Head & Neck Cancer

What head and neck cancer is — in plain words

"Head and neck cancer" is an umbrella term for cancers that arise in the mouth, tongue, lips, throat (pharynx), voice box (larynx), salivary glands, sinuses, and the related lymph nodes in the neck. The vast majority are squamous cell carcinomas — cancers of the surface lining of these areas.

Two distinct stories now sit under this umbrella:

• Tobacco- and pan-related cancers — especially of the mouth and larynx. Very common in Pakistan, strongly linked to smoking, paan, gutka, chaalia and similar products. The single most preventable cancer category in the country.
• HPV-related oropharyngeal cancers — driven by human papillomavirus, often in younger non-smokers, particularly in the tonsils and base of the tongue. These tend to respond very well to treatment and have a better outlook.

Signs and symptoms to take seriously

Other red flags include a white or red patch in the mouth that doesn't go away, persistent blocked nose on one side, nasal bleeding, numbness in the face, or a non-healing tooth socket after extraction.

"Mouth cancer in Pakistan is, far too often, a preventable tragedy. Paan, gutka, naswar, chaalia — every one of them is a risk we can choose not to take. If you use these, today is a good day to stop."

How head and neck cancer is diagnosed

• Clinical examination — a careful look in the mouth and feel of the neck.
• Endoscopy of the throat and larynx — a flexible scope to examine the deeper areas.
• Biopsy — of the suspicious lesion or of a neck lymph node (fine-needle aspiration or core biopsy).
• HPV / p16 testing — on oropharyngeal cancers, this changes the prognosis and may influence treatment.
• Imaging — CT and/or MRI of the head and neck, with a CT of the chest to check for spread; PET-CT in many cases.
• Dental assessment — essential before radiation. Any teeth that need to come out should be extracted before treatment starts.
• Nutrition and speech-swallow assessment — built in from the beginning, not added later.

Stages — what the numbers mean

How we treat head and neck cancer

Surgery

For most oral-cavity cancers, surgery is the first treatment — removing the tumour with clear margins, with reconstruction where needed (often a free flap from the forearm or thigh). Lymph nodes in the neck are usually addressed at the same operation. Skilled surgical and reconstructive teams matter enormously for function and appearance.

Radiation therapy

An alternative to surgery for many laryngeal and pharyngeal cancers, and a standard add-on after surgery for higher-risk disease. Modern intensity-modulated radiation (IMRT) spares the salivary glands and reduces long-term dryness compared with older techniques.

Chemoradiation

For locally advanced disease, weekly or three-weekly cisplatin given alongside radiation improves cure rates significantly. The combination is intensive but worth the difficulty for the survival benefit it offers. Read more about chemotherapy →

Targeted therapy

Cetuximab (an EGFR-targeting antibody) is an alternative to cisplatin in selected patients who cannot tolerate platinum chemotherapy.

Immunotherapy

For recurrent or metastatic disease, pembrolizumab — alone or with chemotherapy — has improved outcomes substantially and is now first-line standard in PD-L1 positive cases. Read more about immunotherapy →

Speech, swallowing and nutrition rehabilitation

This is not an afterthought — it is half of the cure. Speech therapy, swallowing exercises before and during treatment, careful dietary support (sometimes through a temporary feeding tube), and dental and prosthetic work all preserve function and dignity. Patients who engage actively with rehabilitation recover voice and swallow far better than those who don't.

What the outlook honestly looks like

Outcomes depend heavily on the site, the stage, and (for oropharyngeal cancers) the HPV status. HPV-positive oropharyngeal cancers have five-year survival above 80% even at locally advanced stages. Smoking-related head-and-neck cancers have a wider range — early-stage disease is highly curable, while advanced smoking-related disease has more guarded outcomes. Modern immunotherapy has changed the picture for recurrent and metastatic disease.

Prevention and early detection

• Stop tobacco in all forms — cigarettes, naswar, paan, gutka, chaalia. This is the single most powerful prevention.
• Limit alcohol — combined with tobacco, the risk is multiplied.
• HPV vaccination — protects against HPV-related throat cancers in addition to cervical cancer.
• Regular dental checks — dentists often spot oral cancers and pre-cancers (leukoplakia, erythroplakia) before patients do.
• Self-check your mouth monthly — any ulcer or patch lasting more than three weeks needs review.

Life during treatment

Chemoradiation is the hardest treatment many patients ever undertake. Mouth sores, dry mouth, taste changes, difficulty swallowing and significant weight loss are common. Nearly all patients need a temporary feeding tube to stay nourished. Pain management, mouth care, and frequent contact with the team make a major difference. The intensity is real — and the cure that follows is worth it.

After treatment — survivorship

Follow-up is intensive in the first two years, with regular clinic visits and imaging. Long-term effects on swallowing, voice, saliva, hearing and thyroid function need ongoing attention. Watching for second cancers (especially in continuing smokers) is part of routine care. Read about survivorship care →