What is head and neck cancer? Signs, symptoms, and when to seek help
Head and neck cancer is one of the fastest rising cancers in the UK, yet many people don’t know what to look for. Consultant Oral and Maxillofacial/Head and Neck Surgeon Mr Raf Niziol explains the warning signs and when to get checked.
Head and neck cancer is one of the fastest rising cancers in the UK, yet many people don't know what to look for. Consultant Oral and Maxillofacial/Head and Neck Surgeon Mr Raf Niziol explains the warning signs and when to get checked.
Most of us know we need to check a mole or a breast lump. Far fewer of us know that a mouth ulcer that hasn't healed after three weeks, or a hoarse voice that won't settle, deserves the same attention.
Head and neck cancer is now one of the most common cancer groups in the UK, with around 12,000 new cases diagnosed each year - and the numbers are rising, particularly in younger people who have never smoked. The good news is that a lot of the time, these cancers develop in areas we can see and feel, which means they can often be caught early. The challenge is recognising the signs and symptoms.
What is head and neck cancer?
"Head and neck cancer" is an umbrella term for cancers that start in the mouth, throat, voice box, and surrounding structures. It does not include brain cancer or cancers of the eye.
The main areas affected are:
- the mouth (tongue, gums, floor of mouth, lips and cheek lining)
- the oropharynx (tonsils and the back of the tongue)
- the voice box (larynx) and throat
- the salivary glands, including the parotid gland in front of the ear
- the nose and sinuses
Most of these cancers begin in the thin lining of the mouth and throat and share similar risk factors and warning signs.
What increases your risk of head and neck cancer?
Several factors are well established:
- smoking and tobacco use: the single biggest modifiable risk factor
- alcohol: particularly when combined with smoking, where the risks multiply rather than simply add up
- HPV (human papillomavirus): a common virus now responsible for a large share of cancers from the tonsils backwards towards the throat. This is often seen in younger, otherwise healthy non-smokers
- betel quid or paan chewing: a significant risk in some South Asian communities
- age: risk rises after 50, though cases in people in their thirties and forties are increasingly common
It's worth saying that plenty of people who have head and neck cancer have never smoked and rarely drink. Having no obvious risk factors does not mean symptoms should be ignored.
What head and neck cancer symptoms should you look out for?
The most important thing to understand is that these cancers are usually painless in their early stages. Waiting for something to hurt is one of the most common reasons for delay.
See your GP or dentist if you notice any of the following:
- a mouth ulcer that hasn't healed after three weeks
- a red or white patch inside the mouth that won't go away
- a lump in the neck, jaw or face
- a hoarse or changed voice lasting more than three weeks
- persistent difficulty or pain when swallowing
- a persistent sore throat, especially if it’s only on one side
- unexplained loose teeth, or dentures that suddenly stop fitting
- numbness or tingling of the lip, chin or tongue
- a blocked nose or nosebleeds affecting only one side
- difficulty opening your mouth fully
- unexplained bleeding from the mouth or weight loss
One-sidedness is the detail people most often overlook. A sore throat on both sides after a cold is usually just that. A sore throat, earache, or blocked nose that affects one side only, and persists, needs looking at.
The three-week rule
If any symptom in the mouth, throat, or neck has been present for three weeks or more without improving, get it assessed. Three weeks is long enough for infections, minor injuries, and ulcers from a sharp tooth to settle. Anything that outlasts that window deserves a professional opinion.
Your dentist is often the best first port of call. A routine dental check includes an examination of the soft tissues of the mouth, and dentists pick up a significant proportion of early oral cancers in people who had no idea anything was wrong.
Why early action matters for cancer
Mr Niziol tells his patients that their first chance is their best chance especially in head and neck cancer.
A small, early cancer can often be removed with one relatively contained operation, with excellent chances of cure and minimal lasting effect on how you speak, eat and look.
The same cancer found a few months later may require removing large parts of your tongue/jaws or face, alone with the lymph nodes in your neck, and typically requires transplanting other parts of your body to reconstruct the area and restore form and function.
When we get to this stage, patients often also require radiotherapy and chemotherapy after surgery.
The difference between those two scenarios is often just a few months of waiting.
What happens when you seek help
Being referred to see a head and neck consultant is not the same as being diagnosed, and most people investigated for these symptoms turn out not to have cancer.
If your GP or dentist is concerned, you'll be referred urgently to a head and neck specialist. Assessment usually involves an examination of the mouth and neck, placing a flexible camera up your nose to examine the back of your throat, and at Cromwell Hospital we have the facilities to offer a biopsy at the same time as your first appointment.
If cancer is confirmed we will order some scans to make sure it has not spread to other parts of your body and your case is discussed by a multidisciplinary team of surgeons, oncologists, radiologists, pathologists, specialist nurses, speech therapists and dietitians before any treatment is recommended.
Reducing your risk of head and neck cancer
- stop smoking and avoid all forms of tobacco
- keep alcohol within recommended limits
- attend regular dental check-ups, even if you wear dentures or have no natural teeth
- take up the HPV vaccination if it is offered to you or your children
- check your own mouth and neck once a month in good light. There are a lot of videos available online showing you how best to do this
What this means for you
Most mouth ulcers, sore throats and neck lumps are entirely harmless. But head and neck cancer is highly treatable when caught early, and far harder to treat when it isn't — and the only thing standing between those two outcomes is usually how quickly someone gets checked.
If something in your mouth, throat or neck has been there for three weeks and isn't getting better, please have it looked at. It will most likely be nothing. And if it isn't, you will be very glad you went.
About the author
Mr Rafal (Raf) Niziol is a Consultant Oral and Maxillofacial and Head and Neck Surgeon at Cromwell Hospital and Guy's and St Thomas' NHS Foundation Trust, one of the UK's highest-volume head and neck cancer units. He specialises in head and neck cancer surgery and complex microsurgical reconstruction, performing over 100 major cases each year, alongside subspecialty interests in salivary gland surgery, microparotidectomy and nerve repair.
About our head and neck service
Cromwell Hospital's head and neck service offers rapid access to specialist assessment, with on-site imaging, ultrasound-guided biopsy and consultant-led multidisciplinary care from diagnosis through treatment and follow-up.
