Head and neck cancers are mostly squamous cell cancers of the mouth, throat and larynx. Tobacco and alcohol are the classic causes, and HPV now causes many throat cancers in younger nonsmokers.
Key symptoms
- Mouth sore or ulcer that does not heal after 2 to 3 weeks
- Hoarseness lasting more than a few weeks
- Painless lump in the neck
- Trouble or pain swallowing, ear pain on one side
- Weight loss or bleeding from the mouth
What you find on exam
- Inspect and feel the whole mouth, tongue and floor of the mouth
- Feel the neck for firm, fixed lymph nodes
- Look for white or red patches
- Check the cranial nerves and look for fluid behind one eardrum
Tests
- Laryngoscopy by ENT to see the throat and larynx
- Biopsy of the lesion or fine-needle aspiration of a neck node
- HPV (p16) testing on throat cancer tissue
- CT or MRI of the neck and PET-CT for staging
Treatment basics
- Surgery, radiation or both for early disease
- Chemoradiation with cisplatin for advanced disease
- Immunotherapy such as pembrolizumab for recurrent or spread disease
- Stop smoking and alcohol; dental, nutrition and speech support
Red flags
- Noisy breathing or stridor
- Cannot swallow liquids or major weight loss
- Bleeding from the mouth or neck
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.