Cancer starts when normal cells develop abnormal changes and begin growing uncontrollably. Unlike normal cells, these cancerous cells ignore the signals that keep growth in check. Over time, cancer cells can invade nearby tissue or spread to lymph nodes in the neck.
Head and neck cancer is a group of cancers that start in the mouth, throat, nose, sinuses, voice box, salivary glands or the nearby tissues. Most head and neck cancers arise from the squamous cells lining the moist surfaces of the upper aerodigestive tract, accounting for about 90% of cases.
Head and neck cancer usually does not include brain or eye cancer. Cancer of the thyroid gland may sometimes be managed by head and neck specialists, but the thyroid gland is often discussed separately because the cancer does not behave the same as head and neck cancer and is treated differently.
Head and neck cancer is highly curable when detected early. Early-stage head and neck cancer often has better treatment outcomes and may need less aggressive treatment than cancer found after it has grown deeply or spread to the lymph nodes. Cure rates decrease significantly for advanced-stage head and neck cancers, which are harder to control and may need combined treatments.
Nasal cavity and paranasal sinus cancers start in the nasal cavity and the air-filled spaces around the nose. A tumour in the nasal cavity can grow quietly, because the nasal cavity has room to expand before symptoms appear. They may cause one-sided blockage, nosebleeds, facial pressure, eye symptoms, or a reduced sense of smell.
Salivary gland cancers start in the glands that produce saliva, including the major salivary glands such as the parotid and submandibular glands, and the minor salivary glands. They may appear as a lump near the jaw, below the ear, under the chin or inside the mouth.
Barrie Tan ENT Head & Neck Surgery provides comprehensive care for all types of head and neck cancers.
If you believe you or a loved one has a head or neck cancer, contact us today so that we can start working on an optimal treatment plan.
Sore Throat
A sore throat that does not improve for weeks, a mouth ulcer that does not heal, a lump in the neck, persistent hoarseness, difficulty swallowing, or unexplained weight loss should be taken seriously. Many benign conditions can cause similar symptoms, but persistent symptoms need a proper assessment.
Mouth Cancer
Mouth cancer may cause a non-healing ulcer, a lump, bleeding, loose teeth, pain, numbness or red and white patches inside the mouth. A sore spot caused by a sharp tooth or denture should improve once the irritation is removed. A persistent ulcer should not be ignored.
Throat Cancer
Throat cancer may cause pain when swallowing, a feeling of something stuck in the throat, ear pain, a change in voice, coughing up blood, or weight loss. Throat cancer can begin in the oropharynx or hypopharynx, and is strongly linked to smoking and alcohol. Voice box cancer may cause hoarseness that lasts more than two to three weeks.
Nasal Cavity
Cancer in the nasal cavity, sinuses or nasopharynx may cause a one-sided nasal blockage, bloodstained mucus, repeated nosebleeds, hearing loss, a blocked-ear sensation, headaches, facial numbness, double vision, or a neck lump. These symptoms can sometimes be mistaken for sinus disease or ear blockage.
Salivary Glands
Salivary gland cancer may cause a firm lump near the jaw, under the chin or below the ear. Pain, facial weakness, numbness or a rapid enlargement of the glands are more concerning features.
Neck Lumps
Neck lumps are important to note. A painless lump in the neck may be an enlarged lymph node containing cancer cells from the mouth, throat, nose or voice box. In some patients, a neck lump is the first sign of cancer.
Head and neck cancer causes include cell changes linked to tobacco, alcohol, viral infection, age, inherited risk and environmental exposure.
Tobacco and alcohol are two of the most important head and neck cancer risk factors, and are responsible for many head and neck squamous cell carcinomas, particularly tumours of the oral cavity, hypopharynx and larynx, with the oral cavity being a frequent site.
HPV infection is an increasingly important cause of oropharyngeal cancer, which affects the tonsils and base of the tongue. About 70% to 75% of oropharyngeal cancers are linked to chronic HPV infection. HPV-positive oropharyngeal cancer often responds better to treatment than HPV-negative cancer. Vaccination against the human papillomavirus helps prevent infection with cancer-causing HPV types and may reduce the risk of HPV-related oropharyngeal cancers. Vaccination works best before exposure to HPV, but adults who are not vaccinated when younger can discuss their suitability with their doctor.
Age also affects risk. Head and neck cancers are diagnosed more often in older adults, and the risk generally rises after the age of 40 to 50. However, HPV-related oropharyngeal cancer can occur in younger adults as well.
