vaccinated against HPV that might not have if it weren’t for this story – then I’m happy.
BRAD KEELING: I started smoking when I was 17 and I gave up when I was 24 so I smoked for about eight years I guess, and not very heavily, but yeah, I smoked. I’ve been around smokers all my life. My Dad worked for WD & HO Wills but that didn’t really mean that I took up smoking because of him, he was the person most against me smoking.
Both my parents smoked all their lives and both of them died from cancer, but neither of them died from a cancer which was caused by smoking. My father was a blender of tobacco. A buyer of tobacco originally for William Butler tobacco company, then WD & HO Wills which became British American Tobacco.
As a buyer he eventually became a blender and then he effectively was the chemist who put together the cigarettes in the way they were compiled – flavours with different leaves and things.
He travelled lots of places from Mareeba in Australia to Rhodesia in Africa and just like somebody would create perfume with different blends, my dad created cigarettes. I remember one interesting one, Port Royal roll your own tobacco, which smells great. To this day I think it smells great when I smell it in the pouches. It was sweet and fruity.
Anyway, he created all those things. He’d travel around and look for leaves from different places, if it rained too heavily in South America, he’d have to find somewhere else in New Guinea that had the same type of leaf or whatever. Today, of course, cigarettes are not created by blenders, it’s all created artificially by computer programs.
I think there has been an element of passive smoke around me all my life, no question about it, certainly in my childhood and twenties. In those days people smoked in the house, bars and restaurants and all sorts of places. It was really only in the eighties that we publicly stopped smoking in places like aeroplanes and offices and so on, so I’ve had passive smoke around me all of my life because of my upbringing and the general community. It was just what we did.
My cancer is throat cancer and one of the causes of throat cancer is smoking, but I’m not a smoker. There are other potential causes but we just don’t know, and may never know, what caused my cancer. I guess they’ll have some pathology eventually and will know. I like a beer and alcohol is another cause.
Smoking and alcohol are the most prevalent causes but another is HPV (human papilloma virus) which apparently people can have, and not know, for decades. I’ve since found out this is why they now want to immunise young teen boys against HPV with the cervical cancer vaccine.
I went to the doctor back in September for a persistent sore throat that was quite persistent, I’d had it for what seemed like months. I’d put up with it and it seemed to come and go but actually it was always there. Eventually I gave up whinging about it and went to the doctor. She looked in my throat, saw it was a little red so prescribed antibiotics which I took religiously for two courses and then went back to her and said, ‘No, I still have a sore throat’. She was wondering then if I had some post-nasal drip. I felt like I did although I couldn’t quite work it out but I now know that the lump in my throat that I’m constantly trying to swallow is actually attached to the back of my tongue but I didn’t know that at the time so we put some steroids up my nose for a few weeks to try to dry up my nose.
That didn’t help the throat and I still had that feeling (of wanting to swallow something) and so I went back and saw her late November. At that point she decided to have me see an ear, nose and throat specialist that Saturday (24 November). He had a look down my throat and told me I had a lump and sent me off for an MRI on the Tuesday. He then phoned me on the Wednesday to say he wanted me to have a biopsy on the Saturday (1 Dec). He rushed through the pathology and rang me on the Monday night to say I had a tumour, cancer, and that there was more than likely a secondary cancer in my lymph glands.
I went on the Tuesday to a cancer specialist head and neck surgeon, Dr Jonathan Clarke, who confirmed that I had cancer and that, again, most likely that there was a secondary cancer. He ordered a PET scan that showed that I have a cancerous tumour in my throat and also one of the lymph glands in my neck.That afternoon I saw Professor Milross at RPA and discussed the treatments available. I’d also discussed the treatments with Dr Clarke.
The other interesting thing that I now know, having read about throat cancer, there’s not a lot everybody tells you that’s interesting but I now know that throat cancer often first presents as an ear ache. I went to the doctor for an ear ache back in February. Of course, I had an ear ache and my jaw was a bit sore so we just thought that maybe I slept with my mouth open or maybe I held my head strangely so I had some jaw exercise to try to relieve the pressure. There was nothing wrong with my eardrum it just looked like I was putting some pressure on a nerve or something. I didn’t, of course, couple the ear ache with the sore throat until reading about it now.
It was only the radio-oncologist who asked me when I first got the ear ache. He was trying to analyse how fast the tumour was growing. So given that I’ve had the ear ache since at least February the tumour is not growing terribly fast. That’s a good thing. Even so, I’m going to have to have it out. I had to decide between surgery and chemotherapy, both of which would probably be coupled with radiation therapy. That’s been pretty difficult. It’s not like going to the doctor and finding, ‘You’ve got a sore throat and this is what you do – take this pill and lie down.’
