Head and Neck Cancers

The incidence of head and neck cancer is increasing; around 1,200 people are diagnosed with a head and neck cancer each year in Scotland and around 240 with thyroid cancers. The incidence of oropharyngeal cancer is increasing in the younger population, and appears to be associated with human papilloma virus (HPV) infection.

Risk factors for head and neck cancers (excluding thyroid) include: social deprivation; smoking; HPV; alcohol; drugs (especially opioids and cannabis); poor diet; tobacco chewing habits (including betel, gutkha and pan); and older age. The risk of developing nasopharyngeal cancer is higher in people of Chinese origin and a higher index of suspicion should be used in these people.

If any uncertainty about the significance of an abnormality in the mouth, a dentist’s opinion should be sought in the first instance. There should be systems in place for urgent suspicion of cancer referral pathways for dentists.

All people with features suspicious of malignancy should be referred to a team specialising in the management of head, neck or thyroid cancers, depending on local arrangements.

With the changing pattern of disease, age, non-smoking or non-drinking status should not be a barrier to referral.

Emergency referral

  • Stridor

Urgent suspicion of cancer referral

Head and neck cancer:

  • Persistent unexplained head and neck lumps for >3 weeks
  • Unexplained ulceration or unexplained swelling/induration of the oral mucosa persisting for >3 weeks
  • All unexplained red or mixed red and white patches of the oral mucosa persisting for >3 weeks
  • Persistent (not intermittent) hoarseness lasting for >3 weeks. If other symptoms are present to suggest suspicion of lung cancer, refer via lung cancer guideline
  • Persistent pain in the throat or pain on swallowing lasting for >3 weeks

Thyroid cancer:

  • Solitary nodule increasing in size
  • Thyroid swelling age 16 and under
  • Thyroid swelling with one or more of the following risk factors:
    • neck irradiation
    • family history of endocrine tumour
    • unexplained hoarseness
    • cervical lymphadenopathy
Quick Reference Guideline