Doctors Revision

Oncology

Head and Neck Cancers (Overview)

A group of cancers arising in the nasal cavity, sinuses, lips, oral cavity (mouth), salivary glands, pharynx (throat), or larynx (voice box). Most are Squamous Cell Carcinomas (SCC).

Also known as: Oral Cancer, Throat Cancer, Laryngeal Cancer

Open in the interactive guide
On this page

Referral and warning signs

When to refer

Refer urgently to ENT/Head & Neck specialist for: Persistent sore throat/mouth ulcer (>2-3 weeks). Persistent hoarseness (>3 weeks). Unexplained neck lump. Persistent unilateral ear pain without ear pathology. Dysphagia/Odynophagia.

Red flags

  • Non-healing oral ulcer or sore
  • Persistent neck lump
  • Persistent hoarseness (>3 weeks)
  • Unilateral ear pain with normal ear exam
  • Dysphagia / Odynophagia
  • Unexplained weight loss
  • Cranial nerve palsy

Signs and symptoms

  • Persistent sore throat or mouth sore/ulcer that does not heal (>2-3 weeks).
  • Painless or painful lump/mass in the neck (cervical lymphadenopathy).
  • Dysphagia (difficulty swallowing) or Odynophagia (painful swallowing).
  • Hoarseness or voice change persisting >3 weeks.
  • Persistent ear pain (otalgia), often unilateral (referred pain).
  • Difficulty moving tongue or jaw.
  • Loosening of teeth.
  • Unexplained weight loss.
  • Persistent nasal obstruction or bleeding (nasal/sinus cancer).
  • Unilateral hearing loss or serous otitis media (nasopharyngeal cancer).
  • Cranial nerve palsies.

Risk factors

  • Tobacco use (smoking, chewing).
  • Excessive alcohol consumption (synergistic effect with tobacco).
  • Human Papillomavirus (HPV) infection (esp. type 16 - major cause of oropharyngeal cancers).
  • Epstein-Barr Virus (EBV) infection (associated with nasopharyngeal carcinoma).
  • Poor oral hygiene.
  • Occupational exposures (wood dust, nickel, formaldehyde).
  • Betel quid chewing.
  • Genetic predisposition (rare).

Diagnosis

Clinical assessment

Suspect based on persistent symptoms (>2-3 weeks). Requires thorough examination of oral cavity, pharynx, larynx (indirect/flexible laryngoscopy), and neck palpation.

Investigations

  • Biopsy of suspicious lesion: Essential for diagnosis. Via endoscopy or direct biopsy.
  • Fine Needle Aspiration (FNA) Biopsy: Of suspicious neck lymph nodes.
  • Imaging: CT Scan (Neck/Chest +/- Abdomen/Pelvis), MRI Scan (soft tissue/base of skull/tongue), PET-CT Scan (metastases/unknown primary).
  • Panendoscopy (Examination under anaesthesia): Laryngoscopy, pharyngoscopy, oesophagoscopy, bronchoscopy.
  • HPV testing (p16) on oropharyngeal SCC biopsies.

Diagnostic criteria

Histopathological confirmation from biopsy.

Management

Non-pharmacological management

  • Referral to specialized multidisciplinary Head & Neck Oncology team.
  • Management depends on site, stage, histology, HPV status, patient factors.
  • Surgery: Resection of primary tumour +/- neck dissection.
  • Radiotherapy: Primary treatment (often with chemo), adjuvant, or palliative.
  • Speech and Swallowing Rehabilitation.
  • Nutritional Support (often requires feeding tube).

Pharmacological treatment

  • Chemotherapy: Concurrent with radiotherapy (chemoradiation - e.g., Cisplatin), induction/adjuvant/palliative.
  • Targeted Therapy (e.g., Cetuximab - EGFR inhibitor).
  • Immunotherapy (e.g., PD-1 inhibitors) for recurrent/metastatic.
  • Pain management.

Monitoring

Close follow-up with clinical exam, endoscopy, imaging. Monitor swallowing and speech function. Monitor thyroid function after neck radiation.

Complications

  • Airway obstruction
  • Difficulty swallowing / Malnutrition
  • Speech impairment
  • Local recurrence
  • Regional/Distant metastasis
  • Treatment side effects: Mucositis, xerostomia, dysphagia, fibrosis, dental problems, hypothyroidism, hearing loss, secondary malignancies.

Prevention

  • Tobacco cessation.
  • Limit alcohol consumption.
  • HPV vaccination.
  • Good oral hygiene.
  • Avoid betel quid.

Patient education

  • Explain diagnosis, site, stage.
  • Discuss treatment options and multidisciplinary approach.
  • Potential impact on speech, swallowing, appearance.
  • Importance of smoking/alcohol cessation.
  • Need for dental assessment before radiation.
  • Nutritional support needs.
  • Importance of rehabilitation and follow-up.

Uganda-specific notes

Nasopharyngeal carcinoma (EBV-associated) relatively common. Oral cancers linked to tobacco/alcohol. Access to specialized H&N surgery, radiotherapy (IMRT), chemotherapy, and supportive care limited.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 12, Section 12.3.2

Scroll to Top