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Health condition · Clinically reviewed

Head and neck cancer, a family of diseases with modern, MDT-led treatment.

Around 12,000 people in the UK are diagnosed each year. Smoking, alcohol and HPV shape the picture - and early, specialist care changes outcomes.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG12, NCCN and the British Association of Head and Neck Oncologists sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including HPV-driven oropharyngeal disease, transoral robotic surgery and adjuvant pembrolizumab.

Key facts

Head and neck cancer at a glance.

The essentials, in plain English - what it covers, the main drivers and how UK teams treat it today.

  • What it is

    A family of cancers arising in the mouth, throat, voice box, sinuses, salivary glands and related structures - around 12,000 UK cases each year.

  • Main types

    Oral cavity, oropharyngeal, hypopharyngeal, laryngeal, nasopharyngeal, sinonasal, salivary gland, thyroid, cutaneous and unknown-primary neck node disease.

  • Biggest drivers

    Smoking plus alcohol act synergistically; HPV drives most new oropharyngeal cancers in the UK; EBV drives nasopharyngeal disease.

  • HPV shift

    HPV-positive oropharyngeal cancer is now the commonest new head and neck cancer in UK adults and carries a much better prognosis.

  • How it is treated

    Surgery, radiotherapy and chemotherapy - alone or in combination - with a growing role for immunotherapy and targeted agents.

  • MDT-led

    All cases are discussed at a specialist commissioned head and neck cancer MDT before a treatment plan is finalised.

Types

One family, many distinct diseases.

"Head and neck cancer" is an umbrella - each subtype has its own biology, risk factors, red flags and treatment ladder.

  • Oral cavity

    Lip, tongue, floor of mouth, hard palate, buccal mucosa and retromolar trigone - strongly linked to smoking, alcohol and betel use. See our floor of mouth cancer guide.

  • Oropharyngeal

    Tonsil, base of tongue and soft palate - now dominated by HPV-driven disease in the UK, with better prognosis and confirmation by p16 immunohistochemistry.

  • Hypopharyngeal

    Piriform sinus, postcricoid area and posterior pharyngeal wall - often presents late with dysphagia and neck nodes; historically the poorest prognosis in the group.

  • Laryngeal

    Glottic, supraglottic and subglottic tumours - strongly linked to smoking, presenting with persistent hoarseness or airway symptoms.

  • Nasopharyngeal

    Epstein-Barr virus associated, more common in patients of Southeast Asian heritage - often diagnosed via a neck node and needs specialist chemo-radiotherapy.

  • Nasal and paranasal

    Sinonasal tumours linked to occupational wood dust and nickel exposure - unilateral nasal blockage or bloody discharge is the classic red flag.

  • Salivary gland

    Parotid gland accounts for the majority - a mix of benign and malignant tumours needing specialist head and neck surgery and pathology.

  • Thyroid

    A distinct disease with its own guidance and generally excellent prognosis - see our related guide on goitre and thyroid nodules.

  • Cutaneous, esthesio and unknown primary

    Skin cancers of the head and neck, rare olfactory-nerve esthesioneuroblastoma, and metastatic neck nodes without an obvious primary - each has its own pathway.

How the diagnosis is made

From first symptom to a clear MDT plan.

The steps a UK head and neck team will normally follow, in order - so you know what to expect and why each step matters.

  1. 01

    Assessing

    History and 2WW referral

    A persistent mouth ulcer, unexplained neck lump, hoarseness beyond three weeks or referred ear pain triggers a NICE NG12 two-week-wait pathway.

  2. 02

    Assessing

    Flexible nasoendoscopy

    A clinic-based look at the nose, pharynx and larynx to find the primary tumour or reassuringly exclude one.

  3. 03

    Assessing

    Targeted biopsy

    Tissue from the primary or a suspicious neck node - reviewed by a specialist head and neck pathologist with HPV p16 testing where relevant.

  4. 04

    Confirming

    Cross-sectional imaging

    CT of neck and chest, MRI for oral cavity and oropharyngeal detail, and PET-CT where staging or unknown primary work-up is needed.

  5. 05

    Confirming

    Molecular profiling

    HPV p16, EGFR and PD-L1 testing where the treatment decision depends on it - specialist molecular profiling in selected cases.

