I thought my mouth ulcers were caused by exam stress – but then I was diagnosed with cancer

One medical student had two-thirds of her tongue removed and recreated with her leg after persistent mouth sores were found to be cancerous.

Rachel Morton, who studies in Edinburgh, developed sores on her tongue in 2019.

The 21-year-old claims the sores lasted for a year until one side of her tongue completely covered and became deformed.

She was also extremely tired, had dry, red and swollen lips and had severe tonsil pain. After struggling to be seen by doctors, Ms Morton switched GP practices in November 2020.

At that time, she was referred for a biopsy, before being diagnosed with tongue cancer on December 18, 2020, at the age of 19.

Rachel Morton (pictured above), who lives in Edinburgh, Scotland, said she started getting sores on her tongue in 2019, which she initially attributed to being busy with studying but went to get it checked out

After the life-saving surgery, Ms. Morton had to relearn how to walk and talk, and remarkably she took no time off from her studies as she returned to online classes just four days later. The 15-year-old dancer then had two rounds of chemotherapy, 30 rounds of radiotherapy and speech therapy over six months before finally getting the all-clear in June 2021.

The avid baker underwent ten different surgeries in a 16-hour session to break her jaw, remove two-thirds of her tongue and remove lymph nodes.

The surgeons then used muscles and blood vessels from her thigh to reconstruct her tongue and the arteries and veins in her neck.

After the life-saving surgery, Ms. Morton had to relearn how to walk and talk, and remarkably she took no time off from her studies as she returned to online classes just four days later.

The 15-year-old dancer then underwent two rounds of chemotherapy, 30 rounds of radiotherapy and speech therapy over six months before finally getting the all-clear in June 2021.

WHAT IS TONGUE CANCER?

Tongue cancer is a form of head and neck cancer.

Although the exact number of patients is unclear, approximately 12,000 people are diagnosed with head and neck cancer in the UK each year.

And in the US, 51,540 new patients are diagnosed each year.

Cancer can develop in the mouth tongue – the front two-thirds visible when you stick your tongue out at someone – which is classified as oral cancer.

Or it can start in the base of the tongue near the throat, which is a form of oropharyngeal cancer.

Symptoms can include:

  • Red or white spot that does not go away
  • Persistent sore throat
  • Ulcer or lump on the tongue that does not relieve
  • Pain when swallowing
  • Numbness in the mouth
  • Unexplained bleeding
  • Ear pain (this is rare)

Most head and neck cancers have no clear cause, but smoking, excessive drinking and the HPV virus are risk factors.

Early cancer (when the growth is less than 4 cm and is in the tongue) can be removed through surgery.

Radiotherapy may also be necessary.

Advanced cancer may require surgery to remove the entire tongue, as well as chemotherapy and/or radiotherapy.

Source: Cancer Research UK

Ms. Morton, who is interested in a career as a psychiatrist, has several scars, including a ‘Harry Potter-esque’ scar on her chin, one from a tracheostomy, on her neck, abdomen and down her leg.

When Mrs. Morton’s sores first appeared, she had several telephone consultations with the doctor and also went to the dentist, who both prescribed her antibiotics.

By the time she had moved to Edinburgh to start her second year at university, they had become so painful that her tongue had become so misshapen that she could no longer stick it out or drink alcohol.

She said: ‘I had tongue ulcers on my 18th birthday, I couldn’t really drink alcohol because they were so painful.

“When I’m a little tired, exhausted, or stressed out from exams, I seem a little prone to stomach ulcers anyway, so I just chalked it up to that and started college.

‘I went to the doctor and I was given painkillers, Bonjela and things like that.

“I still had them a year later, but I wasn’t too worried about them. I had so many other things going on in my life and it wasn’t really at the forefront of my mind.

“It was just a few sores at first, but over the course of a year they got bigger and spread and covered the entire side of my tongue. They were really red, raw and painful.

“I went through the process of going through a lot of different ones [medical] people and not really cared for and at one point a doctor actually said ‘there’s really nothing else we can do’.

‘I had moved to Edinburgh and was getting very tired. I didn’t really pick up on it at first, but I would take an online class and then just fall asleep.

“And maybe once a week my lips got really red, dry, swollen and inflamed. I also got a rash around it, it almost looked like I had an allergy [to something].

‘At that point I started to get really bad tonsil pain, I felt like I had a sinus infection or an ear infection. Everything on the left side of my face and neck felt off.”

When Mrs. Morton’s sores first appeared, she had several telephone consultations with the doctor and also went to the dentist, who both prescribed her antibiotics. By the time she’d moved to Edinburgh to start her second year at university, they had become so painful that her tongue was so misshapen that she couldn’t stick it out or drink alcohol.

But the student doctor said she fully embraces her scars as they show how strong, resilient and powerful her body is to have fought and conquered such an aggressive cancer.

Ms Morton said she was being examined for a range of conditions, such as haemochromatosis – a hereditary condition where iron levels in the body slowly build up over many years.

She booked an appointment with a new GP in November 2020, who sent her for a biopsy and days later on December 18, she was diagnosed with tongue cancer.

Ms Morton said: ‘The biopsy was probably one of the worst experiences of the whole case – it was absolutely horrifying.

“You lie there, of course they stun you, but it’s the sound of the scissors cutting your tongue because it’s such a strong muscle, it really took a lot of force.

“They told me they would get back to me in a few weeks and four days later I got a call, I had just taken an exam and they told me to call them back as soon as possible. It was quite an urgent message.

‘At that moment I thought ‘I have cancer, I know’.

“We went to the surgeon’s room and he had a box of tissues there. There were all small queues which made me think ‘oh ok, I know what’s going on now’.

‘He had actually never spoken to anyone as young as me with tongue cancer. He said he has only treated people over 60, mostly men, who have smoked and drunk all their lives.

Ms Morton, who is interested in a career as a psychiatrist, has several scars, including a ‘Harry Potter-esque’ one on her chin, one from a tracheostomy, on her neck, abdomen and down her leg

“While he told me I had cancer I don’t remember this but my mom did, he got a rash trying to tell us because he was just so uncomfortable. I felt sorry for him because it was a horrible situation.

“It really was a surreal experience. You go into survival mode. You think ‘okay, this is reality, this is what’s going to happen, and I’ll get through it’.

Exactly one month after her diagnosis, she underwent surgery.

In doing so, they had to use some of the muscles and blood vessels from her legs to reconstruct her tongue and the arteries and veins in her neck.

They first tried to take it out of her calf but then it was not viable, they used her thigh so most of her entire left leg was operated on.

She received a tracheostomy about four days later and a feeding tube inserted into her stomach for about nine months.

This was followed by two rounds of chemotherapy and 30 radiation treatments, which she had five days a week for six weeks, and speech therapy for about six months.

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