The Epstein-Barr virus is linked to nasopharyngeal carcinoma. Other risk factors include a family history of nasopharyngeal cancer, consumption of preserved or salt-cured foods, poor oral hygiene, long-term exposure to wood dust, nickel dust, formaldehyde, asbestos, or certain industrial chemicals, previous radiation exposure, a weak immune system, and inherited conditions.
You should see an ENT specialist if symptoms in the mouth, throat, nose, voice box or neck last more than two to three weeks without a clear reason.
Arrange an ENT assessment if you have persistent hoarseness, a non-healing mouth ulcer, a lump in the neck, difficulty swallowing, pain when swallowing, an unexplained ear pain, repeated nosebleeds, one-sided nasal blockage, blood-stained mucus or an unexplained weight loss.
You should seek prompt assessment if a neck lump is growing, hard, fixed or painless. A painless lump can still be significant. You should also be assessed early if you have facial weakness, tongue weakness, numbness, double vision, coughing up blood or breathing difficulty.
Smokers, heavy alcohol users, and patients with a family history of nasopharyngeal cancer should be especially careful about symptoms that persist. An early review can rule out serious causes, and immediate treatment can begin sooner.
Head and neck cancer diagnosis starts with a careful examination of the mouth, throat, nose, voice box and neck.
An ENT specialist will ask about your symptoms, the duration, your smoking habits, alcohol use, occupational exposures, family history, previous cancers and your general health. The examination may include feeling the neck glands, inspecting the mouth and tongue, and checking the nose and throat.
A flexible nasoendoscopy is often used. This involves passing a thin camera through the nose to examine the nasal passages, nasopharynx, throat and voice box. It can usually be done in the clinic with a local anaesthetic spray.
Imaging may be needed to define the size and extent of the disease. CT, MRI, and PET scans may be used depending on the suspected site of the cancer. Imaging helps show whether the cancer has invaded nearby structures or spread to the lymph nodes, and helps map head and neck tumours before treatment.
A biopsy is needed to confirm cancer. A small tissue sample is taken for microscopic examination. The biopsy may be done in a clinic, with a needle for a neck lump, or during a procedure under anaesthesia. The pathologist will identify the cancer type and may test for markers such as HPV or Epstein-Barr virus, where relevant.
Head and neck cancer staging describes how advanced the cancer is. The TNM system (Tumour-Node-Metastasis) classifies head and neck cancer from Stage I to Stage IV by assessing tumour size, local spread, lymph node involvement, and whether the cancer has spread to distant parts of the body. Advanced head and neck disease often needs combined treatment. Staging helps guide this treatment.
Dr Barrie Tan was the former Head of the Department of Otolaryngology (ENT) at Singapore General Hospital and has dedicated his career to improving his patients’ ENT health and quality of life.
Radiotherapy, also called radiation therapy, uses high-energy beams to kill cancer cells. Radiation therapy may target one area or a wider field. It may be used alone for some early cancers, after surgery to lower recurrence risk, or together with chemotherapy for more advanced diseases. It is commonly used for nasopharyngeal cancer because of the location and the sensitivity of this cancer type to radiation.
Chemotherapy uses medicines to kill cancer cells or make them more sensitive to radiotherapy. It may be used with radiotherapy, before other treatments to shrink cancer, or for cancer that has spread or returned.
Targeted therapy uses medicines that act on the specific cancer pathways. Immunotherapy offers newer treatment options for selected patients with advanced, recurrent or metastatic head and neck cancer by helping the immune system recognise and attack cancer cells. It works by waking up immune cells so they can fight cancer, and by training the immune system to find tumour cells it would otherwise miss.
Supportive care is a major part of any cancer treatment. Patients may need help with pain control, nutrition, swallowing, speech, dental care, dry mouth, skin care, and emotional support. A feeding tube may be recommended temporarily if swallowing becomes unsafe or nutrition is poor.
Palliative care may also be involved. This does not mean giving up treatment. It means improving comfort, supporting function and helping patients manage their symptoms at any stage of serious illness.
Head and neck cancer surgery aims to remove the cancer completely while preserving speech, swallowing, breathing and appearance as much as possible.
Head and neck cancer treatment with surgery may be used alone for early cancers or combined with radiotherapy and chemotherapy for more advanced cancers. The choice of head and neck cancer treatment depends on the stage. Treatment planning is usually discussed by a multidisciplinary team so that the safest and most effective approach is chosen.
