Head and neck cancer is often caught late because its early signs look benign. A small set of red flags should trigger urgent referral and endoscopic assessment rather than a trial of treatment: hoarseness persisting beyond three weeks, a neck lump, unilateral ear pain with a normal ear examination, a non-healing mouth ulcer beyond three weeks, or unexplained unilateral nasal obstruction or bleeding.
Unilateral otalgia with a normal otoscopy is the one most often missed — referred pain from a pharyngeal or laryngeal tumour. Persistent unilateral symptoms in a tobacco or areca-nut user deserve particular suspicion.
In India, where tobacco chewing and areca nut drive a high oral-cancer burden, a low threshold for scoping and referral is the single most useful habit for the clinician who sees these patients first.
- Refer urgently for hoarseness lasting more than three weeks, especially in a tobacco user.
- A neck lump or a non-healing oral ulcer beyond three weeks needs assessment, not watchful waiting.
- Unilateral ear pain with a normal ear exam is referred pain until proven otherwise — scope the throat.
- Lower the threshold further in anyone using tobacco or areca nut.
Why it matters
These cancers are curable when caught early, and the early signs are exactly the ones easy to treat as benign.
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