What the diagnosis means
"Head and neck cancer" covers cancers of the lips and mouth (oral cavity), the throat behind the mouth (oropharynx), the lower throat (hypopharynx), the voice box (larynx), the nose and sinuses, and the salivary glands. Most are squamous cell carcinomas. In India, oral cavity cancer is the most common of these, strongly linked to smokeless tobacco, areca nut (gutka, paan) and smoking. Some throat cancers are linked to HPV and behave differently.
Staging uses examination, endoscopy, CT or MRI and sometimes PET-CT. A non-healing ulcer, a patch or lump in the mouth, or a persistent change in voice or swallowing lasting more than three weeks should be examined.
Where medical oncology fits
This is a surgery- and radiation-led cancer. Head-and-neck surgeons remove tumours and neck nodes, often with reconstruction; radiation oncologists treat with curative intent alone or after surgery. Medical oncology contributes in defined ways:
- Chemotherapy with radiation (chemoradiation) for locally advanced disease, to make radiation more effective.
- Induction chemotherapy before definitive treatment in selected situations — for example to shrink a large tumour or to attempt organ preservation of the larynx.
- Systemic treatment for recurrent or metastatic disease, where immunotherapy (checkpoint inhibitors, guided by PD-L1) and chemotherapy are the options.
Decisions are made in a joint clinic so that surgery, radiation and drugs are sequenced deliberately rather than added on.
What to expect
Chemoradiation typically runs for six to seven weeks with weekly or three-weekly chemotherapy. Mouth soreness, difficulty swallowing, taste changes, dry mouth and skin reaction are expected and peak towards the end; a feeding tube is sometimes placed temporarily so that nutrition and treatment can continue. Dental assessment before radiation, speech and swallowing therapy, and nutrition support are part of the plan, not optional extras.
Stopping tobacco and alcohol before and during treatment improves how well treatment works and lowers the risk of a second cancer.
Questions to ask
- Is my cancer best treated with surgery, radiation, or both — and where does chemotherapy fit?
- If radiation is planned, will chemotherapy be added, and what will it involve week by week?
- How will treatment affect speech, swallowing and appearance, and what rehabilitation is available?
- For recurrent or metastatic disease: what did the PD-L1 test show, and is immunotherapy an option?
- What help is available to stop tobacco?
Preparing for your consultation
Bring the biopsy report, scans (CT/MRI/PET-CT) with reports, any dental assessment, and a note of tobacco, areca nut and alcohol use — this is asked without judgement because it changes treatment planning.