The type of surgery depends on where the cancer starts.
Salivary gland cancer surgery may remove the affected gland.
Nasal cavity and sinus cancers may require endoscopic or open approaches, depending on the extent of the disease, since the nasal cavity lies close to the eye and brain.
The head and neck cancer survival rate varies widely. It depends on the cancer site, stage, HPV or Epstein-Barr virus status, whether the cancer has spread, the patient’s health and response to treatment.
Head and neck cancer treatment side effects may affect eating, swallowing, speech, breathing, taste, saliva, appearance and energy levels. Surgery can cause pain, swelling, bleeding, infection, scarring, numbness, shoulder stiffness, weakness, voice change or swallowing difficulties. More extensive operations may require the reconstruction, a tracheostomy care or temporary feeding support.
Radiotherapy may cause mouth ulcers, dry mouth, thick saliva, taste changes, skin irritation, tiredness, swallowing pain, dental problems and long-term stiffness of the neck or jaw. Chemotherapy may cause nausea, lowered immunity, fatigue, mouth ulcers, hearing changes, nerve symptoms or kidney effects, depending on the medicines used.
Speech therapy and swallowing therapy can help patients regain function. Speech therapy is often started soon after treatment. Dental assessment is often important before radiotherapy to reduce the risk of later dental and jaw complications. Nutrition support helps maintain weight and strength during treatment.
Follow-up is essential after treatment. The care team will monitor the healing, check for recurrence, manage side effects and support rehabilitation.
Some head and neck cancers can be prevented or detected earlier by reducing risk factors and promptly addressing symptoms.
Stopping tobacco use is one of the most important steps. Tobacco use in any form, including smoking and chewing tobacco, raises risk. Reducing alcohol consumption lowers risk further, especially when combined with smoking cessation. Avoiding betel nut chewing is also important.
The HPV vaccine is effective in preventing infection with the HPV types that cause many HPV-related cancers, including oropharyngeal cancers.
Good oral hygiene and regular dental care help reduce chronic irritation and may support earlier detection of mouth changes. Dentists may notice suspicious ulcers, red or white patches, or lumps during routine care.
People with high occupational exposure to wood dust, asbestos, paint fumes or industrial chemicals should use proper protective measures. Sun protection helps reduce skin cancers in the head and neck region, especially those of the lips, ears, scalp, and face.
For patients already treated for a primary cancer, follow-up is important to detect recurrence or a second primary cancer early.
A cancer concern can feel overwhelming. A clear cancer diagnosis and timely treatment can make a meaningful difference. Barrie Tan ENT Head & Neck Surgery can help by assessing the warning signs, arranging the diagnosis, and guiding patients through their treatment options with clarity and care.
At Gleneagles Hospital in Singapore, Dr Barrie Tan evaluates persistent throat symptoms, neck lumps, voice changes, mouth lesions, nose and sinus symptoms, salivary gland lumps and suspected head and neck cancer.
If you have a persistent mouth ulcer, neck lump, hoarseness, difficulty swallowing, one-sided nasal symptoms, or other warning signs, contact our head and neck surgeon today for a consultation.
MBBS, MRCS (Edinburgh), MMed (Otorhinolaryngology), FAMS
Dr Barrie Tan is an ENT specialist at Gleneagles Hospital, Singapore, with more than 20 years of clinical and surgical experience. He previously served as Head of ENT and Director of the Centre for Hearing and Ear Implants at Singapore General Hospital. The information provided is not intended as medical advice. More about our medical experts.
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Senior Consultant ENT Specialist
MBBS (Singapore), MMed (ENT) (Singapore)
MRCS (Edinburgh, UK), FAMS (Otolaryngology)
Dr Barrie Tan is a dedicated ENT specialist with over 20 years of experience and a keen focus on hearing loss and cochlear implants, among others. Prior to setting up his own practice, Dr Tan was the Head of the ENT Department at the Singapore General Hospital (SGH) – the largest ENT department in Singapore – as well as the Director of the Centre for Hearing and Ear Implants at SGH.
Dr Tan was a President’s Scholar and completed his subspeciality Fellowship in Otology, Hearing Implant, Neurotology and Skull Base Surgery at the Ear Science Institute in Australia. Today, Dr Tan remains actively involved in the ENT fraternity, holding several leadership positions and being engaged in the nurturing of the next generation of ENT surgeons. He has organized numerous ENT conferences and continues to devote his time towards meaningful volunteer work and medical missions.
