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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
• Our own cancer
• Our treatments
• NHS and multidisciplinary team
• Our fears and
• Short term effects
• Long term effects/
living with Cancer
Our main messages:
• Early diagnosis key to
patients’ future Quality Of
• Multiple and life-long side
effects and impacts of
surviving oral cancer,
even when these are
hidden from view
Catherine’s Cancer “Journey”
• 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
• Squamous cell
carcinoma T2 in tonsil
tissue/back of tongue
• Metatasized to neck
lymph glands
Treatment options
• Radical surgery to
remove primary tumour,
and neck glands with
reconstruction with a skin
• Chemo-radiotherapy for 4
or 7 weeks
Opted for this approach.
Treatment options
• More minor surgery to
remove neck glands
• Chemotherapy to
shrink/eliminate tumour
and course of
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
• Macmillan Specialist Nurse
• Surgeons
• Anaesthetist
• Oncologist and Radiography team
• GP
• Restorative Dentists
Karen’s Cancer “Journey”
• 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
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
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
• 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
• Jaw exercises every
week – with a hi-tec
device of mouth
• Re-training the
tongue to speak
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