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Oral Exams: Chef with Tongue Cancer and a Sense of Taste

MedpageToday

Grant Achatz, at age 32, was well on his way; Gourmet magazine named his the best in the nation in 2006, and Achatz received the James Beard Foundation’s award for outstanding chef in 2008. Then came the devastating news: Achatz had advanced cancer of the tongue. The standard treatment would involve radical surgery, with removal of his tongue, lymph nodes and a portion of his jaw, followed by radiation and chemotherapy. He might survive the disease, but his career as a chef would be over.

However, Achatz rejected this idea, and with his business partner, Nick Kokonas, finally found a pioneering , which would use intensive chemotherapy and radiation to shrink the tumor first, so that radical surgery would not be necessary. The regimen was grueling, but it worked and now Achatz has been cancer-free for three years. Although the treatment completely destroyed his sense of taste, it has been coming back slowly, one flavor at a time. (For more information about this topic, see  on the chef’s ordeal and recovery.)

In an interview with , Achatz says:

“I started from zero, and the first thing back was sweet,” he says. “So my palate developed just as a newborn — but I was 32 years old. So I could understand how flavors were coming back and how they synergized together. … It was very educational for me. I don’t recommend it, but I think it made me a better chef because now I really understand how flavor works.”

Achatz, with partner Kokonas, recently published a book about their experiences entitled .

Oral or pharyngeal cancer will be diagnosed in an estimated35,000 Americans this year, and will cause approximately 7,500deaths. On average, only 60 percent of those with the diseasewill survive more than 5 years. However, with early detection and timely treatment, deaths from oralcancer could be dramatically reduced: the 5-year survival rate for those with localized disease atdiagnosis is 82 percent compared with only 28 percent forthose whose cancer has spread to other parts of the body.

Age is frequently identified as a risk factor for oral cancer. However there has been, over the past decade, a rise in the incidence of oropharyngeal squamous cell carcinoma (OPSCC) in caucasian men younger than age 50 who have no history of alcohol or tobacco use and this disease is associated with human papillomavirus (HPV) 16 infection. Furthermore, HPV-negative and HPV-positive OPSCCs seem to have distinct molecular characteristics and the latter is thought to be associated with a better prognosis. For more information consult the .

Early detection of oral cancer is often possible. Tissue changes in the mouth, that might signal the beginnings of cancer, often can be seen and felt easily. Here's a narrated, pictorial review of the oral exam:

Photo credit: Lara Kastner for Metropolis