Clinical update

Head and neck cancers

Posted 14 October 2015

Head and neck cancers include those that affect the mouth and throat, as well as rarer cancers of the nose, sinuses, salivary glands and middle ear.

Essential facts

Head and neck cancers include those that affect the mouth and throat, as well as rarer cancers of the nose, sinuses, salivary glands and middle ear. There are 13,000 new cases each year, according to the NHS.

Macmillan Cancer Support has called for action to reduce the variation in survival rates for people with head and neck cancers. The survival rate at four years varies from 60% for those with cancer of the voice box to only 33% for those with cancer of the hypopharynx, according to the Health and Social Care Information Centre’s national head and neck cancer audit, published in September.

The National Institute for Health and Care Excellence says a referral for suspected oral cancer should be considered for a patient with unexplained ulceration in the oral cavity lasting for more than three weeks, or an unexplained lump in the neck. An urgent referral should be considered for those with a lump on the lip or in the oral cavity, or a red or red and white patch in the oral cavity, consistent with mouth cancer. For laryngeal cancer, a referral should be considered for persistent unexplained hoarseness or an unexplained lump in the neck. People with an unexplained lump on the thyroid should be checked for thyroid cancer.

Three quarters of cases are thought to be related to tobacco and alcohol consumption. Head and neck cancers are more common in men and in people aged over 50.

Cancers at the back of the tongue and in the tonsils have become more common in the past 20 years. Many of these are linked to infection with human papilloma virus 16 (HPV16). It is not clear how HPV16 is spread, but one theory is through oral sex, according to Macmillan Cancer Support.

Encouraging and supporting people to live a healthy lifestyle can reduce risk. Cancer Research UK says 91% of oral cancer cases are linked to lifestyle factors, including the use of tobacco and alcohol. Nurses in all settings should be aware that patients who have undergone treatment might experience difficulties with eating and drinking, be embarrassed about their speech or need extra time to express themselves.

Expert comment

Louise Pearson is a head and neck clinical nurse specialist at the Worcestershire Royal Hospital

‘The impact of head and neck cancer on the lives of patients can be debilitating. It can include physical changes, such as facial disfigurement, and permanent changes, and can affect breathing and the ability to eat and drink a normal diet. Speech can be affected, which can leave some patients feeling socially isolated.

‘All patients need the support of the multidisciplinary team during and after treatment, which can be invasive. Head and neck cancer patients need access to counselling because the disease can lead to depression. After treatment, they need continued support from the team to achieve normal functions again, such as swallowing and speech.’