• 3/22/2007
  • Ottawa, Ontario, Canada
  • Lorianne Garrison
  • OttawaCitizen.com

For Donna Walsh, it began as a little nip on the tongue. It didn’t seem like much of a problem — sore, tender, but not a big deal.
Then, on Christmas Day in 2005, she experienced a terrible pain that “felt like something had exploded” in her mouth. A doctor sent her to a specialist, and then another specialist. On Feb. 1 — her 53rd birthday — Ms. Walsh, an Ottawa public school teacher, wife and mother, was diagnosed with tongue cancer.

“It surprised me incredibly, because I was never a smoker,” she said. “It was something I didn’t expect at all.”

A little more than two weeks after her diagnosis, Ms. Walsh had surgery to remove one-third of her tongue, to stop the cancer from spreading. She became one of between 25 and 30 people each year in Ottawa who have a unique procedure called a radial forearm free flap, involving the domino-like replacement of flesh from arm to tongue, and leg to arm.

Dr. Martin Corsten, a head and neck cancer specialist at the Ottawa Hospital, working with plastic surgeon Murray Allan, removed the cancerous portion of Ms. Walsh’s tongue, which was four centimetres long and one centimetre deep. Ms. Walsh was sedated, Dr. Corsten said, and the infected tissue cut out with an electric knife.

In cases where little of the tongue is removed, the patient doesn’t have much trouble adjusting to having “a little bit less tongue,” Dr. Corsten said. In cases such as Ms. Walsh’s, though, where a lot was lost, the patient would have trouble speaking and swallowing normally.
So the doctors removed a piece of Ms. Walsh’s left forearm, complete with vein, artery and nerve, and sutured it into her mouth to replace part of her tongue. “There is nothing in the body the exact same as the tongue,” Dr. Corsten said. But because the arm flesh is attached with a nerve, the piece of skin is able to act and feel similar to a real tongue. A piece of Ms. Walsh’s left inner thigh was then grafted to her forearm to replace the skin taken from there.
“I thought it was really neat how they were able to do that,” she said.

Dr. Corsten said the operation was not revolutionary. “This is something we do commonly, it’s just that people don’t hear about it very often,” he said.

After the operation, Ms. Walsh spent more than a month in recovery, which is normal, she said. The cancer was aggressive though, spreading into seven of her lymph nodes; intensive radiation treatments and chemotherapy were required for most of May and June.

“It was very, very tiring,” she said, adding it became worse as the weeks went on.

Radiation and chemotherapy are hard on patients, Dr. Corsten said. “Toward the end of (the treatment) it’s virtually impossible to swallow. The head and neck are also quite burned” (from radiation). But Ms. Walsh was determined to beat the disease, he said. “She was so motivated.”

Even with the refitted tongue, Ms. Walsh said she still had to “completely re-learn how to speak.”

It can take a patient who has had this kind of surgery weeks or even months to re-learn how to speak properly, but most do eventually recover “a high level of intelligibility,” according to Pam Maser, the acting chief of speech-language pathology and audiology at the Ottawa Hospital.

With the help of a speech pathologist, Ms. Walsh can now speak and swallow almost as well as she could before the cancer. The radiation therapy damaged her saliva glands, resulting in a permanently dry mouth, a common side-effect, Dr. Corsten said. There was also some scarring, on her neck and arm, and skin damage from the radiation.

Ms. Walsh went back to Hopewell Avenue Public School last September, where she teaches Grade 7 and Grade 8 science. She credits her recovery to the “amazing” support of her family and friends and people in the community who sent her cards and organized meals for her family while she was in the hospital.

Dr. Corsten said in cases such as Ms. Walsh’s, there is a 50-per-cent chance of remission.
Ms. Walsh is hopeful. “I’m very optimistic that we beat it,” she said.

According to Dr. Corsten, tongue cancer accounts for about one or two per cent of cancers yearly, with 75 to 100 cases in the Ottawa area. The disease begins with a spot on the tongue. As with all cancers, he said, early detection is important in treatment.

What caused Ms. Walsh’s cancer is unknown — in 90 per cent of cases, the disease is associated with smoking, Dr. Corsten said.

He said he has recently been seeing more cases of tongue cancer in young, non-smoking patients. One theory is the cancer may be associated with human papillomavirus (HPV), but no definitive link has been found.