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Health condition · Clinically reviewed

Head and neck cancers, from the 2-week-wait pathway to modern robotic surgery.

One umbrella term, many subsites. The good news: modern imaging, HPV testing and multimodal treatment mean most patients are treated with cure in mind.

Jump to treatment

Also see our companion page: head and neck cancer (singular) for the same clinical detail in a single-topic layout.

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 UK head and neck oncology clinician before publication.

  • 02

    Aligned with UK pathways

    Checked against NICE, NHS 2-week-wait guidance, BAHNO, RCR and peer-reviewed sources listed in full.

  • 03

    Current for 2026

    Covers modern practice including HPV-driven oropharyngeal disease, TORS, chemo-radiotherapy and immunotherapy.

Key facts

Head and neck cancers at a glance.

The essentials, in plain English: what the umbrella term covers, why HPV matters, how the NHS pathway works and what treatment looks like today.

  • What it covers

    An umbrella term for cancers of the oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, nose, sinuses and salivary glands.

  • Common subsites

    Tongue, tonsil, larynx and oropharynx account for the bulk of new UK diagnoses each year.

  • HPV-driven disease

    A rising share of oropharyngeal cancers are HPV-positive, tend to affect younger non-smokers and respond well to treatment.

  • 2-week-wait pathway

    Persistent neck lump, hoarseness beyond 3 weeks, non-healing mouth ulcer or unexplained oral pain triggers urgent referral.

  • Curative treatment

    Surgery (including transoral robotic surgery), radiotherapy and concurrent chemo-radiotherapy - often used in combination.

  • Recurrent or metastatic

    Immunotherapy with pembrolizumab, platinum-based chemotherapy and targeted agents such as cetuximab where appropriate.

Why this guide matters

One family of cancers, many stories.

Where the tumour starts shapes almost everything - the pathway, the operation, the radiotherapy field and the follow-up. The three points below run through the rest of this page.

  • Subsite is everything

    A tonsil cancer, a laryngeal cancer and a parotid cancer share the same postcode but behave very differently - the plan is built around the exact site.

  • HPV changes the calculation

    HPV-positive oropharyngeal disease is a distinct entity - younger patients, better prognosis, evolving evidence for de-escalated treatment.

  • Multimodality is normal

    Surgery, radiotherapy and systemic therapy are combined, not chosen between - decisions are made by a full MDT in the light of function and cure.

How the diagnosis is made

From first symptom to an MDT plan.

The steps a UK ENT or head and neck team will normally follow, in order, so you know what to expect from referral to treatment start.

  1. 01

    Assessing

    Symptom review and risk profile

    A structured history of neck lumps, voice change, swallowing, oral ulcers and risk factors including tobacco, alcohol and HPV exposure.

  2. 02

    Assessing

    Head and neck examination

    Full ENT examination with flexible nasoendoscopy to view the nasopharynx, larynx and hypopharynx that a torch cannot reach.

  3. 03

    Assessing

    Ultrasound-guided neck biopsy

    Ultrasound of suspicious lymph nodes with fine-needle or core biopsy for a rapid tissue diagnosis.

  4. 04

    Confirming

    HPV and p16 testing

    Oropharyngeal specimens are tested for p16 immunohistochemistry and HPV - a decisive factor in prognosis and staging.

  5. 05

    Confirming

    Cross-sectional imaging

    CT of the neck and chest, MRI for soft-tissue and perineural detail, and PET-CT where distant disease or unknown primary is suspected.

  6. 06

    Planning

    Panendoscopy and biopsy under GA

    Examination of the upper aerodigestive tract under anaesthetic to map extent and take definitive biopsies.

  7. 07

    Planning

    Multidisciplinary team decision

    A head and neck MDT of surgeons, oncologists, radiologists, pathologists and specialist nurses agrees the treatment plan with you.

Typical timeline: 2-week-wait clinic to first treatment in around 4 to 6 weeks.

Symptoms

What to watch for.

