Head and neck cancer

What is head and neck cancer?

Head and neck cancer is a general term to describe different cancers in this area. These cancers start in the tissues in the head and neck area. For example, in the:

mouth which includes the tongue, palate, gums and lips
throat (the pharynx) which is divided into the nasopharynx, oropharynx and hypopharynx
nose and sinuses (air-filled spaces in the bones of the face)
salivary glands which make saliva
middle ear which contains the ear drum.

Image: Cross-section of the head and neck

About 12,200 people are diagnosed with head and neck cancer in the UK every year. This includes cancer of the larynx (voicebox). In the UK, head and neck cancer is the 4th most common cancer in men.

We have separate information about cancer of the larynx.

To make sure you have the right information, it is important to know the type of head and neck cancer you have. If you are not sure, ask your cancer doctor or specialist nurse.

Other types of cancer can start in the head and neck area, but they are not head and neck cancers. We have separate information on these. They include cancers that start in the thyroid, oesophagus (gullet), windpipe (trachea) and brain.

Booklets and resources

Types of head and neck cancer

Head and neck cancers are named after where they start – the area of the head or neck, and the type of cell. The most common type of head and neck cancer is squamous cell carcinoma. About 9 out of 10 head and neck cancers (90%) start in squamous cells. Squamous cells line the surfaces inside the head and neck, such as the mouth, nose and throat.

The most common place for head and neck cancer to spread to is the lymph nodes in the neck. This may cause a swollen lymph node in the neck. Lymph nodes are part of the lymphatic system which helps protect us from infection and disease.

Mouth cancer (oral cancer)

Mouth cancer is one of the most common areas for head and neck cancer to start. It can start anywhere in the mouth, such as on the lip, inside the cheek, the gums, the front part of the tongue, or on the floor or roof of the mouth.
Tongue cancer

The tongue has 2 parts and cancer can develop in either of them. If cancer develops in the front part, which is the area you can see, it is usually called mouth cancer. We have more information about tongue cancer.

The back part is the base of the tongue close to the throat (pharynx). Cancer that develops in this part of the tongue is called oropharyngeal cancer.
Nasopharynx cancer

Nasopharyngeal cancer starts in the upper throat (pharynx) area behind the nose. This area is called the nasopharynx. The nasopharynx allows air to flow from the nose, through the rest of the throat and into the lungs. Often the first symptom of nasopharyngeal cancer is a painless swelling or lump in the upper neck.
Oropharyngeal cancer
Oropharyngeal cancers start in the middle pharynx, behind the mouth. This area is called the oropharynx. The oropharynx is a passageway for air and the food you swallow. It has muscles that help move food from the mouth to the gullet (oesophagus).

It includes the:

soft part of the roof of the mouth (soft palate)

the base or back of the tongue (the part you cannot see)

tonsils and the side walls of the throat.

Oropharyngeal cancers usually develop on the tonsils or the base of the tongue.
Hypopharyngeal cancer

These cancers start in the lower part of the pharynx, behind the voice box (larynx). This area is called the hypopharynx. It has muscles that move food into the gullet (oesophagus), which it connects to. Air passes along the hypopharynx into the airways to the lung. Cancer of the hypopharynx may be treated in the same way as laryngeal cancer.
Cancer of the larynx (voice box)

The larynx is the voice box. It is a short passageway in front of the hypopharynx. It contains the vocal cords. We have separate information about laryngeal cancer and its treatment.
Cancer of the nose and sinuses (paranasal sinuses)

The space inside the nose is called the nasal cavity. The bones around the nasal cavity have small hollow spaces called paranasal sinuses. These sinuses affect the sound and tone of your voice. The most common symptoms of nasal and sinus cancer include a blocked nose that does not go away (usually only on 1 side) and nosebleeds.
Cancer of the salivary glands

The salivary glands make saliva (spit). The biggest pairs of salivary glands are the parotid glands at the sides of the mouth, just in front of the ears. This is the most common place for salivary gland cancer to develop. Tumours that develop in the salivary glands can be non-cancerous (benign) but some are cancer.
Cancer of the middle ear

Rarely, cancer can develop in the middle ear. The middle ear is made up of the eardrum and a cavity called the tympanum. The tympanum contains 3 small bones, which connect the eardrum to the inner ear. It is also connected to the nasopharynx by the eustachian tube.

Related pages

What is cancer?

Symptoms of head and neck cancer

The symptoms depend on where the cancer started in the head or neck. With certain symptoms, you may see a specialist within 2 weeks (called an urgent referral).

Some of these symptoms include having:

an ulcer in the mouth for more than 3 weeks
red or white patches in the mouth.

Others are symptoms that do not go away, such as:

a lump in the neck, on the lip or inside the mouth
a sore tongue
a sore throat
hoarseness
problems swallowing.

We have more information about the signs and symptoms of head and neck cancer.

Related pages

Do I have cancer?

Causes of head and neck cancer

The main risk factors for head and neck cancer are tobacco and alcohol, especially when combined. Head and neck cancer is also much more common in men than in women.

