Oral Cancer Awareness

April is Oral Cancer Awareness Month. Oral cancer is a type of cancer not discussed enough in the news and on social media. According to The Oral Cancer Foundation, “This year an estimated 51,550 new cases of oral and oropharyngeal cancers will be diagnosed in the US. Of those individuals, 40 percent will not survive longer than five years, and many who do survive suffer long-term problems, such as severe facial disfigurement or difficulties with eating and speaking.”

In our office, we routinely perform oral cancer screenings during bi-annual dental exams on patients. This is an important first line of defense to combat this disease. The other is HPV vaccinations and HPV awareness. These new vaccines are important in preventing the spread of human papillomavirus (HPV16), the leading cause of oropharyngeal cancers; followed by tobacco and alcohol use.

The Oral Cancer Foundation lists the following as signs and symptoms of oral cancer:

• Any sore or ulceration that does not heal within 14 days
• A red, white, or black discoloration of the soft tissues of the mouth
• Any abnormality that bleeds easily when touched
• A lump or hard spot in the tissue, usually bordering the tongue
• Tissue raised above that which surrounds it, a growth
• A sore under a denture, which even after adjustment of the denture, does not heal
• A lump of thickening that develops in the mouth
• A painless, firm, fixated lump felt on the outside of the neck, lasting for at least two weeks
• All these symptoms have the commonality of being persistent and not resolving

If you notice or feel any of the above symptoms call your dentist for an examination.

Since the numbers of individual cases of oral cancer are not as prevalent as other types of cancers, very few people know those that have had oral cancer. My patient, Raymond Hord, was brave enough to share the story of his oral cancer discovery. Our hope is that everyone gains awareness of oral cancer and seeks treatment if symptoms are present.

My name is Ray Hord and I am a cancer warrior and survivor.

I was diagnosed with and successfully treated for prostate cancer December 1998 and January 1999. During the years since, I have lived in the shadow of that cancer, always fearing an elevated PSA at lab work time. A recurrence of prostate cancer was one of my greatest fears. I was convinced that if cancer was to be dealt with again, it would be on that front. Boy was I wrong.

November 7, 2017, my perspective changed dramatically. While preparing to shave, that morning, I found a walnut-sized mass at my left side jawline. Immediately I got that indescribable feeling of realization and fear. I knew what it was and I knew it was not going to be a simple fix. The first two questions that came to mind were: How bad? How soon can I get to the Lewis Cancer Research Pavilion for treatment?

Very few minutes passed until I was on the phone with my internist’s office. The doctor was not available, as is always the case, so I insisted on seeing one of the Physician’s Assistants that day. A few hours later I was in for an exam. The P.A. thought that the mass, an enlarged lymph node, may have been the result of an infection. She suggested we wait a couple of weeks and see if it went away. For me, waiting was definitely not an option she agreed to order an ultrasound and I insisted on having the procedure that day. A long twenty-four hours later, I got the radiologist’s report that I was expecting, we were dealing with something more than an infection. Next, I needed a CT scan with contrast. Unfortunately, that requires a pre-cert from the insurance company, so the first of several “waiting periods” began. I stayed in touch with the insurance company and finally got the pre-cert. Knowing I could not count on my doctor’s office, I was in full management mode of my testing. The only way I could get things scheduled in a timely manner was to work with the person who made the appointments rather than trying to go through my doctor. The doctor, by the way, was not concerned enough to return a phone call. I got the CT done and the result the next day. Things continued to look worse. Next, I needed an ultrasound with a fine needle biopsy. I got that scheduled and got the results. No real surprise, definitely cancer, just not sure where and how bad. Finally, I had all the information in hand to get on a path for treatment.

By now, about two weeks had passed. I went in to see my ENT specialist, Dr. Moretz. I have to interject, at this point, that he is one of the greatest people that I have ever had the opportunity to meet. His “care factor” is off the charts as opposed to my “former” internist who didn’t care at all. We started an action plan and scheduled a PET scan at the Lewis cancer research Pavilion and scheduled appointments with the rest of my “dream team”. I would be using Dr. John Pablo for radiation oncology and Dr. Mark Taylor for chemotherapy oncology, and of course Dr. Charles Fana for my required dental exam, clearance letter for radiation, fluoride trays, etc.

The PET scan confirmed cancer was in the area of my left tonsil and of course the lymph node. Surgery was scheduled immediately to remove my tonsil and for biopsies. During the procedure, Dr. Moretz found the extent of cancer and made the decision not to remove the tonsil. He did, however, take numerous tissue samples from my mouth and throat. I saw Dr. Pablo the day after surgery and started treatment preparation and planning the day after that.

As of today, I have completed 35 radiation and 8 chemotherapy treatments. With the great help of the staff at the LCRP, I did extremely well through the course of treatments. I am relearning to eat “real food” as opposed to nutrition drinks. I am feeling stronger every day and having more good days than bad. I have a PET scan scheduled for May 24 th to see “how we did”. I am praying for a great result and to be, once again, cancer free.

My cancer was HPV, P16 gene related. Human Papillomavirus accounts for about 70 % of oropharyngeal cancers, which affect the middle part of the throat, base of tongue and tonsils.

This type of cancer is fast on the rise, among men, in the U.S.

If you only take one thing away from my experience, it is taking charge of your health. If your doctor is too busy or not engaged, find another doctor or use the office staff to get tests scheduled. See your dentist regularly, he or she will perform mouth and throat exams. No one is going to care, about your health, as much as you do. Take time to learn about HPV related cancers. Get your children and young adults vaccinated against HPV. Most everyone carries this virus. Cancers in women are more easily found in routine screenings. Unfortunately, in males, it is much harder to detect until it is later staged. You must be on guard.

(The “real” story was during the treatment period and this healing/recovery time. That story will be for a later time. In this message I wanted to keep focus on detection and the run up to treatment.)

If I may be of any help please contact me at raymond.hord@yahoo.com

With much gratitude to my doctors:

William Moretz III, MD
John Pablo, MD
Mark Taylor MD
Charles Fana Jr., DMD

All of their staffs and all of the staff at the Lewis Cancer Research Pavilion.

A special “thank you” for my wife Sandy, our friends and their unwavering prayers and support.

More information on HPV related oral cancer can be found on The Oral Cancer Foundations website.
https://oralcancerfoundation.org/understanding/hpv/hpv-oral- cancer-facts/