Head and neck cancer is classified by the specific site where it begins:

Overview

• Head and neck cancer is a group of cancers that develop in the tissues and organs of the head and neck region
• It includes the mouth (lips, tongue, gums, inner cheeks, floor and roof of the mouth), throat (pharynx, the food pipe and windpipe), voice box (larynx), salivary glands and the nasal cavity and sinuses

Main types

Head and neck cancer is classified by the specific site where it begins:

• Oral cavity cancer: Cancer of the lips, tongue, gums, inner cheeks, floor of mouth and hard palate (roof of mouth); most common type in India
• Oropharyngeal cancer: Cancer of the middle part of the throat, including the soft palate, base of tongue and tonsils
• Laryngeal cancer: Cancer of the voice box (larynx), the structure in the throat responsible for producing the voice
• Nasopharyngeal cancer: Cancer of the upper part of the throat behind the nose
• Hypopharyngeal cancer: Cancer of the lower part of the throat, just above the oesophagus (food pipe)
• Salivary gland cancer: A less common type arising in the glands that produce saliva

How common is head and neck cancer?

• Head and neck cancer ranked as the 6th most common cancer worldwide in 2022, with approximately 946,000 new cases diagnosed globally
• Among all types, oral cavity cancer making up the largest share (42% of these)
• India accounts for approximately one-third of all oral cancer cases in the world, with oral cancer representing around 30% of all cancers diagnosed in India
• Tobacco use (smoked and smokeless) is responsible for up to 80% of all cases in India

Causes

• Tobacco use: The single most important risk factor; all forms increase risk: cigarettes, bidis, cigars, pipes and smokeless tobacco (khaini, gutka, betel quid with tobacco); smokeless tobacco is particularly associated with oral cavity cancers and is a major driver of India's high burden
• Alcohol consumption: Increases risk for oral cavity, oropharyngeal, laryngeal and hypopharyngeal cancers; when combined with smoking, the risk is 40 times greater
• Paan and supari: Can cause cancer even without tobacco addition
• Human Papillomavirus (HPV) infection and Epstein-Barr virus (EBV): Both are linked to throat cancer
• Age over 50 and male sex: Both are the risk factors
• Weakened immune system: Increases the risk of HPV-related head and neck cancers
• Poor oral hygiene and ill-fitting dentures: Prolonged irritation of the mouth lining can increase cancer risk over time
• Poor diet low in fruits and vegetables and high intake of processed foods
• Prolonged exposure to wood dust, paint fumes or certain industrial chemicals
• Excessive sun exposure may also cause cancer

Common symptoms

• Many early symptoms are vague and can be mistaken for common conditions such as a sore throat, dental problem or a persistent cold
• Any symptom in this region that does not resolve within three weeks should be assessed by a doctor:A mouth ulcer or sore patch (red or white) that does not heal after three weeksA persistent lump or swelling in the mouth, neck or throatDifficulty or pain when swallowing (dysphagia)A persistent sore throat or hoarse voice lasting more than three weeksPersistent blocked or bleeding nose or unusual discharge from the noseNumbness or pain in the face, mouth or neckUnexplained loosening of teeth or poorly fitting denturesBlood in saliva or phlegmUnexplained weight loss, loss of appetite, or persistent tirednessEarache on one side that persists, particularly if associated with a sore throatRapidly enlarging or painless lump in the neck Severe difficulty swallowing or breathingSudden change or complete loss of voice (hoarseness)Significant unintentional weight loss over a short period
• A mouth ulcer or sore patch (red or white) that does not heal after three weeks
• A persistent lump or swelling in the mouth, neck or throat
• Difficulty or pain when swallowing (dysphagia)
• A persistent sore throat or hoarse voice lasting more than three weeks
• Persistent blocked or bleeding nose or unusual discharge from the nose
• Numbness or pain in the face, mouth or neck
• Unexplained loosening of teeth or poorly fitting dentures
• Blood in saliva or phlegm
• Unexplained weight loss, loss of appetite, or persistent tiredness
• Earache on one side that persists, particularly if associated with a sore throat
• Rapidly enlarging or painless lump in the neck
• Severe difficulty swallowing or breathing
• Sudden change or complete loss of voice (hoarseness)
• Significant unintentional weight loss over a short period

Diagnosis and investigations

• Clinical examination: Careful examination of the mouth, throat and neck, looking for any abnormal areas, ulcers or swellings; enlarged lymph nodes in the neck
• Endoscopy: A thin, flexible tube with a camera (endoscope) is passed through the nose or mouth to visualise the throat, voice box, nasopharynx or other areas not visible directly
• Panendoscopy: A thorough endoscopic examination performed under general anaesthetic, allowing the surgeon to inspect the entire upper airway and digestive tract
• Biopsy: A small tissue sample is taken from any suspicious area and examined under a microscope by a pathologist
• CT scan: Imaging test used to assess tumour size, depth of invasion and spread to lymph nodes or other organs
• MRI scan: Detailed images of soft tissues, particularly useful for assessing the extent of tumours in the tongue, throat and salivary glands, where precise detail of soft tissue involvement is important
• PET-CT scan: A specialised combined scan that detects areas of high metabolic activity; useful for identifying spread to lymph nodes and distant organs, locating an unknown primary cancer and monitoring response to treatment
• Fine needle aspiration cytology (FNAC): A thin needle is used to sample cells from a lump in the neck, guided by ultrasound

Understanding staging

After all tests are complete, the cancer is assigned a stage (I to IV) describing its size and how far it has spread.

