August 8, 2022

Routine dental visit leads to brain lymphoma diagnosis

Our highly integrated care team approach resulted in lifesaving early cancer detection and treatment.

Kaiser Permanente member Alan Crymes with his dentist, Dr. Rebecca Guild, sharing photos of his recent vacation.

Kaiser Permanente member Alan Crymes was at a routine dental visit when his dentist in Portland, Oregon, Rebecca Guild, DDS, saw something subtle but concerning: different coloring on the left side of the roof of his mouth.

Crymes, 77, wasn’t feeling any symptoms or any pain. The 50-year Kaiser Permanente member didn’t think it was serious.

But it very much was. And fortunately, in Kaiser Permanente’s Oregon and Southwest Washington region, where dentists are a highly integrated part of our members’ care teams, they can play an important part in early cancer detection.

A rare discovery

Crymes was referred to an oral pathologist for an additional exam and 2 biopsies. Word came back from the lab — it was B-cell lymphoma, non-Hodgkin brain lymphoma. “This was definitely rare,” said oral pathologist Nadia Ghanee, DMD. “This type of cancer doesn’t usually present in the soft palate and without symptoms.”

Before the second biopsy came back, Crymes and his wife of 50 years, Lynn, were set to fly to Mexico when he had momentary double vision the night before the trip. Lynn Crymes, a former pediatric nurse practitioner, didn’t think twice. Soon he was on the way to a Portland-area hospital.

The CT scan showed blood on his brain under his skull — a subdural hematoma.

Integrated care: medical and dental

Through fully integrated electronic health records, Kaiser Permanente dental teams routinely remind patients about preventive medical screens and can help monitor care for people with diabetes. And, in Oregon, dentists can administer vaccinations. Because dentists and physicians are part of the same health care team, they can easily consult and coordinate care — and aid with early detection.

After his diagnosis, Crymes was quickly referred to Kaiser Permanente’s oncology department. Further scanning revealed lymphoma in his sinus, below his left eye. And another tumor on his left kidney. It was stage 4 cancer. Enter oncologist Soames Boyle, MD.

“This type of cancer is often diagnosed on a CT scan for some other indication, or when people seek medical care for weight loss, fevers, or enlarged lymph nodes,” said Dr. Boyle.

“The concern in Alan’s situation is that the lymphoma was growing in very close proximity to nerves that control facial expression, and, if left undetected, could cause permanent nerve damage.”

The benefits of early detection

Drs. Guild and Ghanee’s catch proved valuable to the oncology team — and Crymes. Thanks to early detection, 2 highly tailored radiation doses for the sinus tumor could be 70% effective.

Six months of chemotherapy followed, with the hope of shrinking both sinus and kidney tumors. Crymes says neither the radiation nor the chemotherapy ever affected him physically.

“The idea that I had the ‘big C’ never hit home,” he says. “I don’t know why. I just knew somehow, I would be OK.”

Over 2 years, he had follow-up scans. He’s in remission, and realistic.

“They said this type of lymphoma is not curable; it will show up again,” he said. “But it’s just as likely it won’t be my demise. I don’t let it bother me.”