Delayed Diagnosis of Oral Cancer Leads to Metastatic Carcinoma in Neck

Otolaryngology Expert WitnessThis case involves a a male patient from Nebraska who presented to his dentist with a yellow spot on the left side of the tongue without undergoing appropriate screening for oral cancer. Some time after his initial presentation, the patient was seen by another dentist who noted two yellow and white patches on his tongue. At this point, the second dentist referred the patient to an oral surgeon. The surgeon diagnosed the lesions as a common irritation of the tongue and prescribed topical medication, however she did not perform a biopsy to rule out cancer. She advised that the lesions should be monitored by the patient’s dentist at routine appointments, and that she would only remove the lesions surgically if they grew. The patient continued to follow up with his dentist several times over the course of the next year, but no further action was taken in regards to the lesions on his tongue. Some time later , the patient called the oral surgeon’s office complaining of pain. The treating surgeon did not ask the patient to come in for examination – instead he prescribed more of the topical medication. A month later, the patient called the surgeon’s office again, complaining of worsening pain. At this point, the surgeon referred him to an ENT department following examination. The patient was subsequently diagnosed with squamous cell carcinoma, requiring surgical removal. The patient had his tongue removed, and additional exploratory surgeries discovered that the cancer had spread to his neck.

Question(s) For Expert Witness

  • 1. What is your experience of oral cancers?
  • 2. Have you ever published research papers regarding oral cancer?
  • 3. Do you diagnose and treat squamous cell carcinomas?
  • 4. What is the natural history of this type of oral cancer?

Expert Witness Response E-007668

I have treated many patients with oral cancers and have published several research papers regarding oral cancer. I diagnose and treat squamous cell carcinomas of the upper aerodigestive tract on a regular basis in my capacity as a head and neck cancer specialist and past president of the American Head and Neck Society.The natural history of cancer of the oral cavity is growth and progression. Local progression is evidenced first, followed by regional (cervical nodal) involvement. Patients suffering from this form of cancer are also at risk for distant metastatic disease. Patients diagnosed with early stage cancers as a whole do better than patients diagnosed with advanced stage. This patient now evidently has an advanced stage disease, as evidenced by regional nodal involvement. This appears to be a case of delayed diagnosis resulting in progression of disease, and a biopsy was indicated at initial presentation which would have confirmed this diagnosis much sooner.

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