Dr. Keith Roach

Dear Dr. Roach: I’m a healthy 69-year-old woman who exercises daily and attends an exercise class twice a week. During a routine dental cleaning, my dentist found a spot on the left side of my tongue, which turned out to be squamous cell carcinoma.

I’ve never smoked, and I have less than one drink per month. After surgery, my PET scan showed no signs of cancer spreading to my lymph nodes. I feel fortunate that we caught it early. I encourage your readers to keep up with routine dental cleanings; it really could save your life.

— Anon.

Dear Anon: Your message is important, and I appreciate you sharing your experience. I commend you on seemingly conquering this issue. My own dentist takes care to conduct thorough mouth examinations for cancer at every visit.

The traditional risks for squamous cell cancer (SCC) in the head and neck generally include smoking and tobacco use. However, there’s been a significant shift recently, as human papilloma virus (HPV) has emerged as a major concern. The treatment trajectory for HPV-related and non-HPV-related SCC is essentially the same, though the outlook tends to be better if HPV is involved—a fact that the pathologist usually tests for.

Since the HPV vaccine effectively lowers the likelihood of head and neck cancers, it’s vital that we continue vaccinating our kids. HPV isn’t solely an infection linked to sexual activity; it can lead to preventable cancer.

Dear Dr. Roach: Can having a bunion lead to other issues on the same leg? I visited an orthopedist about my bunion about eight or nine years ago. Although he mentioned it could be repaired, he suggested I wait until it begins to hurt. It doesn’t really bother me much; I’ve never worn shoes like high heels that could exacerbate the situation. However, in the past year, I’ve developed arthritis in the inner part of my knee on that same leg. Rehab exercises along with some “arthritis strength” acetaminophen generally keep the discomfort manageable.

I’m curious if my bunion could be contributing to the arthritis in my knee—maybe it’s impacting the way I walk and putting stress on my knee? Should I consider getting the bunion fixed to avoid further problems with my knee? I’m a 67-year-old woman, and I’m hesitant about the bunion surgery since I’ve heard it’s quite painful.

— B.J.S.

Dear B.J.S: A bunion is essentially a deformity of the large toe at the metatarsophalangeal joint, causing the joint to jut outward while the toe angles inward.

You are correct in thinking that issues in one joint, like your big toe, can lead to problems in another joint, such as your knee or hip. When pain occurs, the body often adapts its walking pattern to minimize discomfort, but this adjustment can put additional strain on other joints. I’ve seen many patients who don’t continue to feel pain in the original area as they adapt their pressure points to avoid it.

That said, one common underlying cause of bunion deformities is arthritis. It’s possible you would have developed knee arthritis regardless of the bunion’s presence.

I’ve treated many bunion deformities, and not everyone requires surgery. For many, conservative measures like wearing shoes with a wide toe box, using orthotics, and managing pain are often sufficient. The success and satisfaction rates for bunion surgery have improved considerably over the past 30 years, but I still advise against hastily opting for a procedure.

Readers can email questions to ToYourGoodHealth@med.cornell.edu.