Tag: Surgery

Two teeth fewer

I saw Dr. Pite today, and he extracted the two teeth: the exposed-root, root-canaled, top-right molar; and the one molar opposite on the bottom jaw.

I was shaky going in; this is the first actual thing that I have to do to my body because it has cancer. It’s the beginning of a hard, steep road.

I’m really sorry that those two teeth had to go; they’ve been with me a long time, and have done a good job. I would have liked to keep them. I asked Dr. Pite if there was any chance he’d changed his mind about this being a good idea; he hadn’t.

Hey, did you know that some people have denser jaw bones than others? What was predicted to be a 1-hour session to remove two teeth went just under 2 hours, because I have really dense jaw bones. I’ve got to give him credit; not once did I hear Dr. Pite say anything like a four-letter word, and I never saw him break a sweat. He just kept working to unwedge those four roots from the matrix in which they were embedded.

X-rays after the work showed no bone or tooth chips left behind.

What was found was infection on the root-exposed tooth. Now Dr. Pite is very happy that he made his recommendation. I guess I am too. But my mouth is sore, and it wasn’t before. But this is only the beginning Ken…

Prescriptions include:

  • penicillin to combat infection
  • Tylenol 3’s to combat pain
  • Dexamethasone (corticosteroid in pill form) to reduce inflammation
  • Chlorohexadine gluconate (e.g. Perio Plus) antiseptic mouthwash
  • plus Advil / Ibuprofen as needed

Soft diet for next 36 hours, soft tooth brushing, no sucking and no heavy weight-lifting, because we don’t want to pop the developing clots.

I’ve started to notice minor pain in the back of my throat that I attribute to the cancer growing. I want to get radiation and chemo started as soon as possible so that I can be “cured” as soon as possible, so I don’t want the extraction-healing process to go awry. I’m sorry to say that I’ve had teeth removed before, and I know the difference between a nice heal and a poor one; I’ll be a good boy and do whatever the dentist tells me to do. I want my jaw in really good shape for the upcoming CT scan a week from today.

Final meeting with ENT/Surgical Oncologist

I met with my ENT for the final time June 17. I asked him to clarify again why I was not a candidate for surgery, notably TORS. He said, as he’d said in an earlier meeting, that after having surgery I would still need to have radiation. What he didn’t say, but what I now understand, is that my radiation therapy will hit not just the primary site at the base of my tongue, but also the lymph nodes on the right side of my neck that have swollen dramatically, and likely the lymph nodes on the left side of my neck as well. So, there’s no way of getting away from having radiation. His take on this is that it is standard practice in Canada to not do surgery on squamous cell cancers that have advanced beyond the primary site at the base of the tongue, because there’s very little likelihood that all the cancer will be caught. The standard procedure, where radiation, not surgery, is the primary treatment, consistently results in good long-term survival rates, and that’s what Canadian doctors are focused on.

So, yes, I could go to the USA to have TORS done, and possibly take advantage of reduced radiation dosages that would result in reduced side effects, but BC doctors do not currently support those treatments, and the BC Cancer Agency would not fund those treatments.

I accept this doctor’s arguments. I’ll skip surgery.

Possible Treatments

The following articles outline some of the treatments, along with treatment side effects, that can be proposed for a person with base-of-tongue cancer.

Treatments are one or more of surgery, radiation, chemotherapy.

Surgery

As of June 2019, my ENT is not recommending surgery.

Radiation Therapy

The BC Cancer Agency has prepared a tentative plan for me that includes radiation therapy. That plan indicates that the lymph nodes on the right side of my neck and the base of my tongue will be hit with 35 doses of radiation totalling 75 Gy (definition of Gray). Other areas, like my upper and lower right jaw, and the rest of my neck, might be hit with 56 Gy over the 35 doses.

BC Cancer Agency’s preliminary idea of where radiation will be, and approximate dosages. The Upper and Lower teeth are those discussed in this post.

Concerns

I’ve found pages that indicate radiation exposure could be much less than the “standard” 56 Gy currently planned for me. This is something I want to talk over with my radiation oncologist when we meet.

Methods

Intensity Modulated Radiotherapy (IMRT)

Intensity modulated radiotherapy (IMRT) is a type of conformal radiotherapy. Conformal radiotherapy shapes the radiation beams to closely fit the area of cancer. … This means that the tumour receives a very high dose and normal healthy cells nearby receive a much lower dose. … IMRT can be very helpful in areas such as the head and neck, for example to avoid the spinal cord or salivary glands.

https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/radiotherapy/external/types/intensity-modulated-radiotherapy-imrt

Volumetric Modulated Arc Therapy (VMAT)

VMAT is a type of IMRT technique. … VMAT is different to normal IMRT in that the radiotherapy machine rotates around the patient during a radiotherapy beam in an arc shape. The machine continuously reshapes and changes the intensity of the radiation beam as it moves around the body.  Giving the radiotherapy in this way makes it very accurate, shortens the treatment time, and uses a lower overall dose of radiation.

https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/radiotherapy/external/types/intensity-modulated-radiotherapy-imrt

I’m fortunate that VMAT is offered at the Victoria Cancer Clinic.

Systemic Therapy (aka Chemotherapy)

to be done