Supporting the oral cancer patient – what is the role of the dental team?

Karen Matley Catherine Waldon

•Patient Involvement in Service improvement groups, ‘buddying’ and research projects.

•Our own experiences and that of other patients too

•Catherine – Volunteer helper in Maxillofacial clinics in Bradford

Outline:• Our own cancer

experiences• Our treatments• NHS and multi-

disciplinary team• Our fears and

anxieties• Short term effects• Long term effects/

living with Cancer

Our main messages:

• Early diagnosis key to patients’ future Quality Of Life

• Multiple and life-long side effects and impacts of surviving oral cancer, even when these are hidden from view

• Tonsils removed when young

• History of sore throats• Branchial cyst 1984• No history of heavy

drinking or smoking• GP consultation re

“something at the back of my throat”

• GP referral to ENT

• Biopsy and bad news• Scans, x-rays, blood

tests• Squamous cell

carcinoma T2 in tonsil tissue/back of tongue

• Metatasized to neck lymph glands

Catherine’s Cancer “Journey”

Treatment options1

• Radical surgery to remove primary tumour, and neck glands with reconstruction with a skin flap

• Chemo-radiotherapy for 4 or 7 weeks

Opted for this approach.Opted for this approach.

Treatment options2

• More minor surgery to remove neck glands

• Chemotherapy to shrink/eliminate tumour and course of radiotherapy

Major treatment fears:

• Loss of front tooth/teeth• Damage to lip nerves• Pain after surgery• Facial disfigurement• Talking/communication problems• Eating problems/swallowing• Damage to hearing, kidneys, and hair loss etc.

The NHS roller coaster:• Dentist• Dental hygienist • Speech therapist• Dietician • Radiologically Inserted Gastrostomy (RIG) also

(PEG)• Macmillan Specialist Nurse• Surgeons• Anaesthetist• Oncologist and Radiography team• GP• Restorative Dentists

• Lump in the back of my mouth

• Aching jaw• Non smoker• Not a heavy drinker• Face began to swell• Blocked saliva glands

referral to St. Lukes’• ‘Slow tracked’

• Routine operation to remove lump

• Routine biopsy• Early recall• BAD NEWS!

Karen’s Cancer “Journey”

Karen’s Treatment:

• Further surgery to area where lump was

• Full neck dissection

• All lymph nodes removed from neck

• Facial split surgery

• Skin graft from arm to mouth

• Temporary tracheotomy

• 6 and a half weeks of radiotherapy with chemotherapy

Immediate Effects of Treatment:

• Loss of mobility

• Learning to eat again

Long Term Effects

• Xerostomia

• Worse at night time –disturbed sleep

• Always having to check out where the toilets are!

• Saliva problems

Long Term Effects

FOOD! EATING!• Anxiety about eating

out with friends

• Having to check out menus before-hand

• Choking and swallowing problems

Long Term Effects

• Continuing fear of losing teeth

• Constant care of mouth and teeth

Long Term Effects

Trismus • Jaw exercises every

week – with a hi-tec device of mouth spatulas

Speech• Re-training the

tongue to speak clearly

Other Long Lasting Effects of Treatment:

• Numbness in lips or hypersensitivity

• Ringing in ears

• Susceptibility to infection

To summarise:

1.Importance of regular and careful screening and health promotion to help minimise life long side effects and prevent re-occurrence of cancer.

2.Description of our treatment options.

• Still grateful!

• Thank you for listening!

• Any questions?

• And now for something completely different!!...............

Finally