Mr Zaid Sadiq
Speaker key
ZSZaid Sadiq
IVInterviewer
ZSMy name is Zaid Sadiq. I’m a consultant maxillofacial surgeon, with an interest in head and neck oncology, and my talk was focused on oral cancer.
IVWhat oral cancers might GPs see?
ZSThe majority of oral cancers are squamous cell carcinomas, but GPs may also encounter other rarer forms such as sarcomas or nasopharyngeal carcinomas.
IVWho are the groups at high risk?
ZSThe biggest high-risk groups are individuals who have a high alcohol or tobacco intake. There are also subpopulations from the Indian subcontinent who chew beetlenut and that is a known carcinogen in the oral cavity.
IVHow do oral cancers present?
ZSOral cancers can present as a variety of clinical entities. The simplest form could be a white patch, or a red patch, or a mixed white and red patch. But they can also present, and that’s the most common form, as an oral ulcer that does not heal spontaneously within a period of two weeks. If an advanced cancer is not immediately obvious within the oral cavity, patients may present with a lump in the neck that on diagnosis reveals that this lump is a metastasis from an oral cancer, an oropharyngeal cancer.
IVWhat are the common differential diagnoses?
ZSLike most surgical conditions, I would encourage using a surgical sieve approach, and the most common presentations that can be confused with oral cancer could be a lesion of a traumatic origin, i.e. trauma from the surrounding teeth or dentures, it could be a fungal infection, or it could be a bacterial infection. But usually all of these respond to simple treatments, unlike an oral cancer.
IVAre there any red flags in history or examination?
ZSYes. A patient usually would come into the surgery and may complain to you of an ulcer in the mouth that hasn’t healed, despite conservative measures. They may also complain of a red or a white patch that could be burny in nature. They may complain of a lump or a loose tooth, or difficulty with speech, and lastly they may complain of pain.
IVAre there any common pitfalls in diagnosis?
ZSIn my practice where I’ve seen delays in diagnosis they’ve usually been generated by treating, continually treating lesions within the oral cavity as an antibiotic or a viral infection. I think the key message is if whatever treatment you give them, there is no response within a period of two weeks, then I would encourage an expedited referral to hospital.
IVAre there any investigations that GPs could or should perform before referral?
ZSI think the key message is to send the patients straight in if you have any suspicion of cancer. There are no particular investigations we would ask of you to perform and when you do send the patients in, it would be good to have their complete medical history and the latest blood tests that you’d have on your computer system.
IVWhere is the specialist service that GPs refer to?
ZSIn the area in central London, then it would be to UCLH, University College London Hospital, the head and neck cancer centre where all referrals are triaged, especially two-week wait referrals, and patients are seen and worked up to treatment.
IVWhere can GPs find out more?
ZSThe easiest way is to reach us through the UniversityCollegeLondonHospital website, or I’m more than happy for colleagues to contact me directly. My email address is .
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