Are you worried that you might have head and neck cancer? Have you been seen in the NHS and are scared and worried that nothing makes sense or progress is slow? Not every GP or ENT consultant specialises in head and neck cancer, so seeing a general ENT surgeon, who does not deal with cancer day to day can lead to delay, confusion and fear.
I see head and neck cancer patients from all over the south east of England, and some patients come to see me, from abroad, for my expertise.
I can see you quickly, investigate you, and come up with comprehensive personalised treatment plan.
Like an experienced and confident pilot, my job is to take you by the hand, navigate the turbulence, and give you a soft landing. If you can't afford private healthcare, your GP can refer you to me on the NHS.
What are the signs and symptoms of head and neck cancer? Hoarseness can be associated with a cancer of the vocal cords. Some patients sound like they are talking with a hot potato in the back of their throat because a cancer is growing in the back of the tongue or in a tonsil. Cancers of the throat can cause pain in the throat, and this often radiates to the ears along the nerves. Pain is a cardinal symptom. Some patients have a tumour in the throat which obstructs the passage of food, so patients may find it difficult to eat or drink and lose weight. Nose bleeds may be a sign of a cancer in the nose. Smoking and high alcohol intake, especially of spirits, is often associated with head and neck cancer. Alternatively, a younger adults can develop cancers in the tonsils and back of the tongue, even if they don't smoke or drink, because of infection with a high risk human papilloma virus (HPV).
I would examine your mouth, throat, nose and check your neck for lumps. Sometimes, I can touch a lump in the neck and immediately know it is cancerous. The cancer doesn’t normally start in the neck, it starts somewhere in the throat (primary tumour) and spreads to the neck (secondary tumour). I use a nasendoscope (camera) to check the inside of the nose and throat to see if there any (primary) cancers lurking.
If you have a lump in the neck I would send you for an ultrasound scan. The radiologist can look at the shape and size of the neck lump and if deemed suspicious use a needle to take a biopsy of the lump. This is sent off to the lab, where they can check it for cancer under the microscope. I would normally order an MRI scan of the neck with CT scan of chest and abdomen, or just a CT scan of the neck, chest and abdomen. These scans allow us to see where the cancer has started (primary tumour) and also any lymph nodes in the neck which it has spread to. The scans are used to check that the cancer hasn’t spread to the lungs or liver. If it has, this is called distant metastasis, and makes it difficult to cure. Sometimes, I would order a whole body scan, called a PET CT scan, if I have found a cancerous lump in the neck, but have not identified the primary site by examining you. Any sites of cancer should light up on a PET CT scan.
We also often have to biopsy the primary site. If the tonsils are enlarged, or one is bigger than the other, you might need to have an operation to remove to tonsils and to send them off to the lab for analysis (tonsillectomy for histology).
Alternatively, I might have to look down your throat using a rigid metal tube and biopsy any suspicious lump. This is called a panendoscopy and biopsy. It involves coming into hospital, and having a general anaesthetic. Once you are asleep, I cover your teeth with a plastic gum guard, and use the rigid metal tube to inspect the throat, the voice box and the gullet. The risks of this procedure include pain, bleeding, infection, general anaesthetic, damage to the lips, teeth or gums, perforation of the gullet, or 20% risk of mortality if COVID positive at the time of the anaesthetic.
If you have some one at home to look after you, you can go home the same day, otherwise you may need to stay the night in hospital and go home the following morning. You will have a sore throat for 48 hours, which should respond to paracetamol or codeine. The results from the biopsies normally take 2 weeks to come back.
The treatment for head and neck cancer involves surgery, radiotherapy, chemotherapy, immunotherapy or a combination of the above. The treatment will vary according to the site where the primary tumour is located.
These treatments are best conducted by experts, like me, with a super specialist interest in head and neck cancer who meet together regularly to discuss the individualised treatment plan for each patient (multidisciplinary meeting (MDT)).