Newly Diagnosed With Head and Neck Cancer: First Steps

Head and neck cancer means cancer of the oral cavity, the pharynx, the larynx, the paranasal sinuses and nasal cavity, or the salivary glands. Most begin in the squamous cells lining those surfaces.

The pharynx alone has three parts, and they behave differently. The nasopharynx sits behind the nose. The oropharynx is the middle, holding the soft palate, the base of the tongue, and the tonsils. The hypopharynx is the lower section.

Some nearby cancers are excluded. Cancers of the brain, eye, esophagus, thyroid gland, and skin of the head and neck are not classified as head and neck cancers.

For 2025, the American Cancer Society projected 59,660 new cases of oral cavity and pharynx cancer with 12,770 deaths, plus 13,020 new laryngeal cancers with 3,910 deaths. Both NCI PDQ summaries lead with those numbers and cite the Society as reference 1.

When these cancers spread, they almost always go locally or to neck lymph nodes.

Human papillomavirus, especially HPV type 16, causes cancers of the oropharynx that involve the tonsils or the base of the tongue. About three-quarters of all oropharyngeal cancers are caused by long-term HPV infection.

HPV-caused oropharyngeal cancer is rising in the United States while oropharyngeal cancer from other causes is falling.

One detail is often misread. HPV can be detected in other head and neck cancers, but it appears to actually cause cancer only in the oropharynx.

Status is established by biopsy with p16 testing. If your tumor is in the oropharynx and your report does not mention p16 or HPV, that result is missing, not optional.

For oropharyngeal cancer, three things drive prognosis: HPV status, smoking history measured in pack-years, and tumor and nodal stage. A pack-year means one pack a day for one year.

Analysis of a randomized chemoradiation trial produced three groups with very different 3-year overall survival.

Low risk is HPV-positive, 10 or fewer pack-years, and N0 to N2a nodal disease. Three-year overall survival was 93%.

Intermediate risk is HPV-positive with more than 10 pack-years and N2b to N3 nodes, or HPV-negative with 10 or fewer pack-years and either N2b to N3 nodes or a T2 to T3 tumor. Three-year overall survival was 70.8%.

High risk is HPV-negative with more than 10 pack-years, or HPV-negative with 10 or fewer pack-years and T4 disease. Three-year overall survival was 46.2%.

The 10 pack-year line is doing real work in that table. That is why your smoking history gets asked about repeatedly.

Alcohol and tobacco are the two most important risk factors, particularly for the oral cavity, hypopharynx, and larynx. Using both raises risk more than using either alone. Most squamous cell carcinomas of the mouth and voice box are caused by tobacco and alcohol.

Other exposures attach to specific sites. Paan, also called betel quid, is strongly linked to mouth cancers. Wood dust exposure is a risk factor for nasopharyngeal cancer. Wood dust, nickel dust, or formaldehyde raise the risk of paranasal sinus and nasal cavity cancer. Work in construction, metal, textile, ceramic, logging, and food industries has been linked to laryngeal cancer.

Assessment starts physically. It uses inspection, feeling the tumor where possible, and an indirect mirror exam. The neck drainage areas are checked by careful palpation. Tumor must be confirmed on tissue, not on imaging.

Procedures used to evaluate the primary tumor include PET-CT, MRI, endoscopy, laryngoscopy, and the biopsy with p16 testing.

Neck nodes are involved often. In advanced base-of-tongue cancer, roughly 70% or more have nodal spread on the same side, and 30% or fewer have it on both sides. The nodes commonly involved are levels II, III, IV, and V, plus the retropharyngeal nodes.

Treatment here affects how you eat, speak, breathe, and look. These roles work far better when they start early.

Dental. Ask directly whether a dental evaluation is needed before radiation begins, and how soon.

Speech-language pathology. A speech-language pathologist plans therapy and teaches speech exercises or alternative ways of speaking. The same clinician helps people learn to swallow again after surgery. Ask to meet them before the first treatment.

