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ILT had cancer of the tongue some thirty
years ago . This is his story.
My personal account of the events and experiences
regarding my medical history and its treatment
can best be described in three parts:
- The initial trouble
A malignant rodent ulcer
on my tongue
- The treatment
Radiation. Deep x-ray
- The aftermath
The lengthy surgery and
dental treatment required and received
up to the present time
1. The initial trouble
The initial trouble was an ulcer on my tongue
some thirty years ago. I thought at the
time it would clear up, but after using
mouthwashes and various detergents it did
not. It soon became necessary to see my
GP, Dr Whammond and later his partners Dr
Forsyth and Dr Belsey, who very quickly
referred me to a consultant at the then
Victoria Hospital in Keighley.
An appointment was made for me to be seen the
next day privately. This happened to be a Saturday,
and I remember that after he examined me the consultant
immediately phoned a specialist at Cookridge Hospital
in Leeds, who arranged to see me at Victoria Hospital
on the following Monday. This duly took place,
and after further examinations by the specialist,
Dr Worthy, and Dr Berry; it was decided that immediate
treatment at Cookridge Hospital was necessary.
It was arranged to start the following Wednesday.
On the Tuesday Dr Worthy took a piece of my tongue
for analysis (a biopsy). The ulcer tissue proved
to be malignant. I recall the biopsy was a very
painful procedure. I was then measured up for
positioning on the deep x-ray apparatus. This
was essential so the beam could be targeted in
exactly the right position on each of the ensuing
treatments.
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2. The treatment
I was told this would be given over a period
of 3 weeks. One week of treatment, one week
of rest and a final week of treatment. I
was also told as the treatment progressed
I would become gradually physically worse
and that I would lose some facial hair where
the x-rays penetrated. They were right,
for towards the end of the treatment, which
was completed without a break, I was in
a very sorry state. My moustache, which
I had worn from my teens, had disappeared
(and incidentally has never grown back)
and my mouth became increasingly sore. I
must mention at this point that shortly
after the treatment started, Dr Worthy decided
that a tooth in my bottom jaw was impeding
the treatment and would have to be removed.
So an appointment was made for me at BRI
on the Saturday morning to have this done.
I recall that what should have been a fairly
straightforward extraction proved to be
a rather difficult encounter. In effect,
after two or three attempts and one or two
breakages, it was thought to be complete.
I mention this because after the radiation
therapy this was where the aftermath started.
As I said previously, after the treatment
I was in a very sorry state. My mouth was
very badly burnt, as I recall to the extent
that when I closed my mouth my lips were
literally sealing together. Eating and drinking
were almost impossible for the next ten
days or so and my life was a virtual nightmare.
I was kept under observation for the next
few weeks and eventually things settled
down and life became more tolerable, after
about six months I was given the good news
that the treatment on my tongue had been
successful and the tumour had been cured.
3. The Aftermath
As time went by I became increasingly troubled
by a lot of pain and discomfort in the part
of my jaw where the tooth I previously mentioned
had been removed. So much so that Dr Worthy
referred me to the late Mr Penny at St Luke’s
Maxillofacial Unit. Here started what was
to be a lengthy investigation and treatment
of my lower jaw. Lots of x-rays were taken
at regular intervals and it was eventually
realised that a radionecrosis (bone death)
had started. It was thought at first that
this would eventually stop spreading and
the surgeon would be able to remove the
dead bone and that all would be well. Unfortunately
this was not to be and the necrosis kept
on spreading, until a decision was made
to remove the affected part of my jaw. For
this the plastic surgeons, Mr Crockett and
Mr Barclay, were called in. They decided
to cut away the affected bone and replace
it with a bone transplant from my hip. Plans
were made and, after much deliberation,
a date was fixed for the operation to be
done. Details of the operation were explained
to me, and I must admit it seemed so complex
that I could not comprehend how on earth
it could be done. The reality was that it
had to be done.
Here started what I think was the most traumatic
part of my life. I was admitted to J1 ward
at St Luke’s Hospital, which for the
next three months or so was my permanent
residence. The operation was carried out.
The first part was the removal of the dead
bone. This resulted in the loss of tissue
in that area of my jaw, which needed to
be replaced with a transplant flap from
my forehead in order to provide a satisfactory
location for the ensuing bone transplant.
The first transplant was a failure, which
was a big disappointment. The second, however,
was more successful, and after a period
of healing was ready to receive the replacement
bone. This was taken from the top of my
hip bone, which apparently was a similar
shape to the piece, which had been removed.
To do this, the surgeons has to make a framework
of stainless steel rods and pins which were
screwed into my head and what was left of
my jaw. This was necessary in order to hold
the bone transplant rigidly in place until
the rest of my jawbone accepted it. It was
not a pretty sight, and for some considerable
time I could not move my jaw at all. During
this time I had to be fed liquid foods through
a tube, I was very grateful at the time
to the nurses for the variety of liquid
meals they were able to make for me.
Eventually the transplanted bone began to
live with the adjacent bone and the supporting
metal framework could be removed. I regained
movement of my jaws and soon was able to
eat more solid foods again. I said earlier
I had difficulty comprehending the complexity
of the operations. Not surprisingly, I lost
count of the number of times I had to visit
the operating theatre. One nursing sister
told me at one time she thought it was twenty-eight.
At that time we were winning, so it seemed
worthwhile. It had been explained to me
that I would be rather badly scarred particularly
on my forehead where the skin flaps were
taken from and also that I would be toothless
for some time until the transplant had completely
healed. It is worth mentioning that one
of the oddities of the operation was that
part of the second flap used in the transplant
was taken from my temple. This had hair
follicles growing which continued to grow
in my mouth for quite a few years. This
created a rather amusing problem because
I could not manage to cut the hair, and
had to attend the clinic at regular intervals
for haircuts inside my mouth. After some
time Mr Penny decided it was time to try
and make some dentures, at this time Mr
Roberts, the maxillofacial technician, and
his staff were called in, I must explain
here that Mr Roberts is something of an
expert when it comes to making artificial
limbs and things. His skills were brought
to bear. After much trial and error we had
a set of dentures that were reasonably serviceable
and cosmetically brilliant.
Since then, Dr Joshi has joined the department
and has made me another set. I have had
some success with chewing food, but still
have a lot of difficulty in swallowing food
with my dentures in place. So, I usually
take them out at meal times. Over the years
I have managed to enjoy food and learnt
to compensate for my reduced chewing ability
with a knife and fork and by choosing softer
food to eat.
Recently I have experienced difficulty with
drinking as I find myself dribbling from
the corner of my mouth. This can be a bit
embarrassing, mainly to myself. A few weeks
ago at Dr Joshi’s suggestion, I went
with Mr Carroll to see Mr Foo at BRI head
and neck clinic to see if he thought anything
could be done surgically to improve this.
However, it was decided that, owing to the
heavy radiation I had undergone in the past,
it would not be prudent to try plastic surgery
at this time.
To conclude: at the end of the day, and
by and large, I consider myself extremely
lucky to be writing this and enjoying my
good health as I approach my 78th birthday.
Best wishes.
ILT
18 October 1999
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