The Co-Management of an Esophageal Cancer Survivor

The Challenge:

In 2013, this patient was diagnosed with esophageal cancer and received surgical treatment. A comprehensive oral cancer risk assessment is necessary and recommended for everyone in our practice. OraRisk^® HPV completes the comprehensive risk assessment and is especially crucial for this patient with an oral cancer history.

The Background:

• Age: 75
• Sex: F
• Medical History: Allergy to Vicodin and Thermasol, history of gastric reflux, lichen planus and the esophageal cancer in 2013 was treated surgically with removal of the lesion, no reconstruction was needed. Currently patient has been prescribed and is taking Omeprazole, Ranitidine, Restasis and Acyclovir. The patient states the original cause of the cancer was lichen planus.
• Last Dental Exam: 12/28/2017
• Home Care: 3 month periodontal maintenance with good home care consisting of daily flossing and brushing 2x/day.
• Other Notes: Post-surgical treatment of esophageal cancer to present date, the patient has experienced severe acid reflux and sleeps with her head elevated. She is unable to recline in the dental chair. She states being in monogamous relationship for last 40 years. No education was provided about the HPV connection to some oral cancers at time of cancer diagnosis.
• Head and Neck oral cancer screening – No significant findings

The Solution:

• OraRisk^® HPV specimen collected 12/28/2017.
• Co-manage/ Referral: The OraRisk HPV results were reviewed 1/9/2018 and revealed that the patient was positive for HPV type 82, associated with a probable high risk. These were sent to the patient’s primary care provider, ENT and thoracic surgeon at oncology center, along with a message explaining our dental follow up protocol of retesting the OraRisk HPV in 6 months. Due to the patient’s history and the positive OraRisk HPV results, a co-management plan was established. All medical providers requested the patient appoint at their respective offices for a check-up. She is to remain on a frequent recall with all offices to ensure anything abnormal is caught early.
• Next Dental visit: June 2018 for a 6-months OraRisk HPV follow-up test to establish persistence of the infection.
• Additional Notes: A 6-months retest interval was established due to the patient’s history of cancer. Our higher standard of care when there is a positive OraRisk HPV is to retest is 12 months to establish persistence of the infection.

The Result:

This case was a great learning experience on collaborating with medical providers. The thoracic surgeon was intrigued that a dental office was performing this type of screening and oral cancer risk assessment. They were quick to contact the patient and schedule a follow up visit. They were supportive of our proposed 6-month retest interval due to her history.

About the Author:

Camille Luke RDH, MSDH has been practicing dental hygiene since 1992. She is a former clinical lead for Pierce College Dental Hygiene Department, adjunct faculty for Eastern Washington University, and practices clinical hygiene part-time in Tumwater, WA. Her recent experience has been mentoring and coaching dental hygienists in multiple practices around Puget Sound implementing systems and protocols to support practice growth. Camille is an active member of ADHA, the American Academy of Oral Systemic Health, the Academy of Laser Dentistry and an affiliate member of the Academy of General Dentistry. In her down time, she enjoys spending time outdoors with her family; running, hiking, kayaking, rock climbing and biking. She is always up for a challenge and finding new opportunities for personal and professional growth.