Nutrition. Eating is often difficult after treatment. Some people receive nutrition into a vein after surgery, and some need a feeding tube until they can eat on their own. A feeding tube can be passed into the stomach through the nose, or through a small opening in the abdomen. Ask whether one is expected.

Reconstruction or prosthetics. For oral cavity cancer especially, reconstructive surgery may be used to rebuild bone or tissue. It is not always possible, because remaining tissue may be damaged by the original surgery or by radiation. When it is not, a prosthodontist can build a prosthesis to restore swallowing, speech, and appearance.

Lymphedema care. Removing lymph nodes can slow lymph flow, so fluid collects in the tissues. Head and neck lymphedema can be visible on the outside or internal, in the throat. In most cases it can be reversed, improved, or reduced if treated promptly. Left untreated, it raises the risk of cellulitis, a tissue infection that can become dangerous and worsen swallowing or breathing.

Surgery can change chewing, swallowing, and speech. The face and neck may swell, and that usually improves with time.

After a laryngectomy, meaning removal of the voice box, or other neck surgery, parts of the neck and throat may feel numb because nerves were cut. If neck nodes were removed, the shoulder and neck may become weak and stiff.

Radiation brings its own list, during treatment and after: redness, irritation, and sores in the mouth; dry mouth or thickened saliva; trouble swallowing; taste changes or loss of taste, which cuts appetite; nausea; and earaches caused by hardened ear wax. The skin under the chin may swell or droop and change texture. The jaw may stiffen so the mouth does not open as wide as before.

Most of this improves slowly. Some people are left with lasting swallowing trouble, speech problems, and skin changes.

Head and neck examinations are scheduled every 6 to 12 weeks during the first year after treatment. In the second year, every 3 months. In the third year, every 3 to 4 months. After that, every 6 months.

Head and neck cancers not related to HPV are especially likely to come back, and follow-up is also watching for a second, separate cancer.

• Call 911 or go to an emergency department if breathing becomes hard or noisy, or a tracheostomy tube blocks or comes out. The airway here is narrow to begin with, and swelling from surgery or radiation can close it.
• Call 911 or go to an emergency department if blood comes from the mouth, throat, or a surgical site and does not quickly stop, or if you suddenly cannot swallow liquids and are choking.
• Call your cancer team without delay, day or night, if your temperature reaches 100.4 degrees F (38 degrees C) or higher while you are on chemotherapy. CDC calls this a medical emergency, because fever can be the only sign of an infection that spreads within hours. If you cannot reach them quickly, go to an emergency department and tell staff at once that you are on chemotherapy.
• Call your care team the same day if redness, warmth, and swelling spread across the neck or face. That is how cellulitis behaves, and lymphoedema here raises the risk of it.
• Call your care team the same day if a feeding tube blocks, leaks, or slips out, or if pain outruns the medicine you were given.
• Call your care team within a day or two if mouth sores, thick saliva, or pain stop you eating and drinking enough, or your weight starts dropping. Ask for the dietitian rather than waiting for the next visit.
• Call your care team within a day or two if swallowing gets steadily worse, your jaw stiffens so your mouth opens less far, or new swelling appears under the chin. Head and neck lymphoedema can usually be reversed or reduced when treated promptly.

• The exact site: oral cavity, oropharynx, hypopharynx, larynx, sinus, or salivary gland
• The p16 or HPV result, if the tumor is in the oropharynx
• Your pack-year total, calculated rather than guessed
• The T and N stage
• Whether a dental evaluation, speech-language pathologist, and dietitian have been arranged
• The date of the first follow-up visit after treatment ends

https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet https://www.cancer.gov/types/head-and-neck/hp/adult/oropharyngeal-treatment-pdq https://www.cancer.gov/types/head-and-neck/hp/adult/laryngeal-treatment-pdq https://www.cancer.gov/about-cancer/treatment/side-effects/infection https://www.cancer.org/research/cancer-facts-statistics.html https://www.cdc.gov/cancer-preventing-infections/patients/fever.html