Pain as sign of recurrent disease in head and neck squamous cell carcinoma

The role of pain in head and neck cancer is seldom addressed. This retrospective study examined in a group of 190 curatively treated patients to what extent pain complaints should be considered to be the first sign of recurrent disease.

The research population exists of 95 patients with a recurrent head and neck carcinoma and control group matched for age, gender, primary tumor, and duration of follow-up.

Of the patients with proven recurrent disease, 70% reported pain complaints as the first symptom. In 35% of these cases, the complaints concerned referred pain, whereas in 65% localized pain complaints in the head and neck were registered. The median interval between reporting localized pain complaints and histologic confirmation of recurrence was 4 months. In the case of referred pain, this delay was 2.5 months. No statistically significant correlation between pain complaints and site of recurrence could be demonstrated. Only 2% of the control group reported pain complaints.

This study confirms that each pain complaint after intentional curative treatment should be regarded as a warning sign. Recurrence of disease without preceding pain complaints (30%) emphasizes the importance of a thorough follow-up.