EN2.8 | Premalignant and Malignant ENT Screening — Summary & Reflection

KEY TAKEAWAYS

ENT cancer screening requires: (1) risk factor profiling — tobacco (smoked + smokeless), alcohol (synergistic with tobacco), betel nut (OSMF → oral SCC), HPV (oropharyngeal SCC, tonsil + tongue base, younger patients), EBV (NPC, Southeast Asian/Cantonese, bilateral cervical nodes + Eustachian tube obstruction + nasal symptoms); (2) systematic examination — oral cavity (torch + tongue depressor, look for leukoplakia [white, can't rub off], erythroplakia [red velvety, urgent biopsy ~50% malignancy], OSMF [pale fibrous mucosa + trismus], ulcers), oropharynx (tonsil asymmetry, ulcers), larynx (indirect laryngoscopy for hoarseness >3 weeks — glottic SCC early/good prognosis/no hoarse voice early; supraglottic SCC late/nodes early/poor prognosis), neck (palpate all levels, hard non-tender nodes in smoker = metastatic SCC). Leukoplakia: 5% malignant transformation, all need biopsy. OSMF: 7–12% malignant transformation. NPC triad: cervical nodes + serous OM (ETD) + nasal symptoms + EBV. All suspicious mucosal lesions: biopsy; all neck nodes: FNAC first (not open biopsy).

REFLECT

Consider this: in India, the average delay between first symptom and ENT cancer diagnosis is 6–18 months. Much of this delay occurs at the primary care level — the first doctor seen by the patient. That doctor — who might be you — either identifies the lesion and refers urgently, or reassures the patient that the painless white patch is 'nothing serious' and tells them to come back in a month. The outcome of that decision is potentially the difference between a T1 lesion (>90% cure rate) and a T4 lesion (<30% cure rate). As you go through clinical postings, practise the habit of looking at every patient's oral cavity when you examine them — not just when they complain of oral symptoms. ENT cancer is often found by accident during a non-ENT consultation. Be that doctor.