  6. 06

    Preparing

    Dental clearance

    Restorative dental review before radiotherapy to reduce the risk of osteoradionecrosis and post-treatment dental problems.

  7. 07

    Preparing

    Specialist MDT decision

    A specialist commissioned head and neck cancer MDT agrees the plan - surgery, chemo-radiotherapy, immunotherapy or a combination.

Typical timeline: 2WW referral to MDT plan within a few weeks under NHS and private pathways.

Symptoms

What head and neck cancer can look like.

The features that should trigger a two-week-wait referral under NICE NG12 - and the ones that need urgent same-day review.

  • Persistent mouth ulcer

    Any ulcer or sore area in the mouth lasting more than three weeks warrants urgent review, especially in smokers or drinkers.

  • Red or white patches

    Leukoplakia and erythroplakia can be premalignant - a specialist should look, and often biopsy, before assuming they are benign.

  • Unexplained neck lump

    A firm, painless lump in the neck lasting more than three weeks - especially in the upper neck - needs urgent head and neck assessment.

  • Persistent hoarseness

    A hoarse voice beyond three weeks, particularly in a smoker over 45, is a 2WW indication to exclude laryngeal cancer.

  • Swallowing difficulty

    Progressive dysphagia, painful swallowing or a sensation of food sticking needs prompt investigation for a pharyngeal or oesophageal cause.

  • Referred ear pain

    Otalgia with a normal ear examination can reflect a tumour of the tongue base, tonsil or hypopharynx - not just an ear problem.

  • Nasal and sinus signs

    Unilateral nasal blockage, bloody discharge, facial numbness or a mass in the nose or sinus can point to sinonasal disease.

  • Red flag - rapid neck node growth

    A rapidly enlarging, hard neck node in an adult is a nodal metastasis until proven otherwise and needs same-week head and neck review.

Treatment

How head and neck cancer is treated in the UK.

Surgery, radiotherapy and chemotherapy remain the backbone - with immunotherapy, targeted agents and reconstruction shaping modern practice.

  • Transoral robotic surgery

    Minimally invasive removal of selected oropharyngeal and supraglottic tumours - preserves speech and swallow function in suitable early disease.

  • Open head and neck surgery

    Resection with neck dissection where robotic or endoscopic approaches are not appropriate - often combined with reconstructive flap surgery.

  • Definitive chemo-radiotherapy

    Cisplatin with concurrent radiotherapy for locally advanced disease, especially in the larynx and pharynx where organ preservation matters.

  • Adjuvant chemo-radiotherapy

    Post-operative chemo-radiotherapy where pathology shows involved margins or extranodal extension - reduces the risk of recurrence.

  • Pembrolizumab

    Anti-PD-1 immunotherapy - first-line in recurrent or metastatic disease per KEYNOTE-048, and now adjuvant per KEYNOTE-689 (approved 2024).

  • Nivolumab

    A further anti-PD-1 option in platinum-refractory recurrent or metastatic disease, delivered in a specialist commissioned setting.

  • Cetuximab

    An anti-EGFR monoclonal antibody used selectively with radiotherapy in patients who cannot tolerate cisplatin.

  • Reconstructive flap surgery

    Radial forearm, anterolateral thigh or fibula free flaps to rebuild the tongue, jaw or pharynx after tumour resection.

Supportive and preventive care

Speech and language therapy, swallow rehabilitation, PEG feeding when needed, dental rehabilitation, lymphoedema management, HPV vaccination, and structured smoking and alcohol support all sit alongside cancer-directed treatment. Charities such as the Mouth Cancer Foundation and Macmillan add practical and emotional support.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or head and neck team knows your history and can tell you which parts of this apply to you. If in doubt, get seen.

  • NICE. Suspected cancer: recognition and referral (NG12) - head and neck section.

  • NICE. Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over (NG36).

  • NCCN. Head and Neck Cancers - clinical practice guidelines in oncology.

  • British Association of Head and Neck Oncologists (BAHNO). National standards and audit data.

  • MHRA and NHS England commissioning policy. Pembrolizumab (KEYNOTE-048, KEYNOTE-689) and nivolumab in head and neck cancer.

Red flags

When head and neck cancer needs urgent attention.

Most symptoms are managed through outpatient pathways. These are the situations that need same-day, in-person specialist care.