The text book treatment, I’m told by the radio-oncologist, for throat cancer is chemotherapy and radiotherapy combined and that surgery, in the past, has been a drastic measure only taken if necessary because to get to the back of your throat the surgeon needs to cut through your jaw, split your jaw open, and then excise the tumour, close your jaw up and join it back together again. Apparently that’s not always that successful and affects all sorts of things from speech to swallowing to goodness only knows what.
However, there is a newer option for surgery these days which is a robotic surgery option where they don’t need to split your jaw, they essentially send a little robot down your throat. It makes no choices of its own, the surgeon manipulates it remotely, and it chops out the tumour. But I had to choose between surgery and chemotherapy and I’ve chosen the surgery route.
I think surgery for throat cancer now with this robot (Da Vinci machine), whilst new, I gather this robot has been used by all sorts of people from the US military to people using it here. We have one here in Australia at the Macquarie University Hospital. I’m going to go with the robotic surgery because I think it’s going to be less of a strain on me and my body than the combination of chemotherapy and radiotherapy.
There’s not enough data at the moment but for some people the robotic surgery result is complete cure and no need for radiotherapy, but I’m in stage three cancer where I have a secondary cancer in my lymph gland. They can’t use the robot for that, they’ve actually got to cut me from my ear to the middle of my throat and extract lymph glands. Because of the possibility of microscopic cancers being elsewhere in the lymph glands the likelihood of radiotherapy following surgery is pretty high for me.
But for others who have throat cancer and no secondary cancer, to excise the tumour with this Da Vinci robot would be pretty good. I’m told the current data says that 60% of those people don’t have any follow-up radiation needed. I don’t think I’m going to be in that category because of the secondary cancer but that’s neither here nor there, and it’s most unlikely that I’ll require chemotherapy post-operation. I’m confident that this is a curable cancer. Both the surgeon and the radiologist separately and independently said that the outcome of this is most likely that it will be cured and it will be gone.
CAROL DUNCAN: What is your main worry at the moment?
BRAD KEELING: I don’t know that I’m really worried about much. The things that worry me mostly are family and friends worrying unnecessarily or more than they need to. I’ve found that to be a very interesting process, talking to family and friends, saying ‘Look, I’ve got some news but it’s all OK really. I’ve got cancer.’ Nobody really takes that very well so I’m mostly worried about getting other people worried.
As for surgery, I don’t like the idea of it, never really have, but I don’t like taking a Panadol! Why would I like surgery?! I’ve already had the needles stuck in my arms for the various reasons like the biopsy and PET scan and while I can deal with needles, I don’t really like it. (Laughs) Post-operative care, I’m told, is basically pretty simple. The throat should heal quite well, the stitches in my neck will heal like any other operation would and it will be fine.
I’m having part of the back of my tongue cut out so there’s the potential for an impact on swallowing and my voice but we’ll wait and see. We don’t really know what’s going to happen there. Assuming I have to have radiation therapy after the operation, the impact of the radiotherapy is such that I will lose part of my taste buds and the ability to taste things, and I will have a reasonably dry throat because I’ll lose some of my salivary glands.
The other interesting thing about choosing the operation as opposed to the combination of chemotherapy and radiation with no operation is that the operation is drastic but a kind of triage for the radiotherapy. I’m told they can target much more accurately the radiotherapy post an operation than they can if I don’t have the operation. In the simplest of terms they said, for instance, ‘We’d have to target the radiotherapy on your neck and both sides of your neck and therefore both salivary glands and all of your tastebuds will be affected,’ whereas post the operation they’ll only have to target the radiotherapy on my left side and therefore the impact will be considerably less.
CAROL DUNCAN: Why do you want me to tell your story?
BRAD KEELING: Recording this story is, I think, something that people will be able to listen to, read, look at photos and make an informed decision about the choice between chemotherapy and the operation. The operation using this robot has really only been done in Australia a dozen times or so, we haven’t had the robotic surgery capability here, so when I was given the choice, the necessity to choose between chemotherapy and the operation, I had to do my own research on the robot, read about it, find out what it was.
Now, this little story is something that other people can read and hopefully it will help them weigh up the choices between chemotherapy and radiation, and the operation. But I’m not qualified to give anybody any medical advice, this little story is really just my story. Anybody reading this, listening to this, really should go and get their advice from their own medical practitioners.
** You can read or listen to all of the interviews I conducted for the radio series on the ABC Newcastle website. A documentary version will go to air on Radio National soon.