• Stage I and II represent smaller, more localised cancers
• Stage III and IV indicate larger tumours or spread to lymph nodes

Treatment options

Surgery

• The primary treatment for many early-stage head and neck cancers, particularly those of the oral cavity
• Involves removal of the tumour along with a margin of healthy tissue around it and often nearby lymph nodes in the neck (neck dissection)

Radiotherapy

• High-energy X-ray beams targeted precisely at the tumour; used for pharyngeal and laryngeal cancers or after surgery to destroy any remaining cancer cells
• A course of radiotherapy is usually given daily (Monday to Friday) over 5–7 weeks as an outpatient

Chemotherapy

• Often given alongside radiotherapy (chemoradiation) to make cancer cells more sensitive to radiation, particularly for locally advanced disease
• Chemotherapy may also be given before other treatment (induction chemotherapy) to shrink a large tumour

Targeted therapy

• Targeted drug given alongside radiotherapy when chemotherapy is not suitable; it works by blocking a protein (EGFR — epidermal growth factor receptor) of cancer cells that drives their growth

Immunotherapy

• Immunotherapy drugs that help the immune system identify and attack cancer cells; used for recurrent or metastatic (spread) head and neck cancers that have progressed after chemotherapy

Lifestyle and prevention

Recommended diet

• A diet rich in fresh fruits and vegetables, which contain protective antioxidants
• Whole grains, pulses and lean proteins (fish, eggs, legumes)
• Stay hydrated and avoid processed foods

Exercise

• Regular moderate physical activity supports overall health, helps manage fatigue and aids recovery

Long-term care

• Attend all follow-up appointments
• Stop all tobacco use immediately
• Stop or significantly reduce alcohol consumption
• Speech and language therapy, swallowing rehabilitation and dental review are important components of long-term recovery
• Get vaccinated with HPV vaccination

Myths and facts

Myth 1: Only smokers get head and neck cancer

Fact: While tobacco is the leading risk factor, head and neck cancer can also be caused by HPV infection, EBV, betel quid chewing (without tobacco), alcohol and other factors. HPV-related oropharyngeal cancer is rising even in non-smokers, particularly in younger adults.

Myth 2: A lump in the neck is usually just a swollen gland from infection

Fact: While most neck lumps in children are due to infection, a painless, persistent lump in the neck in an adult is considered a sign of cancer until proven otherwise and should be evaluated urgently. Early assessment is always the right course of action.

Myth 3: Head and neck cancer treatment always results in significant changes to appearance and speech

Fact: Many early-stage head and neck cancers can be treated with radiotherapy or minimally invasive surgery with very limited functional impact. Advances in surgical reconstruction, IMRT and rehabilitation mean that outcomes for function and appearance have improved significantly. A specialist MDT will aim to preserve as much function as possible.

Myth 4: Oral cancer only affects older people who smoke heavily

Fact: Oral cancer rates are rising in younger adults, in part due to HPV and the increasing use of smokeless tobacco products among young people. The age of onset for HNC in India is lower than in Western countries, with many patients diagnosed in their 40s and 50s.

Frequently asked questions (FAQs)

Q1. Can head and neck cancer be prevented?

Many cases are preventable. The most effective steps are: stopping all tobacco use (smoked and smokeless); avoiding betel quid and areca nut; limiting alcohol; getting the HPV vaccine (recommended for adolescents before sexual activity begins); and attending regular dental check-ups, where early changes in the mouth can be spotted.

Q2. What is the HPV vaccine and should I be concerned about HPV?

HPV (Human Papillomavirus) is a very common virus transmitted through close skin-to-skin or sexual contact. Most infections clear on their own. However, persistent HPV type 16 infection can lead to oropharyngeal cancer. The HPV vaccine is highly effective at preventing this. It is recommended for girls and boys before exposure and is part of India's national immunisation discussions.

Q3. Will I be able to speak and swallow normally after treatment?

Many people with early-stage cancers maintain normal or near-normal speech and swallowing. For more advanced cancers or those requiring major surgery, there may be changes to speech and swallowing. Speech and language therapists work closely with patients throughout treatment and recovery to help rehabilitate these functions to the best possible level.

Q4. I chew paan or tobacco but have no symptoms. Should I get checked?

Yes. People who use tobacco in any form including paan, gutka, khaini and supari, are at significantly higher risk of oral and pharyngeal cancer. Regular dental and medical check-ups that include examination of the mouth and throat are strongly recommended. Pre-cancerous changes (white or red patches in the mouth) can be detected and treated before they become cancer.