Head and neck cancer - symptoms, diagnosis and management 

Head and neck cancer is a relatively uncommon type of cancer. Around 10,000 new cases are diagnosed in the UK each year. UCLH treats more than 30 areas within the head and neck where cancer can develop. These include the mouth, throat, voice box, salivary glands and the nose and sinuses.

Our expert is Mr Simon Whitley, consultant oral and maxillofacial surgeon. He specialises in treating patients with head and neck cancer. His specialist interests include surgery for oral cancer, micro vascular reconstruction, salivary gland cancer, head and neck skin cancer, electro chemotherapy and the management of precancerous conditions (conditions that may become cancer later on).

The conversation focussed on identifying the symptoms of head and neck cancer as well as how cancer is diagnosed and then managed. Questions related to cancer in all areas of the head and neck were welcome.

Please note, Mr Simon Whitley no longer works at UCLH.

Below is a transcript of the webchat.

11:32 UCLH: 
Good morning and welcome to our web chat. We will begin at 12:00 noon, but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 12:00 noon.

Mr Simon Whitley will be joining us to take your questions on head and neck cancer and will try to answer as many questions as possible within the hour long web chat.
12:00 Mr Simon Whitley: 
Hello, I am Mr Simon Whitley, consultant oral and maxillofacial surgeon. I'm here and ready to answer your questions on head and neck cancer. Fire away.
12:00 [Comment From Niraj: ] 
Hello Mr Whitley, I have been diagnosed with mouth cancer by my consultant and he wants to do surgery to remove the lump. Is surgery the best treatment or should I insist on chemotherapy and radiotherapy first?
12:01 Mr Simon Whitley: 
Hi Niraj, sorry to hear about your diagnosis. The good news is that most of mouth cancers can be treated very effectively. The main ways of treating mouth cancer are with surgery, radiotherapy and sometimes a combination of both. Chemotherapy is sometimes used alongside radiotherapy to increase effectiveness.

It is difficult to answer exactly which is the best treatment without knowing the extent of the cancer. In most cases however, surgery is the most effective first line treatment. Your surgeon will be working alongside clinical oncologists (who provide radiotherapy and chemotherapy treatment) and your treatment plan will be discussed with you. Don’t be afraid to ask this question to them.
12:04 [Comment From Li-Wei: ] 
My father had very bad cancer in his throat. Does this make me more likely to get cancer too? He was a very heavy smoker and drinker.
12:04 Mr Simon Whitley: 
There are some cancers which have a strong genetic predisposition (that can be passed on from relatives). Head and neck cancer is not one of them. The most likely factors in your father developing cancer were his smoking and alcohol intake. There is a slight increase in the risk of you developing a cancer and the important thing is that you do not smoke.
12:10 [Comment From Alice: ] 
Dear Mr Whitley, what will my recovery from surgery for tongue cancer be like?
12:10 Mr Simon Whitley: 
Hi Alice, again it is difficult to answer this question without knowing the full extent of your surgery. The effects can vary from very mild impact on your speech and swallowing to much more significant long term problems.
Your surgeon will be able to discuss this with you in more detail. They will work as part of a multi-disciplinary team (MDT) which will include speech and language therapists, dietitians and nurse specialists and as well as removing the cancer their focus will be on rehabilitating you and getting your life back to normal – the best we can. Good luck with the treatment and again don’t be afraid to ask your team questions.
12:13 [Comment From Anna: ] 
I have a sarcoma in my lower jaw which they want to operate on. How much is this surgery likely to affect my appearance? Can the reconstructive surgery really make me look ‘normal’ again?
12:13 Mr Simon Whitley: 
Reconstructive surgery can be very effective. The team will be very mindful of making sure your appearance is as good as possible and also that your functions such as speech and swallowing are the best we can achieve. Inevitably there will be some scars, but these are placed carefully to minimise the effect. It may be that the reconstruction will involve microvascular surgery which involves moving tissue from one part of the body to recreate a new jaw bone. Your surgeon, I’m sure, will be happy to speak to you about this and don’t be afraid to voice your concerns. I think that all of us would have similar concerns about our appearance faced with surgery. Your nurse specialist will be able to give you good advice and support.
12:16 [Comment From Jeremy: ] 
I have had two white patches on the side of my tongue for about 3 months. Should I be worried that this is cancer? I am a 44 year old smoker.
12:17 Mr Simon Whitley: 
Hi Jeremy, a white patch inside the mouth is a sign that the lining has become thickened. In the majority of cases this can be something simple like where a tooth has been rubbing against it. However, in a small amount of cases it can be a sign of pre-cancerous changes and is definitely worthwhile getting it checked out. Your dentist will be able to help and either your doctor or dentist will be able to arrange a referral to a specialist.

