Intended for healthcare professionals

Clinical Review

Head and neck cancer—Part 1: Epidemiology, presentation, and prevention

BMJ 2010; 341 doi: (Published 20 September 2010) Cite this as: BMJ 2010;341:c4684
  1. H Mehanna, director and honorary associate professor1,
  2. V Paleri, consultant surgeon and honorary clinical senior lecturer2,
  3. C M L West, professor of radiation biology3,
  4. C Nutting, director4
  1. 1Institute of Head and Neck Studies and Education, University Hospitals Coventry, Coventry CV2 2DX
  2. 2Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne
  3. 3University of Manchester, Manchester
  4. 4Head and Neck Unit, Royal Marsden NHS Foundation Trust, London
  1. Correspondence to: H Mehanna hishammehanna{at}

    Summary points

    • The incidence of head and neck cancer is relatively low in developed countries and highest in South East Asia

    • The main risk factors are smoking and heavy alcohol consumption

    • Incidence of human papillomavirus related oropharyngeal carcinoma is rising rapidly in developed countries and is easily missed. It has a different presentation and better prognosis than other head and neck cancers

    • Patients with head neck cancer often present with hoarseness, throat pain, tongue ulcers, or a painless neck lump, and symptoms for longer than three weeks’ duration should prompt urgent referral

    • No strong evidence supports visual examination or other screening methods in the general population

    Head and neck cancers include cancers of the upper aerodigestive tract (including the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx), the paranasal sinuses, and the salivary glands. Cancers at different sites have different courses and variable histopathological types, although squamous cell carcinoma is by far the most common. The anatomical sites affected are important for functions such as speech, swallowing, taste, and smell, so the cancers and their treatments may have considerable functional sequelae with subsequent impairment of quality of life. Decisions about treatment are usually complex, and they must balance efficacy of treatment and likelihood of survival, with potential functional and quality of life outcomes. Patients and their carers need considerable support during and after treatment.

    Sources and selection criteria

    We used the terms “head and neck”, “larynx”, “oral”, and “oropharynx”—with each limited by “cancer”, “diagnosis”, and “treatment” separately—to search the Medline, Embase, PubMed, Cochrane, CINAHL, and AMED databases. We also used them to cross check national guidelines, reference lists, textbooks, and personal reference lists. We assessed over 1000 identified abstracts for relevance.

    In this first part of a two article series, we review the common presentations of head and neck cancer. We also discuss common investigations and new …

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