A Scotch and Soda And an Alarming Surgical Dilemma – Cancer of the Tongue
02 May 2004
"Stick out your tongue", my dentist invariably requests during my regular dental checkup. I know that shortly he’ll examine my teeth. But for the moment he’s looking for any sign of cancer of either the tongue or the rest of the oral cavity. But what happens if your dentist or doctor detects a malignancy? What I learned over a scotch and soda should alarm all of us.
Cancer of the tongue is one of the more common and serious types of mouth cancer. Every year 30,000 North Americans are diagnosed with this malignancy and it’s curable in about 80 per cent of cases when diagnosed early.
Malignancies of the tongue start as a small lump or a thick white patch. Over time this lump turns into an ulcer that has a firm, raised rim and a delicate center that bleeds easily. If the cancer is not treated it spreads to the gums, lower jaw, lymph nodes and the floor of the mouth. Eventually the tumour blocks the throat making swallowing and breathing difficult.
If th there’s been a growth on the tongue for more than a couple of weeks a biopsy is done to see if cancer is present. This can usually be done under local anesthesia.
How tongue cancer is treated depends on the extent of the malignancy. Some will be treated by radiation, chemotherapy of surgery or a combination of treatments.
But often the treatment depends on radical surgery which requires eight demanding hours to perform. And that’s why I’m writing this particular column.
I recently attended a meeting of oral surgeons and to hear about new treatments for oral cancers. But over the 29 years of writing this column I’ve discovered one important fact. It’s that often the most vital facts are learned over a scotch and soda following the scientific discussions.
It’s not that we all sit around in the evening and get drunk. Rather, it’s that time of the day when everyone relaxes and is more forthright in discussing medical matters. And rambling conversation often centers on topics that should have been discussed in the formal meetings.
One of Canada’s most distinguished oral surgeons made this remark to me. He said, "I used to get more applications for the training in oral surgery than I could accept. Now I can’t get enough doctors to fill the training program. It won’t be too long before there are not enough surgeons to treat oral cancers."
I obviously asked the reason why there should be such a dramatic shift and lack of enthusiasm for going into this surgical specialty. He replied, "The young doctors today are quite practical about the economics of medicine. So they are lining up tp go into cosmetic surgery. They realize that in a couple of hours they can ccharge $20,000 for a face lift operation. Other thousands doing nose jobs or quick nip and tucks on the tummy or breast. So why should they spend eight strenuous demanding hours treating an oral cancer for $1,800?"
So it’s a no-brainer to realize what the future holds for patients suffering from tongue and other oral cancers. As the current oral surgeons retire who is going to do the surgery? It will take years to train others if you can find them.
It’s important for readers not to confuse plastic surgeons with cosmetic surgeons. Plastic surgeons, the ones on the public payroll, spend hours caring for babies born with a cleft lip or cleft palate. Or treating children with severe burns or reattaching severed limbs. These surgeons are not living the high life.
In view of the upcoming shortage of oral surgeons it’s even more important to try and prevent oral malignancies. Make sure you arrange for at least an annual, or better still, a semi-annual dental examination, particularly if you smoke.
Make certain that dentures fit properly and that edges of the teeth are smooth and don’t irritate the tongue or mouth. And if you do notice a lump, discoloured area or sore that fails to heal in two weeks see your doctor.
I’d also suggest that government officials have a couple of scotch and sodas and come up with a solution before our last oral surgeon retires.