Symptoms depend on the subsite - lumps, voice, swallowing, breathing, hearing or nasal function. Anything persisting beyond three weeks deserves a look.

  • Persistent neck lump

    A firm, painless node in the neck for more than three weeks is the single most common presentation.

  • Hoarse voice

    Voice change lasting beyond three weeks - particularly in smokers or ex-smokers - warrants urgent laryngoscopy.

  • Non-healing mouth ulcer

    An oral ulcer that has not settled at three weeks, especially on the tongue or floor of mouth, is a red flag.

  • Sore throat and referred earache

    One-sided sore throat with ipsilateral otalgia can signal oropharyngeal or tonsillar disease.

  • Swallowing difficulty

    Progressive dysphagia or the sensation of food catching needs prompt ENT assessment.

  • Nasal obstruction and epistaxis

    Unilateral nasal blockage or recurrent nose bleeds may reflect sinonasal or nasopharyngeal disease.

  • Salivary gland swelling

    A firm parotid or submandibular lump - especially with facial weakness - deserves urgent imaging.

  • Red flag - cranial nerve deficit

    Any new facial weakness, tongue deviation or hoarseness with a neck mass points to advanced disease and needs same-week review.

Treatment

How head and neck cancers are treated in the UK.

The right mix of surgery, radiotherapy, chemotherapy and immunotherapy depends on the subsite, the stage, HPV status and how the patient wants to prioritise cure and function.

  • Transoral robotic surgery (TORS)

    Minimally invasive removal of oropharyngeal tumours through the mouth - well suited to selected HPV-positive tonsil and tongue-base cancers.

  • Open resection and neck dissection

    Traditional surgical approach for larger tumours or when comprehensive nodal clearance is required.

  • Radical radiotherapy

    Intensity-modulated radiotherapy (IMRT) preserves function and is often curative for early laryngeal and oropharyngeal disease.

  • Concurrent chemo-radiotherapy

    Cisplatin combined with radiotherapy for locally advanced disease - the standard of care for many stage III and IV tumours.

  • Cetuximab bio-radiotherapy

    For patients unfit for cisplatin, the EGFR-targeting antibody cetuximab can be combined with radiotherapy.

  • Immunotherapy (pembrolizumab)

    Anti-PD-1 therapy - alone or with chemotherapy - for recurrent or metastatic disease expressing PD-L1.

  • Reconstructive and free-flap surgery

    Microvascular flaps restore speech, swallowing and appearance after larger resections.

  • Rehabilitation and supportive care

    Speech and language therapy, dietetics, dental prosthetics and lymphoedema care are woven through every stage.

Prevention worth mentioning

HPV vaccination is now the single biggest preventive lever.

The UK schools programme offers HPV vaccination to all children in Year 8, and catch-up is available up to age 25. Along with stopping smoking and moderating alcohol, vaccination is expected to reduce future oropharyngeal cancer incidence substantially. See our HPV vaccination clinic guide.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and cancer registry data, 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 ENT surgeon, oncologist or head and neck clinical nurse specialist knows your case and can tell you which parts apply. If in doubt, get seen.

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

  • NICE. Suspected cancer: recognition and referral (NG12).

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

  • Royal College of Radiologists. Radiotherapy dose fractionation - head and neck.

  • Cancer Research UK. Head and neck cancers incidence and survival statistics.

Red flags

When head and neck symptoms need urgent attention.

Most of what walks into an ENT clinic is benign - but a small number of situations need same-day or same-week specialist review. Here are the ones we don't ever want missed.

  • Airway compromise

    Stridor, drooling or a rapidly enlarging neck mass with breathing difficulty is an emergency - dial 999 or attend A&E.

  • Massive haemorrhage

    Bleeding from a tumour, particularly after radiotherapy, may signal a carotid blowout and needs immediate hospital care.

  • New cranial nerve palsy

    Facial droop, tongue weakness or hoarseness with a neck mass suggests nerve involvement and needs urgent imaging.

