Subtle, early symptoms of head & neck cancer

November 26, 2014

Patients often ask me how long they have had the cancers that they are consulting me for. This question is not intended to shift any responsibility nor accountability, but patients are genuinely trying to understand what they could have done differently. Although the treatment course would not have changed regardless, there were probably some early subtle symptoms that patients might have ignored:

  1. Pain in one ear. This is called “otalgia”, a sensation of a deep intractable nagging discomfort in one ear. The hearing itself is not affected. The head and neck have a very complex network of interconnected nerves providing sensation to all structures within that region. The glossopharyngeal nerve (CN IX) and the vagus nerve (CN X), when involved by cancers of the throat (tonsil, base of tongue, larynx, pharynx), can cause referred pain, which I explain as almost a “phantom” pain inside the ear. A unilateral ear pain should prompt a visitation to the doctor and a thorough examination by an otolaryngologist (ear, nose, and throat specialist).
  2. Numbness in face or neck. This could be the consequence of a deep cancer that is starting to erode through the complex network of sensory nerves of the head and neck region. For example, numbness of the lower teeth or chin could be the result of a cancer involving the nerve within the lower jaw bone (inferior alveolar nerve). Numbness of the cheek under the eye can be a sign of a deep tumor in the skull base.
  3. Tongue deviation. A patient sticks his/her tongue out and the tongue will deviate to one side. This happens when the nerve that controls the tongue muscle (hypoglossal nerve) is eroded by a deep-seated cancer within the tongue.
  4. Subtle facial asymmetry. There are some deep salivary gland tumors that can involve the nerve that controls the face muscles (facial nerve). When this happens, patients will have some very subtle and minor asymmetry of the face. It may be so subtle that when patients are in a neutral expression, it is not noticeable. Only when they smile, frown, or raise their eyebrows can you see a slight asymmetric movement when comparing the right and left side of the face. Unfortunately, this subtle symptom tends to be ignored even by patients themselves, attributing this to fatigue or just getting old.
  5. Unexplained weight loss or lack of appetite. Patients will mention a weight loss in the months prior to the diagnosis of cancer. It is an unexplained weight loss despite consuming a regular diet. Many patients don’t weigh themselves routinely, but they will notice that their clothes have become loose. No adult patient should be losing weight without a defined reason. Unexplained weight loss is not only specific to head and neck cancers, but applies to almost all cancers.
  6. Fetid odor from mouth. Some cancers in the throat will literally undergo necrosis (for lack of words, rot inside the throat). This will create a very foul bad breath. In the past few years, I have had a handful of patients tell me that their pets (usually a dog or cat) will constantly try to smell their breath. This makes sense as both dogs and cats have a much better sense of smell compared to humans. These pets might be extremely curious about the new odor coming from their owner’s mouth.

There are many other early subtle symptoms that make perfect sense in retrospect. However, otalgia (pain in the ear) is definitely the earliest subtle symptom that is most common and often most ignored both by patients and doctors. If you have unexplained ear pain, especially if it’s only on one side, consider seeking medical attention. To make an appointment with the Swedish Head and Neck Cancer Team, call 1-855-XCANCER.

Topics: Cancer, Services