Why palpation is so important: Early detection of oral cancer still depends on correct technique

By Nancy W. Burkhart, BSDH, EdD

I recently attended the Donald Kerr Symposium at the University of Michigan. The theme was, “Personalized Medicine in Oral Cancer.” The seminar had some notable speakers, and I wanted some updates about the human papilloma virus and its role in oral/pharyngeal cancer.

Other topics included valuable information related to the complete treatment of oral cancer patients by head and neck surgeons, ranging from identification of oral/pharyngeal cancer through the actual treatment phase. All of the speakers were excellent and so knowledgeable about HPV and oral cancer.

Two speakers expanded upon the importance of the oral exam in early cancer detection and that the exam is a key factor leading to an early diagnosis – one of the most important components being intraoral and extraoral palpation. One participant asked some specific questions about how one should palpate during an oral exam. I remember thinking that there are probably many dentists and hygienists who really do not know if they are performing this task in the most beneficial way. This is especially crucial regarding pharyngeal cancer since palpation is essential to early detection for this type of cancer.

Carol Bradford, MD, demonstrated on someone close by and suggested some techniques that she felt could be beneficial. Dr. Bradford also stressed the point that these types of cancers are not usually detected early in a medical office but rather in a dental office. She also raised the question of whether we might see dental personnel administering the HPV vaccine since patients are seen more often by dental professionals than medical professionals.

Another speaker, Dr. Mark Lingen, mentioned that a thorough oral exam surpasses any other device that is currently on the market. In the case of HPV, a few signs are known to occur:

  • Swelling and nodules in the salivary gland areas such as submandibular and sublingual glands
  • Pain, discomfort, or tenderness extending into the auricular area
  • Some lesions may be detectable toward the base of the tongue

Because of the extensive tonsillar crypts, there is little to no warning of tissue lesions/ulcerations until the cancer is more advanced in tonsillar cancer. But, palpation is often able to detect the nodes that have been invaded and these nodes often feel firm or hard.