Jan lux 💙 retweetledi
📖 Story time; A general dentist reflects upon a case of throat cancer
A few years ago, at the practice which I now own, I was making my way down to reception with some papers.
The receptionist was talking to a man at the front desk who was not a current patient. She explained that we didn’t have space for new NHS patients. The gentleman explained that he didn’t necessarily want to see someone about his teeth but about the big lump at the back of his throat. He had been to see the GP over the road who had advised him that “it’s probably a cyst, go and see a dentist” as whatever the problem was it was affecting the fit of his denture - red flag 🚩
I had a spare few minutes so invited the gentleman to come to my surgery so that I could “have a quick look”
It was not a “quick look”
Upon inspection I found that the patient had a firm lump extending down the right hand side of his pharynx from the soft palate. He had no gag reflex to speak of so I was able to palpate quite far down. That was the second red flag 🚩
When discussing the patient’s medical history we talked about his use of alcohol (100+ units per week, possibly more) and his use of tobacco (60 cigarettes per day). Red flag number three 🚩
The patient had also recently lost some weight unintentionally but had, understandably, put it down to the stress of looking after his elderly mother who was terminally ill. Red flag 🚩 4
I had heard enough and put in a call to the local Maxillofacial department and asked for him to be seen urgently. Dentists aren’t able to refer directly into ENT.
Within days the patient called to inform us that it was cancer and to thank me for referring him.
This gentleman wrote me a letter some months later to express his gratitude that I had “saved his life”.
Of course, I had done no such thing, I had merely identified a substantial risk and referred him to the appropriate department. The treatment he received there was what saved him.
There are several things to take away from this story (and absolutely no shade to be thrown on my very busy, capable but overstretched GP colleagues)
1) The GP was not able to identify whether this was a lesion of concern (why would they? They have about a one hour lecture on oral cancer or something, the mouth isn’t specifically their area, like it would be for say; a dentist)
2) The GP advised the patient to go and see a dentist (someone who is used to looking at mouths all day), but this patient did not have access to a dentist. Had he not been in the right place at the right time (the front desk of my practice while I happened to be taking paperwork down and have five mins spare to examine him) he might not have been looked at for much, much longer. He was in no pain and would be unlikely to be triaged as “urgent” when ringing any helplines.
I have been the identifying/referring clinician several times through my career. I have cared for some of those patients when they have been well enough to come back to primary care.
I have even referred some of my patients for skin lesions (on the face & head) which have been malignant.
Oral cancer is often painless, unnoticed by the patient. Yes we must teach the public to self screen but where do they go then?
GP colleagues are overstretched, NHS dental services are at breaking point. Who will direct these patients into the hospital? A&E would be wholly inappropriate.
If you have made it this far, please know that I am not writing this to scare anyone or to virtue signal that I’ve picked up so many of these cases. I work in a deprived area, there is a correlation.
There is so much more awareness that needs to be raised around head and neck cancer. The government, healthcare professionals and the public could all stand to know more.
A good place to start is here:
mouthcancerfoundation.org/mouth-cancer-f…
November is a month for Mouth Cancer Awareness and blue is the colour we use to signify that
Thank you for reading
@TheBDA @MouthCancerMCF @TheBMA
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