A Scotch-and-Soda And an Alarming Surgical Dilemma

By Dr. W. Gifford Jones

April 5, 2001

"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 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. Most are treated by surgery, which may include post-operative radiation and/or chemotherapy. Usually, however treatment of advanced cancers of the tongue necessitate a radical surgical resection requiring some reconstruction of the tongue, a demanding eight hour operation. And that's why I'm writing this particular column.

I recently attended a meeting of head and neck surgeons to hear about new treatments for oral cancers. But over the 29 years of writing this column and attending medical meetings I've discovered one important fact. Often the most vital information is learned over a scotch- and-soda following the scientific discussions.

It's not that we sit around in the evening and get drunk. Rather, it's that time of day when everyone relaxes and is more forthright in discussing medical matters. And rambling conversation often centers on experiences that should have been reported in the formal meetings.

On one of these occasions, several of Canada's most distinguished Professors of Head and Neck Surgery made this remark to me, "I used to get more applications for training in head and neck surgery than I could accept. Now I can't find enough doctors to fill the training program. It won't be too long before there are not enough head and neck surgeons to treat oral cancers."

Obviously I asked the reason why there should be such a dramatic shift and lack of enthusiasm for going into this surgical specialty. He replied, "Young doctors today are more practical about the economics of medicine. So they are lining up to go into cosmetic surgery. They realize that in a couple of hours they can charge $20,000 for a face lift operation. Or other thousands doing nose jobs or quick nip and tucks on the tummy or breast. Why should they spend 8 to 12 strenuous hours treating 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 current head and neck surgeons retire who is going to do the surgery? It will take years to train others if we 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 head and neck surgeons it's even more important to try to 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 health officials have a couple of scotch-and-sodas and come up with a solution before Canada's last head and neck surgeon retires.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod