Dentaltown August 2021 - 56

Improving oral cancer awareness, advising patients to
decrease risk factors of oral cancer, encouraging the HPV
vaccine, recognizing signs and symptoms of oral cancer,
and ensuring patients get a prompt diagnosis and
referral for treatment are all ways dentists can prevent
oral cancer and increase survival rates.
His recovery was arduous, involving
nearly dying from a severe facial infection
and learning how to speak, swallow and eat,
and use his left hand again. With his strong
will, Manu was back at his dental practice
two months after surgery.12
Prognosis
According to the Canadian Cancer
Society, the five-year survival rate of Stage 1
or 2 tongue cancer is 78%. The prognosis for
squamous cell carcinoma is poorer if any of
the following are present: a higher stage; a
thicker tumor; cancerous cells found in the
tumor margin; and spread to nerves, blood
vessels and/or lymph nodes.13
A study on 117 South Korean patients
with oral squamous cell carcinoma of the
tongue showed that those under the age of
40 had higher rates of metastases and worse
prognosis compared with those over the age
of 40. The authors of the study suggested a
more aggressive treatment plan for younger
patients due to the higher risk of recurrence.14
Manu had Stage 2 tongue cancer and
he was under 40. He had surgery without
chemotherapy or radiation, hoping the cancer
was completely removed; unfortunately,
a cancerous lymph node was left behind.
Recurrence
Eight months after his surgery, just before
the pandemic was declared, Manu went to
his dentist for a restoration. Afterward, the
left side of his neck swelled up-the same
side where he'd had his cancer surgery. He
called his ENT immediately for a CT scan
and biopsy. The CT scan showed a small,
ground glass opaque lesion in the left side
of his chest. The biopsy was positive for
recurrence. Again, Manu and his family
were devastated-the cancer was back.15
56 AUGUST 2021 // dentaltown.com
Manu had another surgery to remove
more lymph nodes and he had 33 treatments
of chemotherapy and radiation over seven
weeks, finishing in July 2020.15
Four months
later, CT scans showed the lesion in the
chest had quadrupled in size. Manu was
coughing and had difficulty breathing. He
had fluid in his lungs, which was drained
multiple times, and a chest tube was placed.
The cancer was in his lung lining, and
doctors deemed it inoperable. There were
several metastases, the furthest being in his
pelvic bone. He had more chemotherapy
and immunotherapy but the cancer was
extremely aggressive and Manu endured
tremendous pain.
Finally, his body had enough. He had
a pulmonary embolism and, two days later,
went into organ failure. His family was told
to say goodbye. Parul frantically tried to
see Manu one last time, but she was stuck
across the border because of COVID-19
regulations. Over the phone, she tearfully
told her younger brother, " You can let go
now. " Soon afterward, in a Calgary hospice,
with his parents by his side, Manu passed
away from oral cancer.
What we can do?
This is a story of a dentist whose life
ended too soon. This is a story meant to
be shared, so no more stories end like this.
What can we learn from the tragic ending
of one of our colleagues? We can learn that
oral cancer can happen to anyone, even one
of us. We can learn that early diagnosis is
the key to prevention and can save lives. We
can talk to our patients about decreasing
the risk factors like smoking and alcohol,
and to be aware of any unusual lesions or
symptoms in and around the mouth. We
can do thorough oral cancer screenings on
every patient, not just the ones with risk
factors or symptoms. We can raise oral
cancer awareness, promote self-exams and
encourage the HPV vaccine.
Manu's death is a harsh reminder and
lesson for all of us as health professionals.
We are more than cavity hunters. We are at
the forefront of overall health care for our
patients. We need to educate and advocate
for our patients and ourselves. This is a story
that shows the important role of dentists in
preventing and decreasing oral cancer. This
is a story that needs a new ending-and it
starts with us.
[Editor's note: Look for Dr. Manu Dua's
book, Life Interrupted: Dr. Dua's Survival
Guide, on Amazon. Proceeds benefit the Oral
Cancer Foundation.] n
References
1. Versaci, M.B. (2019, October 1). " ADA expands policy
on oral cancer detection to include oropharyngeal cancer, "
ADA.com
2. Musa, Z., Johnston, K., Peacock, S., Rosin, M., & Elwood,
M. (2008). " Point of Care: Why Should Dentists Screen for
Oral Cancer? " Journal of the Canadian Dental Association,
74(3), 243-244.
3. Canadian Cancer Statistics Advisory Committee. Canadian
Cancer Statistics 2019. Toronto, ON: Canadian Cancer
Society; 2019. Available at: cancer.ca/Canadian-CancerStatistics-2019-EN
4.
The Canadian Dental Hygienists Association. (2015). Oral
Cancer Screening. Ottawa, Ontario.
5. Oral Cancer Foundation. (n.d.). Oral Cancer Facts.
6.
Cancer Treatment Centers of America. (2021, May 17).
Types of Oral Cancer: Common, Rare and More Varieties.
Oral Cancer Types. cancercenter.com
7. Schiff, B.A., Merck Manuals website (2021, January).
Oral Squamous Cell Carcinoma-Ear, Nose, and Throat
Disorders. Oral Squamous Cell Carcinoma.
8.
9.
Centers for Disease Control and Prevention website cdc.gov
(2020, September 3). " HPV and Oropharyngeal Cancer. "
Cancer Care Ontario website cancercareontario.com (2020,
December 3). " New cases of intraoral cancers increasing after
decades of decline. "
10. Castillo, A., Osorio, J. C., Fernández, A., Méndez, F.,
Alarcón, L., Arturo, G., Herrero, R., & Bravo, L. E. (2019).
" Effect of vaccination against oral HPV-16 infection in high
school students in the city of Cali, Colombia. " Papillomavirus
Research, 7, 112-117.
11.
American Cancer Society website, cancer.org (2021,
March 23). Oral Cavity (Mouth) Cancer Treatment
Options, by Stage. Treatment Options for Oral Cavity and
Oropharyngeal Cancer by Stage.
12.
Dua, M. " Doctor, Heal Thyself. " Dentaltown magazine
(November 2019).
13. Canadian Cancer Society website, cancer.ca. " Survival
statistics for oral cancer. "
14.
Jeon, J. H., Kim, M. G., Park, J. Y., Lee, J. H., Kim, M. J.,
Myoung, H., & Choi, S. W. (2017). " Analysis of the outcome
of young age tongue squamous cell carcinoma. " Maxillofacial
plastic and reconstructive surgery, 39(1), 41.
15. Dua, M. " Leaving Dentistry: This Way Out. " Dentaltown
magazine (March 2021).
16. Canadian Cancer Society website, cancer.ca. " Risk factors
for oral cancer. "
17.
Cancer.Net. (2021, February). " Oral and Oropharyngeal
Cancer-Risk Factors and Prevention. "
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Dentaltown August 2021

Table of Contents for the Digital Edition of Dentaltown August 2021
