Oliver Sachs Has Terminal Cancer

As a physician Oliver Sachs has dealt with patients who are facing death.

However, now the 81-year old neurologist and author is the patient who has discovered his days are numbered.

In an New York Times Op-Ed article, My Own Life, Oliver Sachs discusses his diagnosis and his thoughts on his terminal diagnosis:

“A MONTH ago, I felt that I was in good health, even robust health. At 81, I still swim a mile a day. But my luck has run out — a few weeks ago I learned that I have multiple metastases in the liver. Nine years ago it was discovered that I had a rare tumor of the eye, an ocular melanoma. Although the radiation and lasering to remove the tumor ultimately left me blind in that eye, only in very rare cases do such tumors metastasize. I am among the unlucky 2 percent.

I feel grateful that I have been granted nine years of good health and productivity since the original diagnosis, but now I am face to face with dying. The cancer occupies a third of my liver, and though its advance may be slowed, this particular sort of cancer cannot be halted.”

Sachs is probably best known for his collections of neurological case histories, including The Man Who Mistook His Wife For A Hat: And Other Clinical Tales, Musicophilia,and An Anthropologist On Mars: Seven Paradoxical Tales.
His book Awakenings, about catatonic patients who survived the 1917–28 epidemic of encephalitis lethargica, inspired the 1990 Academy Award-nominated feature film starring Robert De Niro and Robin Williams.

Sachs has no intention of taking this next phase of his life lying down:

“It is up to me now to choose how to live out the months that remain to me. I have to live in the richest, deepest, most productive way I can…

I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.”

What is melanoma?

Melanoma is one of the three main types of skin cancer, the other two types being basal cell and squamous cell cancers.

Each forms from a different cell type within the skin. Melanoma begins in melanocytes (pigment cells). Although most melanocytes are in the skin, they can also be found in other places in our bodies-: the hair, the lining of internal organs, and in the eyes.

What is ocular melanoma?

Ocular melanoma (OM) is a melanoma which develops in the eye. It can develop in almost any part of the eye, including the choroid, ciliary body, conjunctiva, eyelid, iris or orbit. The choroid layer is the most likely site.

Ocular melanoma is diagnosed in approximately 2,000-2,500 adults annually in the United States. Although rare, it is the most common cancer that originates in the eye in adults. It is more likely to occur in fair-skinned and blue-eyed individuals.

Symptoms of OM can include:

• Bulging eyes
• Change in iris color
• Poor vision in one eye
• Red, painful eye
• Small defect on the iris or conjunctiva

It tends to be an aggressive cancer and can spread to other parts of the body. About 50% of patients with OM will develop metastases (spread of the cancer to other areas) by 10 to 15 years after diagnosis. Other the extension of the tumor into the local tissue, the liver is the most common area for metastatic disease.

How is ocular melanoma treated

In the past, enucleation (eye removal) was the standard treatment for primary choroidal melanoma, and it is still used for large tumors. However, today enucleation has been largely replaced by radiation therapy in an attempt to spare the affected eye.

There are two methods of radiation therapy for OM:

• Brachytherapy with radioactive plaques
• External-beam, charged-particle radiation therapy: External Beam RT uses an machine outside your body to direct the radiation to the affected area. It is a local treatment in that the radiation is only aimed at a specific part of the body.

According to the Doheny Eye Institute at USC, brachytherapy is performed as follows:

“While the patent is under general anesthesia, a device called a “plaque” is attached to the eye. The plaque is about the size of an adult’s thumbnail and contains grooves which hold the radioactive seeds. Each seed is approximately a quarter of an inch long and is about the same diameter as the lead in a number 2 pencil.

The seed-loaded plaque is sewn to the eyeball under the top layer of the conjunctiva (the loose connective tissue that covers the white of the eye.) When the plaque is in place it is not visible from the outside, does not interfere with the patient’s vision, and seldom causes any discomfort.

The plaque is removed about a week after the initial surgery, and the size of the tumor is measured and monitored periodically over time, during subsequent patient visits.”

Iodine-125 (125I), cobalt-60 (60Co), palladium-103 (103Pd), iridium-192 (192Ir) and ruthenium-106 (106Ru) are examples of radioactive isotopes used in the brachytherapy plaques.

Another method of treatment for OM is called Transpupillary thermotherapy (TTT). TTT directs an infrared laser through a dilated pupil in one or more sessions to induce heat to cause death of the cancer cells. Although it is a highly precise way to destroy tumor tissue cells under direct visualization, the laser has a limited depth of penetration which only allows it to be used effectively on small melanomas.