By Pat Carragher - April 03, 2023
When John James noticed a bump on the roof of his mouth, his dentist feared he may need a root canal. Two weeks after a dental procedure to relieve the swelling, James grew concerned when the bump didn’t go away.
“My dentist ordered a biopsy, but we didn’t think it was going to be anything,” James said. “When we got the results back, it turned out to be adenoid cystic carcinoma. They were shocked. The first words out of his mouth were, ‘We’re going to send you to Moffitt.’”
Adenoid cystic carcinoma (ACC) is a rare form of oral cancer that develops in the secretory glands. It’s most commonly seen in the salivary glands. According to the National Institutes of Health, the disease accounts for just 1% of all cancers found in the head and neck region.
“It can involve the major salivary glands or minor ones that line the inside of the mouth and sinuses,” said Dr. Caitlin McMullen, a surgeon in the Department of Head & Neck-Endocrine Oncology at Moffitt Cancer Center. “This disease is a mix; sometimes it can be aggressive. The first and best treatment is surgery.”
James was given two options for surgically treating his cancer. The first was to go with a shorter surgery that would require him to use a device called an obturator. It’s a prosthetic that clips into the mouth much like a retainer or denture and acts as a seal to the hole that would be left behind from surgery.
The second option was reconstruction.
“This is not a minor procedure,” McMullen said. “It’s a much longer surgery. We’re taking tissue from other parts of the body so there can be issues down the line. It’s a big commitment.”
"This is not a minor procedure. We’re taking tissue from other parts of the body so there can be issues down the line. It’s a big commitment."- Dr. Caitlin McMullen, Head and Neck Oncology Program
James opted for the 11-hour palate reconstruction. While the risk was higher, it was worth it to him to not live with a device.
After removing the tumor, doctors would take tissue from his wrist and use it to seal off the palette from the sinuses. Once attached, doctors then need to restore blood flow by taking an artery and vein in the tissue and tunneling down into the neck and sewing blood vessels together under a microscope.
“The wrist tissue is thin, pliable and has a very reliable blood supply,” McMullen said. “In most cases it doesn’t affect people from a functional standpoint. They do get a scar on their arm and it can be a little bit stiff after, but they don’t lose any function. It’s a big commitment to go through all that, but it can help patients to seal off the mouth from the nose, which is important for function after surgery for this type of cancer.”
Following surgery, James spent six days in the hospital rehabilitating his wrist and mouth. Moffitt physical therapists worked with him to make sure he could swallow correctly and speak clearly.
“The wrist healing process was tougher than anything in my mouth,” James said. “I don’t have two molars on the left side of my mouth anymore. So I eat slower because I can only chew with one side.”
An avid golf fan, James’ two goals are to see all four major championships in person and golf in all 50 states. He credits Moffitt with allowing him the chance to return to doing what he loves. Shortly after finishing his radiation treatments, he and his wife travelled to Scotland to see the British Open.
“I got lucky to be able to come to Moffitt,” James said. “The first time I met Dr. McMullen, I told her we’re going to St. Andrews in July, so we need to get this done. Once I was all finished, we got on a plane and I was sitting in the stands on 18 drinking a beer. It was awesome.”