Certain risk factors depend on the type of head and neck cancer you have. Many cancers of the oropharynx are linked to an infection with a virus called human papilloma virus (HPV) is linked to the Epstein-Barr virus.

We have more information about the causes and risk factors for head and neck cancers.

Diagnosis of head and neck cancer

If your GP or dentist think your symptoms could be linked to cancer, they will refer you to see a specialist doctor within 2 weeks. This is usually an oral and maxillofacial surgeon, or an ear, nose and throat (ENT) specialist surgeon.

Neck lump clinic

If your only symptom is a lump in your neck, you may be referred to a one-stop neck lump clinic. You can have all the tests needed to check for cancer in a neck lump. These may include:

an ultrasound neck scan
removing a sample of tissue from the lump (a biopsy)
nasendoscopy – a test that looks at the back of your mouth, nose and throat.

You may get the results of your tests on the same day, or 7 to 10 days later.

At the hospital

Your specialist doctor will ask you about your symptoms and examine your mouth, throat and neck. They may take blood tests, to check your general health. If you have an abnormal-looking area that can be seen and is easy to reach, they may remove a small piece of tissue or some cells from the area (biopsy). This is checked for cancer cells.

Your doctor and specialist nurse will explain the tests you need. You may have a test using a thin flexible tube with a light and camera on the end (endoscope). Different types of endoscope can be used to examine the mouth, nose, throat and sometimes the gullet (oesophagus) area.

Some people have a general anaesthetic so the doctor can examine the area more closely using a bigger endoscope. This is sometimes called a panendoscopy.

You may have a biopsy on its own or during some of these tests.

We have more information about tests for head and neck cancer.

Further tests for head and neck cancer

If tests show you have a head and neck cancer, your specialist will arrange further tests. These can help find out more about the size and position of the cancer and whether it has spread. This is called staging. These tests could include:

X-rays

You may have an x-ray of your face or neck to see if any bones are affected by the cancer, and to check your teeth. You may have a chest x-ray to check your general health and to see if there is anything abnormal in the lungs.
CT scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body.
MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body.
PET-CT scan

A PET-CT gives more detailed information about the part of the body being scanned.

Testing for viruses

If you have oropharyngeal cancer, tests are done on the cancer cells to check if it is linked to the human papilloma virus (HPV). The results help your doctor plan the most effective treatments for you. HPV-related head and neck cancers usually have a good outlook.

If you have nasopharyngeal cancer, the cancer cells are tested to see if it is linked to the Epstein-Barr virus (EBV).

Related pages

Staging and grading of head and neck cancer

The stage of a cancer describes its size and if it has spread from where it started.

Staging is slightly different for each type of head and neck cancer. Oropharyngeal cancer that are HPV-positive have a separate staging system.

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer may develop.

Knowing the stage and grade of head and neck cancer helps you and your doctors decide on the best treatment for you.

Treatment for head and neck cancer

Because head and neck cancer is not common, you are usually treated in a specialist head and neck unit. A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

They will also talk to you about preparing for treatment (sometimes called prehabilitation). This may include things like:

stopping smoking or drinking to make your treatment more effective
dental checks or dental treatment
dietary advice to improve your weight
certain exercises to reduce the risk of side effects.

We have more information about preparing for head and neck cancer treatment.

The aim of treatment is to remove or destroy the cancer and reduce the risk of it coming back. Your treatment depends on:

where the cancer is
the type and stage of the cancer
the best way to maintain appearance, speech and swallowing
your general health
your preferences.

Your doctor and nurse will explain the benefits and disadvantages of different treatments. They will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment. You and your doctor can decide together on the best treatment for you.

Doctors plan your treatment so the effect on your appearance, speech, swallowing and eating is as little as possible. If treatment is likely to affect any of these, your doctor and nurse will talk to you about this. They will explain how long this is likely to last and how they can support you. You may see different specialists such as a dentist, speech or language therapist (SLT), or dietitian during treatment.

Treatment for head and neck cancers may include:

Surgery

Surgery is one of the main treatments for cancers of the head and neck. Small cancers may be treated with a simple operation or laser surgery. If the cancer is bigger, the surgeon may also remove the lymph nodes in the neck. Some people might need reconstructive surgery. This is when the surgeon takes tissue from another part of the body to replace tissue taken from the head and neck.
Chemoradiation

Chemoradiation is when you have chemotherapy and radiotherapy together. It is often the main treatment for locally advanced head and neck cancer. The chemotherapy helps the radiotherapy to work better. It can also be given after surgery. Chemoradiation can cause severe side effects so it may not be suitable for everyone.
Radiotherapy

Radiotherapy can be used on its own to treat small cancers or cancers in harder-to-reach areas. But is often given in combination with chemotherapy (called chemoradiation).
Chemotherapy

You may have chemotherapy on its own before radiotherapy or surgery to shrink the cancer and make treatment work better. It is often given in combination with radiotherapy (chemoradiation). Sometimes chemotherapy can be used to control the symptoms of the cancer.
Targeted therapies and immunotherapies

The targeted therapy drug cetuximab is sometimes used if chemoradiation is not suitable for you.

