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Corner Clinic: Our Experts Answer Your Health Questions

This month we talk about head and neck cancer, statins and prenatal testing

Written By: UC San Diego Health System Experts
  1. What are the signs and symptoms of common head and neck cancers?
  2. Should I go on statins if I have borderline high LDL cholesterol?
  3. What are the pros and cons of invasive versus non-invasive fetal testing?
Ezra Cohen

What are the signs and symptoms of common head and neck cancers?
Ezra Cohen, MD, associate director for translational science at Moores Cancer Center, and professor of medicine

Many cancers of the head and neck initially present with a mass in the neck. Although the great majority of these masses prove to be benign, if you have an enlarging neck mass for two weeks you should seek medical attention, even if it is not painful. A sore, such as a tongue or tonsil ulcer, that won’t heal and has persisted for two weeks is another situation that warrants medical attention, especially if the sore is painful or growing. Some unusual symptoms can also signal a serious underlying condition. For example, it is rare for adults to get ear infections without an obvious cause. Facial paralysis is another situation that should not be ignored. A tumor could be affecting the facial nerve, though usually inflammation of the facial nerve is to blame.

In general, any new symptom in the head and neck region or anything affecting speech or swallowing should not be ignored. Moreover, everyone should visit their dentist twice a year and have an oral cancer screening annually. Incident rates of head and neck cancers are rising faster than most other forms of cancer in the U.S.

Pam Taub

Should I go on statins if I have borderline high LDL cholesterol?
Pam R. Taub, MD, cardiologist and assistant professor of medicine

This is a complex question that involves weighing other risk factors for cardiovascular disease, such as family history and lifestyle, as well as the presence of other medical conditions, such as rheumatoid arthritis or inflammatory bowel disease, which can contribute to a person’s risk of heart attack or stroke.

In my clinical practice, I use blood tests to further assess a person’s risk of cardiovascular problems. These include high sensitivity C-reactive protein and lipoprotein(a) tests. The NMR LipoProfile test, which directly quantifies the amount of bad cholesterol circulating in the body, is particularly useful for patients with “borderline LDL,” as measured by a conventional blood test.

These tests, plus a detailed history from the patient, allow me to analyze the cholesterol level in the right clinical context and to make an individualized recommendation for each person.

Andrew Hull

What are the pros and cons of invasive versus non-invasive fetal testing?
Andrew Hull, MD, director, Maternal-Fetal Care, and professor of clinical reproductive medicine

Until very recently, amniocentesis and chorionic villus sampling were the main ways to test for fetal chromosomal and genetic abnormalities. The advantage of these invasive tests is that they result in the collection of fetal cells for highly accurate genetic testing. The downside is that both procedures also carry risks to the fetus. Amniocentesis and chorionic villus sampling will cause approximately one in 500 and 1 in 100 women, respectively, to lose her pregnancy.

Newer non-invasive prenatal testing relies on the fact that fragments of DNA from cellular turnover circulate in our bloodstream all the time. In pregnant women, some of this circulating DNA comes from the placenta and fetus. This means a simple blood sample from the mother can be analyzed to obtain genetic information about the fetus. These newer tests outperform standard serum screening tests used for high-risk women, but they are still not as accurate as invasive testing.

Non-invasive prenatal testing should be regarded as a very sophisticated screening test that, like any screening test, will give both false negatives and false positives. For this reason, an abnormal test result should be confirmed with follow-up invasive testing. Additional testing should also be offered if ultrasound findings suggest a fetal abnormality, despite a reassuring non-invasive prenatal test result. Because the availability and complexity of these newer tests is changing rapidly, anyone considering such testing should seek genetic counseling first.

Care at UC San Diego Health

Cardiovascular Services

Head and Neck Cancers

Maternal-Fetal Care

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