My friend was refused cancer treatment with no explanation. A nurse then told him the sickening reason why… This cannot be true? DR SCURR reveals what’s really going on

Dear Dr Scurr,

My friend has a cancerous growth on his neck and has had one radiotherapy session. He has now been told he cannot be given further treatment, with no explanation about why.

A retired NHS nurse told him this is because his age (he’s 90) makes him low priority. Is there any truth in this?

Steve Allsup, Cheltenham.

I understand why you would suspect this – and I don’t dismiss it out of hand – but I think there is a much more likely explanation.

I suspect that the growth on his neck is a basal cell carcinoma – a skin cancer caused by years of sun exposure.

It’s the most common type of skin cancer, which grows and damages the tissue around it but rarely spreads elsewhere.

The main treatment is usually surgery, but other options include chemotherapy (given as a cream) and photodynamic therapy (using a light-sensitive drug on the area, which is then activated by a lamp or laser, to kill off the cancerous cells). Radiotherapy is a well-recognised treatment for it, particularly in older patients, to avoid having surgery and then a return visit to have stitches removed.

This can be delivered as a single, high dose, rather than a course spread over several visits which can suit people with other health conditions or shorter life expectancy because it’s less invasive and draining.

Furthermore, a single dose can be highly effective in the short to medium term (longer term, over many years, its success rate may be lower than a full course of treatment spread over time).

For a 90-year-old man, such as your friend, this would make a lot of sense.

As long as his GP was kept informed and could monitor the area to check the treatment worked, it would be a perfectly reasonable way to manage his case. Your friend might consult his GP to check this and put his mind at rest.

Overnight, the usual amount of sugar I add to tea or coffee suddenly became unbearably sweet. I halved my usual small teaspoon and it’s still too sweet. My doctor said the problem lies with my tongue, and gave me drops to use four times a day for a week. They made no difference. What are your thoughts on this?

Kevan Derbyshire, Manchester.

This is a recognised, if unusual, problem – a type of taste distortion, sometimes called sweet hypergeusia.

I agree with your GP that the problem lies with your tongue – particularly the nerves of your taste buds, which are found largely on the tongue.

This could be down to type 2 diabetes or to potential imbalances in the body salts (i.e. electrolytes) such as sodium, potassium and particularly zinc; or iron – which could trigger some kind of change in body chemistry, affecting the nerves that transmit taste from your taste receptors. Another potential trigger is an infection – any kind of respiratory infections (and Covid-19 in particular) can alter taste, although they more commonly cause loss of taste or an unpleasant taste rather than making things seem sweeter.

Certain medications can also alter taste – notably ACE inhibitors (such as captopril, prescribed to treat high blood pressure); and some antibiotics, including clarithromycin and metronidazole.

Again, this may be down to neurological function altered by some kind of chemical effect.

I suspect the drops you were given contained nystatin, an antifungal used here for treating oral thrush – possibly your GP thought that a fungal infection might be the cause.

I’d suggest asking your doctor for a blood test for iron (ferritin) as well as electrolytes.