Pembrolizumab and nivolumab are immunotherapy drugs that may sometimes be used if the cancer is advanced or comes back.

Your treatment depends on the stage of the cancer.

Treating early-stage cancer

Small cancers that have not spread can usually be treated with surgery. If the operation causes any small changes to speech, chewing or swallowing, you can usually adapt to these quickly.

Your doctors may suggest radiotherapy instead of surgery if the cancer is in a difficult-to-reach area. Or, if surgery may cause major changes to appearance, speech or swallowing.
Treating locally advanced cancer

If the cancer is bigger, or has spread to lymph nodes in the neck, you usually need more than one type of treatment. Chemotherapy and radiotherapy are often used together (called chemoradiation). This may be your main treatment.

If you have surgery to remove the cancer you may also have the lymph nodes in the neck removed. Some people may need reconstructive surgery. The aim is to cause as little change as possible to appearance and how things like swallowing or speech.

After surgery some people have chemoradiation or radiotherapy to treat any remaining cancer cells. Chemotherapy on its own may also be used to shrink a cancer before radiotherapy or surgery. It can also be used to try to control the cancer and improve symptoms.

A targeted therapy drug called cetuximab is sometimes given with radiotherapy if you cannot have chemoradiation. Sometimes immunotherapy drugs may be given on their own. This is usually if the cancer is advanced, or if it comes back after treatment.
Treatment to control the cancer

If the cancer cannot be cured, you may be given treatment to control the cancer for as long as possible, and to manage the symptoms. You will usually have chemotherapy, or targeted therapy or immunotherapy.
Your doctor and specialist nurse will help to make sure your symptoms are controlled. This is called supportive or palliative care. You may see a specialist palliative care doctor or nurse for expert help with your symptoms.

You may have some treatments as part of a clinical trial.

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After head and neck cancer treatment

After your treatment, you will have regular follow-up appointments for several years. Your specialist will regularly examine your head and neck. This is the most important part of your follow-up. You may sometimes have scans.

It can take several months for the side effects of the treatment to improve. Always tell your specialist about:

ongoing side effects or symptoms that are not improving
any new symptoms that do not get better within 2 weeks.

Your nurse can tell you what to look out for after treatment. For example, this might be a new ulcer or a lump in your neck, pain, or difficulty swallowing or speaking. Contact your doctor or nurse as soon as possible if you notice any symptoms or side effects. You do not need to wait until your next appointment.

Late effects

Treatment side effects may affect how you eat and drink, or your speech. These changes may return to normal, or near normal, as the area recovers from surgery or radiotherapy. Your speech and language therapist (SLT) and dietitian will assess you. They help you learn to cope with any changes.

Late effects are side effects that do not improve, or that develop years after treatment has finished. Your doctor or nurse will explain any likely late effects of your treatment. Not everyone gets late effects. It depends on the treatment you had.

We have more information about managing late effects of head and neck cancer treatments.

Sex life

Head and neck cancer and its treatment can sometimes have an effect on your sex life.

If you are worried about this, talk to your doctor or nurse. You can read about things that may help in our information on cancer and sex.

Fertility

Some cancer treatments can also affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

We have more information about:

Body image

If treatment has changed your appearance, voice or how you eat and drink it can also affect your body image. Talk to your nurse if this is a concern for you. There are different things that can help to improve body image changes. There are also organisations below that can help to support you.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes during and after treatment. For example, if you smoke or drink alcohol, it is best to avoid smoking or reduce the amount of alcohol.

Eating well and keeping active can improve your health and well-being. It can also help your body recover. Your dietitian can help with any difficulties you might have with eating after treatment.

Getting support

It may take several months to recover from treatment. It can be hard if treatment has changed your appearance, how you eat or drink, or your voice. This may also affect your body image but there are ways to help you to manage any changes.

You may still be coping with difficult feelings. Talking to your family and friends or health professionals about how you feel can help them know how to support your well-being.

There are also national support groups that you may find helpful:

The Mouth Cancer Foundation
The Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
Changing Faces
Changing Faces offers advice and information to anyone who is affected by a change in their appearance.
The Swallows Head and Neck Cancer Support Group
The Swallows offers a 24-hour support line to anyone affected by head and neck cancer.
Salivary Gland Cancer UK
Salivary Gland Cancer UK supports people with rare salivary gland cancers, such as adenoid cystic carcinoma, ACC, and unknown carcinoma.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our head and neck cancer forum to connect with people who have been affected by head and neck cancer, share your experience, and ask questions.

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Finishing cancer treatment

About our information

References

Below is a sample of the sources used in our head and neck cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Machiels J.-P, Leemans C. R. et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx. EHNS- ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020. Volume 31, Issue 11, Pages 1462-1475.

National Institute for Health and Care Excellence (NICE). Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. NICE guideline NG36 2016 (updated 2018).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.