  • Unilateral hearing loss with nasal symptoms

    Middle-ear fluid on one side with nasal blockage can be the first clue to a nasopharyngeal cancer - refer for endoscopy.

  • Weight loss and swallowing decline

    Rapid weight loss with worsening dysphagia demands prompt oncology and dietetic review.

  • Post-treatment neck swelling

    A new lump in a treated neck field needs urgent imaging - recurrence is easier to salvage when caught early.

  • Bone pain or breathlessness

    New skeletal pain or breathlessness in a treated patient may indicate distant metastasis and needs staging scans.

  • Osteoradionecrosis risk

    Exposed bone or non-healing dental sockets after radiotherapy needs specialist oral and maxillofacial input.

  • Severe treatment-related dysphagia

    Persistent aspiration or inability to swallow safely warrants urgent speech and language and gastrostomy review.

Living with it

A treatable diagnosis, with life on the other side.

Four things that make the biggest difference across the treatment year - your team, your nutrition, your risk drivers, and steady follow-up.

A quiet reminder

The MDT is on your side.

You are not choosing between surgery and radiotherapy alone - the plan is designed by a team of surgeons, oncologists, radiologists, pathologists and specialist nurses who meet weekly.

  1. 01 Team

    Lean on the MDT

    Speech and language therapists, dietitians, dental hygienists and clinical nurse specialists are as important as the surgeon or oncologist.

  2. 02 Nutrition

    Protect swallowing early

    Prehabilitation exercises before radiotherapy, plus dietetic input, reduce long-term swallowing problems.

  3. 03 Prevention

    Address the drivers

    Stopping smoking, moderating alcohol and completing HPV vaccination for eligible family members reduces future risk.

  4. 04 Follow-up

    Stick with surveillance

    Structured five-year follow-up catches recurrence and second primaries when they are still curable.

Frequently asked

Everything we get asked about head and neck cancers.

Quick answers on the 2-week-wait pathway, HPV, robotic surgery, chemo-radiotherapy and immunotherapy.

  • What are head and neck cancers?

    A family of cancers arising in the mouth, oropharynx, larynx, hypopharynx, nasopharynx, nasal cavity, sinuses and salivary glands. Most are squamous cell carcinomas of the mucosa, but salivary and sinonasal cancers include several rarer histologies. You can read our sister guide at /conditions/head-and-neck-cancer/ for the same clinical detail in a single-topic layout.

  • How is HPV changing the picture?

    HPV, and specifically HPV-16, drives a growing share of oropharyngeal cancers - typically tonsil and tongue base. HPV-positive disease usually affects younger, non-smoking adults and has a substantially better prognosis than HPV-negative disease. Testing for p16 and HPV is now standard for oropharyngeal biopsies and shapes staging and treatment choice.

  • What is the 2-week-wait pathway?

    The NHS urgent suspected cancer referral. Your GP can refer you if you have a neck lump for more than three weeks, hoarseness beyond three weeks, a non-healing mouth ulcer, unexplained oral swelling, red or white patches, or persistent one-sided throat pain with earache. You should be seen by a head and neck specialist within 14 days.

  • When is transoral robotic surgery used?

    TORS suits selected early-stage oropharyngeal cancers - especially HPV-positive tonsil and tongue-base tumours - where the tumour can be reached through the mouth. It can reduce reliance on radiotherapy and preserves swallowing and voice better than open approaches for the right patients.

  • What does chemo-radiotherapy involve?

    Six to seven weeks of daily intensity-modulated radiotherapy (IMRT) with two or three cycles of cisplatin. It is curative for many locally advanced tumours. Side effects include mucositis, taste and swallowing changes, dry mouth and skin reactions - all managed by the MDT with dietetic, dental and speech therapy support.

  • Can immunotherapy help?

    Yes - pembrolizumab is licensed for recurrent or metastatic head and neck squamous cell carcinoma, either as monotherapy (in PD-L1 CPS ≥1 tumours) or combined with platinum and 5-FU chemotherapy. Trials continue to explore its role earlier in the treatment pathway and after surgery.

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