Helen,

If you have a question you should post it, you want to know and on most issues someone has the answer.
I assume by "Nasty" this person was referring to OC. Unfortunatly, many people and even Dentists, MD's, ENT's etc. believe this and tell people this. Every body is different and every H&N and OC even though they may be similarly named, classified and have the same behavioural characteristics is different as well.

Remember, the terms "Never & Always", have little use in medicine and oncology.

Pain is not and has never been used, at least in any textbook, journal article or lecture I have attended, as a major indicator or clinically descriptive term to rule out any kind of H&N or OC. Pain is usually one of the last characteristics used in the long differential diagnostic lists to decide if something abnormal is "Nasty" and/or needs further investigation or biopsy. It usually appears last or next to last and goes something like this (I'm paraphrasing here),...Pain, not always but sometimes present in varying intensities in different patients. Pain may or may not be from the initial lesion and may or may not be present if the lesion has invaded other structures or tissues. Wow!! That's pretty vague.

I personally don't use the prescence or abscence of pain in my clinical decision making process regarding abnormalities in the head, neck, or oral cavity. I note it and query about it but that's about it.

I have personally been involved with SCC base of tongue in an elderly gentleman that was excruciatingly painful. He had complained of the problem for 18 months to his MD and dentist. His wife was my patient and asked me to have a look. I sparyed topical in the back of his throat and then examined him. When I pulled his tongue forward with my gauze I froze, there was a 2 cm round ulceration with indurated borders and tissue necrosis that crossed the midline. He had hard fixated submandibular nodes and cervical nodes. Similar lesions were present on both tonsillar pillars. I immediatly referred him on an emergency basis, he went right from my office, to a surgical ENT at our local Cancer Treatment Center. Unfortunately he passed away several week later from pneumonia brought on by the rigors of chemo and radiation.

Ok...Rambling...

Nasty things in the mouth can be painful.

I hope this answers your question.

Mike