Head and neck cancer

Also called Mouth cancer, Throat cancer, Laryngeal cancer

A mouth ulcer that has not healed in three weeks, or a hoarse voice for three weeks, is a referral. Dentists find more of these than doctors do.

What it is

A group of cancers of the mouth, tongue, throat, voice box, salivary glands, nose and sinuses.

Smoking and alcohol together multiply the risk, and human papillomavirus now causes a growing share of throat cancers, particularly in younger people who have never smoked. The HPV-related ones generally respond better to treatment.

Dentists are the front line. A routine check-up examines the whole mouth, which is why people who attend a dentist regularly have theirs found earlier. That is a real argument for dental attendance in a group who often stop going.

Treatment saves lives and costs function. Surgery, radiotherapy or both affect speaking, swallowing, taste, saliva and appearance, all at once, and rehabilitation is as central as the cancer treatment.

Signs you might notice

A mouth ulcer or sore patch that has not healed after three weeks.

A red or white patch in the mouth that will not rub off.

A hoarse voice for more than three weeks.

A lump in the neck that has been there more than three weeks.

Difficulty or pain on swallowing, a feeling of something stuck in the throat.

Persistent one-sided earache with a normal-looking ear.

Loose teeth with no dental cause, numbness of the lip or tongue, or unexplained bleeding in the mouth.

Three weeks is the number throughout. Any of these persisting that long is an urgent referral, not a repeat prescription.

How it can affect day-to-day life

The combination of losing speech, taste, saliva and appearance at the same time is what makes this group's quality of life so hard, and it is why psychological support and speech and language therapy belong from the start rather than at the end.

Permanent dry mouth after radiotherapy makes eating, speaking, sleeping and dental health difficult for the rest of the person's life, and it is under-treated.

Eating in front of other people is often abandoned, and with it much of social life. Weight loss follows quickly, so a dietitian is not optional. See dietetics.

A tracheostomy or a laryngectomy changes communication completely and needs specialist teaching for the family, not just the person.

Dental work needs to happen before radiotherapy, because extractions afterwards carry a serious risk of jaw bone damage. This is easy to miss in the rush to start treatment.

Supporting someone well

Use the three-week rule and act on it: an ulcer, a hoarse voice, a neck lump, or difficulty swallowing.

Register with a dentist and go. It is the most reliable early detection there is for this group.

Ask for the dental assessment before radiotherapy starts.

Ask for speech and language therapy and a dietitian at the beginning of treatment, not when problems appear.

Ask about saliva substitutes, high-fluoride toothpaste and dental follow-up for dry mouth, and take the mouth care seriously; it prevents a great deal of later trouble.

Support the HPV vaccination for boys as well as girls.

Ask for psychological support. Facial and voice changes are a form of loss and deserve treating as one.

Where to get help

A GP or a dentist urgently for any of the three-week symptoms.

The head and neck clinical nurse specialist once under a team.

Macmillan Cancer Support on 0808 808 00 00.

Oral Health Foundation run a mouth cancer awareness programme and publish clear self-check guidance.