  • Airway compromise

    Stridor, worsening breathlessness or difficulty lying flat with a known or suspected head and neck cancer is an airway emergency - call 999.

  • Massive bleeding

    Sudden bleeding from the mouth, throat or a neck wound after radiotherapy or surgery can indicate a carotid blowout - emergency transfer needed.

  • Rapidly enlarging neck mass

    A hard, fixed or rapidly growing neck lump in an adult is metastatic disease until proven otherwise - same-week head and neck review.

  • New cranial nerve palsy

    Facial weakness, tongue deviation, hoarseness or double vision alongside a head and neck cancer suggests nerve invasion or skull-base disease.

  • Severe unremitting head or facial pain

    Persistent pain waking a patient at night, particularly with numbness, needs urgent imaging to exclude perineural or skull-base spread.

  • Osteoradionecrosis

    Exposed bone in the mouth after radiotherapy, especially the mandible, needs specialist restorative and oral surgery input.

  • Aspiration and swallow failure

    Coughing on every meal, weight loss and recurrent chest infections signal an unsafe swallow - urgent speech and language and nutrition review.

  • Suicidal thoughts or severe distress

    Head and neck cancer carries a high psychological burden - low mood, hopelessness or suicidal thoughts need urgent mental-health support.

  • Second primary cancer

    Patients with one head and neck cancer are at real risk of a second - any new mouth, throat or lung symptom deserves prompt review.

Living with it

A demanding disease, with real support around it.

Nutrition, speech and swallow rehab, smoking and alcohol change, and structured follow-up are the four pillars of living well after diagnosis.

A quiet reminder

Recovery is a team effort - and it works.

With the right MDT around you, most people return to eating, speaking and living well. Ask for the support you need early.

  1. 01 Nutrition

    Protect eating and weight

    Early dietetic input, texture-modified diets and, where needed, a PEG tube protect nutrition through and after treatment.

  2. 02 Voice

    Speech and swallow rehab

    Specialist SLT support - before, during and after treatment - preserves speech, swallow safety and quality of life.

  3. 03 Prevention

    Stop smoking, cut alcohol

    Continued smoking or drinking worsens outcomes and drives second cancers - free NHS support genuinely helps.

  4. 04 Follow-up

    Structured surveillance

    Regular clinical review, endoscopy and imaging pick up recurrence and second primaries early, when they are still treatable.

Frequently asked

Everything we get asked about head and neck cancer.

Quick answers on HPV, diagnosis, immunotherapy and how to reduce your risk.

  • What is head and neck cancer?

    A family of cancers arising in the mouth, throat, voice box, sinuses, salivary glands and related structures. Around 12,000 people in the UK are diagnosed each year, with smoking, alcohol, HPV and EBV as the main drivers.

  • How is HPV changing head and neck cancer?

    HPV-driven oropharyngeal cancer - typically involving the tonsil or base of tongue - is now the commonest new head and neck cancer in UK adults. It responds better to treatment, is confirmed by p16 immunohistochemistry, and is a strong argument for HPV vaccination in boys and girls.

  • What is a two-week-wait referral for head and neck cancer?

    A NICE NG12 pathway for symptoms suspicious of cancer. Triggers include a persistent mouth ulcer beyond three weeks, red or white oral patches, an unexplained neck lump, persistent hoarseness in an older smoker, unexplained swallowing difficulty and referred ear pain with a normal ear exam.

  • How is head and neck cancer diagnosed?

    Assessment usually starts with flexible nasoendoscopy in clinic, followed by a targeted biopsy and specialist head and neck pathology - including HPV p16 where relevant. Staging uses CT of the neck and chest, MRI for detail and PET-CT in selected cases, with dental clearance before any planned radiotherapy.

  • Where does immunotherapy fit in?

    Pembrolizumab, an anti-PD-1 antibody, is first-line for recurrent or metastatic disease based on KEYNOTE-048 and, following KEYNOTE-689 (approved 2024), is now used as adjuvant treatment in selected locally advanced cases. Nivolumab is a further option in platinum-refractory recurrent or metastatic disease.

  • What can I do to reduce my risk?

    The biggest wins are stopping smoking, cutting alcohol - which acts synergistically with tobacco - avoiding betel or paan use, protecting the lips from sun, and taking up HPV vaccination where eligible. Dental checks matter too, because many oral cancers are picked up early at routine appointments.

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