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  • Q&A with Australian Health Practitioners

    How is oral cancer diagnosed?

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    Dr Paul Coceancig

    Oral and Maxillofacial Surgeon

    I am a specialist oral & maxillofacial surgeon based in Sydney and Newcastle, Australia. I graduated in medicine from the University of Otago, and in … View Profile

    Oral cancer can be devestating, and early diagnosis is both the key to surviving, and surviving well from this condition.

    I saw a man. He is 53 years old, moderately over-weight, and with little time to dedicate to his health. He is an executive in a large charity organisation, and routinely travels the world and Australia as part of his job. 10 years ago he stopped smoking.

    His GP had rung my office at 5pm the previous day, and he wanted an urgent surgical review of Bob. I saw him first thing the following morning (which was yesterday).

    9 weeks ago “Bob” (a pseudonym) saw a dentist (not his usual one, as he never established a long term relationship with any dentist) for a "pea sized“ growth on the inside of his left cheek… which was just beside an otherwise healthy lower wisdom tooth.

    It was tender, and the dentist said not to worry, and gave him antibiotics. The dentist also kindly ”ground down the wisdom tooth“ so he didn't bite the small growth, and aggravate it. He said it was a gum infection, and that he should get his wisdom tooth removed.

    The dentist also charged him $400 for his trouble.

    You can believe then, that Bob thought going to the dentist to check on an otherwise small and innocuous lump, was a waste of time. More especially, he was worried that he'd be charged another $400, and given another prescription for antibiotics, and possibly some more tooth grinding. The dentist had confirmed he didn't have cancer, which was his primary worry. The dentist had said it was a simple infection.

    So Bob went to his doctors surgery 2 weeks later. His usual GP was away, but he saw a locum medical GP with his concerns that his cheek swelling was getting bigger, harder, and it was still sore.

    Of course the out-of-town GP didn't know much about things in the mouth, and gave him another course of antibiotics.

    As this second visit pretty much reaffirmed what his dentist had already said (that it was a gum infection), Bob decided he would go on his 5 week holiday to Canada with his wife.

    During his holiday, the lump in his cheek was getting bigger. He would walk past doctors and dentist offices in the various towns of his trip, always tempted to ask for another opinion, but then was firghtened that maybe it would be expensive, and after all, he already had reassurances from his own dentist and GP back home. His wife was worried though, and she was a nurse. His wife insisted that it looked like cancer.

    Bob was getting worried too, but no one wants to believe they can be vulnerable to such an awful thing. So they continued on their holiday.

    Bob had decided to wait until he could get home, and see his regular GP. It was now 9 weeks since he first noticed the ”pea“ in his cheek.

    When I saw Bob yesterday morning, the ”pea“ was now about 4cm across. It was firm, and unlike the normal tissues of his mouth, it was tethered and inflexible. It was also very sore, and had started to ”grow" over the top of his wisdom tooth… which of course caused him to bite on it. The spread of it was well into the cheek and towards the back of his mouth, behind his tongue.

    We organised a CT, and within 2 hours, I had spoken to the radiologist, and we both confirmed that he had at least 4 lymph nodes under his jaw, and in his deeper neck that looked larger than normal. The following day, we took him into a small private hospital, to put Bob to sleep, and to take a biopsy of his cheek lump… not to exclude that Bob had cancer, but rather… to tell us what type.

    The prognosis for cure of a pea sized lump of oral cancer, is very good.

    But left to develop and grow and spread over 9 weeks, oral cancer can become almost incurable.

    Cure now will involve a multi-disciplanary team of specialists, drawn from several surgical disciplines (ENT, head&neck, plastic & reconstructive, & maxillofacial), as well as radiation oncologists.

    How is oral cancer diagnosed?

    It is by listening to your own inner voice. And it is by seeking early, specialist assessment.

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