Contrary to a clinical aphorism that early head and neck cancer is painless, researchers According to Dr. Schmidt of New York University College of Dentistry and Dr. David K. Lam of the University of California, San Francisco show that patients who develop head and neck cancer experience significant pain at the time of initial diagnosis.
Oral Cancer Patients Report Significant Levels of Spontaneous Pain and Functional Restriction from Pain, Volume 152, Issue 5, May 2011, Pages 1206-1209
"Our research demonstrates that patients with oral cancer experience pain in their mouth but few with precancer suffer such pain. Patients and clinicians should be aware that oral pain could be a sign of malignant transformation from oral precancer," said NYUCD’s Dr. Brian L. Schmidt
According to Dr. Schmidt of New York University College of Dentistry and Dr. David K. Lam of the University of California, San Francisco, detecting head and neck cancer in the first stages can improve survival by as much as 90%.
"Although pain is often recognized as an important symptom," they note, "a clinical aphorism has been that early head and neck cancers often go unnoticed because they are asymptomatic."
To investigate the validity of this notion, the researchers studied 44 patients with oral cancer and 20 with oral precancer. Also involved were 21 dental patients with normal oral mucosa.
They completed the UCSF Oral Cancer Pain Questionnaire at their initial visit. This uses a visual analogue scale (0 to 100 mm) to quantify eight pain-related responses.
The oral cancer patients reported significantly greater spontaneous and function-related pain in comparison to the other groups. Most (84%) presented with moderate to severe pain (greater than 30 mm) at the time of initial diagnosis.
In contrast, there were no significant differences in response between the precancer and normal patients.
The oral cancer patients also experienced a significantly higher function-related rather than spontaneous pain intensity, particularly in regard to sharpness and aching.
There was no correlation between tumor size and reported pain levels or functional restriction.
These findings, say the investigators, "suggest an important predictor for the progression of oral precancer to cancer may be the onset of orofacial pain that is exacerbated during function."
This "may be the best clue and should be included in the clinical assessment of patients to identify a high-risk group to apply screening strategies for early cancer detection," they conclude.
The full article in pdf format, can be found here.
Contrary to a clinical aphorism that early head and neck cancer is painless, we show that patients who develop head and neck cancer experience significant pain at the time of initial diagnosis.
We compared orofacial pain sensitivity in groups of patients with normal oral mucosa, oral precancer, and newly diagnosed oral cancer. The University of California San Francisco Oral Cancer Pain Questionnaire was administered to these patients at their initial visit, before being prescribed analgesics for pain and before any treatment. In contrast to those with biopsy-proven normal oral mucosa and oral precancer, only oral cancer patients reported significant levels of spontaneous pain and functional restriction from pain.
Moreover, oral cancer patients experienced significantly higher function-related, rather than spontaneous, pain qualities.
These findings suggest an important predictor for the transition from oral precancer to cancer may be the onset of orofacial pain that is exacerbated during function. Screening patients who have new-onset orofacial pain may lead to a diagnosis of early resectable head and neck cancer and may improve quality of life and survival for head and neck cancer patients.
David K. Lam Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA and Brian L. Schmidt, Bluestone Center for Clinical Research, New York University, New York, NY, USA; Department of Oral and Maxillofacial Surgery, New York University, New York, NY, USA