2. This nonhealing painful lesion on the side of her tongue had increased in size recently, and the patient, a 56-year-old homeless woman, was worried because her dad had died from oral cancer. She had smoked since she was 11 and acknowledged being a heavy drinker.
Diagnosis: A punch biopsy revealed that the patient had a squamous cell carcinoma. Fully two-thirds of oropharyngeal cancers (OPCs) will present with advanced disease at the time of diagnosis. Ninety percent of OPCs are of the squamous cell type. Reports in the literature suggest that clinicians may be missing early disease by not conducting thorough soft-tissue examinations on a routine basis. However, the fact that more than 35% of patients do not see a dentist on a routine basis likely contributes to the diagnostic delay. The 5-year survival rate for OPC is 62% for whites and 42% for blacks.
Tobacco use is the major risk factor for OPC and is implicated in approximately 75% of cases. Alcohol use is also a major risk factor. The combined use of tobacco and alcohol increases the risk of OPC far more than either alone. Human papillomavirus (especially HPV 16) is a newly recognized major risk factor for carcinomas affecting the lingual and palatine tonsils.
For more information, read “Lesion on side of tongue.” J Fam Pract. 2014.