I can’t resist the opportunity to tell you that you should think about giving up smoking though…
12:19 [Comment From Michelle: ] 
Thanks for answering these questions. I am a singer and rely on my throat. I have a lump at the back of my mouth where my throat begins. I have not seen a doctor because I’m scared I will need an operation. Could this be cancer? If I had an operation would it affect my voice or ability to swallow?
12:20 Mr Simon Whitley: 
Hi Michelle, it is much more likely that a lump at the back of the mouth is benign rather than cancerous, but again I would advise getting it checked out. If a lump needed removing, from where you describe it is, it’s unlikely that it would cause long term problems for your singing and ability to swallow. Of course, a bigger lump will require more extensive surgery so go and get things checked out.
12:24 [Comment From Jonathan: ] 
Hello, I’m going to be having surgery to remove cancer from my mouth and jaw bone. My consultant has talked about “reconstructive surgery” but I don’t know what this will mean?
12:24 Mr Simon Whitley: 
Reconstructive surgery can take many forms. This could be something simple using tissues within the mouth to something very complex such as microvascular surgery which can be rebuilding a jaw bone from tissues taken from elsewhere in the body (such as the lower leg or shoulder bone).

The aim is to restore function and appearance. Your surgeon will be able to explain this in better detail and again, your nurse specialist will be able to offer advice and support.
12:28 [Comment From Anonymous: ] 
Thanks for taking my question. I’m terrified of any kind of operation. Are there any clinical trials at UCLH I could try instead?
12:28 Mr Simon Whitley: 
Not all head and neck cancers have to be treated by surgery. If you have a head and neck cancer you will be looked after by a large team of specialists. Our job is to advise you on the best forms of treatment. You should be involved in the decision making.

You don’t have to be involved in a clinical trial to receive other treatments. Clinical trials are really important in improving the care and outcomes for people with head and neck cancer and if you are suitable for any trials your team will be keen to get you involved.

Don’t be afraid to ask questions and explain your worries. Your nurse specialist is a good person to speak to. I understand it can be quite intimidating meeting so many doctors.
12:32 [Comment From Eleanor: ] 
I am a gardener and spend all of my day outdoors. I am worried because I have heard that lots of sunlight causes cancer on your lips. Is there anything I can do to stop this happening?
12:32 Mr Simon Whitley: 
Hi Eleanor, you’re correct that sunlight can contribute to developing skin cancers. The face and particularly the lower lip are at higher risk as even in our climate we are exposed to quite a lot of UV light! One of the most effective ways of protecting your face is to wear a hat when gardening. A broad brimmed hat will provide cover for your face. Using lip balm with sunscreen is also a good idea. Very jealous that you get to spend all of your day outdoors!
12:37 [Comment From Imran: ] 
I know that after my operations I will have trouble speaking and swallowing. My nurse says that the speech and language therapists can help with this, but are there any longer term side effects I should know about?
12:38 Mr Simon Whitley: 
Hi Imran, it is difficult to give you precise information without knowing the extent of your treatment. There can be long term effects of surgery on your swallowing and speech. If you have radiotherapy as part of your treatment this can also have long term consequences, for instance a dry mouth.
Before you start your treatment your team will be able to give you an idea of the likely long term outcome. We are very mindful how important it is to get people’s function as best we can. Even after completing your treatment the team such as the speech and language therapist will be there to help.
12:41 [Comment From Anthony: ] 
I read in a newspaper that a lot of cancer now is caused by the HPV infection through oral sex. Is there anything I can do (apart from not having sex) to protect myself?
12:44 Mr Simon Whitley: 
Hi Anthony, this is an interesting question.

You are right that HPV (human papilloma virus) is sexually transmitted. In this day and age the vast majority of us who are sexually active are exposed to it. It is very strongly linked to cervical cancer in women and over the last decade or so it is apparent that it is also linked to some cancers of the head and neck. These are mainly at the back of the mouth and throat and in an area known as the oropharynx.

There is a lot of research and clinical trials ongoing and interestingly it appears that in people who have oropharyngeal cancer and HPV can have better outcomes.
It is important however that other factors are taken into consideration such as smoking and alcohol which still remain the most important risk factors.

There is a vaccination program for all teenage girls in the UK. For high risk groups it may be worthwhile considering vaccination. I’d suggest speaking to your GP in the first instance.

12:45 [Comment From Prakash: ] 
What sort of support services are available to uclh patients?
12:48 Mr Simon Whitley: 
We work as part of a large team to provide support for our patients. Have a look at our new head and neck cancer website. It has all the information you should need on who the team are and what they do. You can find the new head and neck cancer website here: www.uclh.nhs.uk/HeadAndNeck...
12:48 [Comment From Amara: ] 
Do you offer keyhole surgery? Thanks
12:48 Mr Simon Whitley: 
Keyhole surgery is often used to describe a technique called laparoscopic surgery where cameras and instruments are passed into the body through very small incisions. Generally for head and neck surgery this is not appropriate. We do use techniques to reduce incisions and scars (minimally invasive surgery). Operations are also carried out using endoscopes which are small cameras attached to the end of a tube. This allows us to operate on sites such as the inside of the nose and voice box through the mouth and nose without any external scars.
12:54 [Comment From Aleem: ] 
If I’m having surgery in my mouth will I need to have any ‘lymph nodes’ removed that you often hear people with cancer talking about? What does this mean?
12:54 Mr Simon Whitley: 
The lymphatic system drains fluid from tissues back into the blood stream. Lymph nodes are large collections of cells along these channels (a bit like stations along a railway line). They are there to help fight infections and inflammation. Unfortunately, cancer cells can also pass into these channels and can stay and grow within the lymph glands. This process is called metastasis.

As part of your investigations prior to treatment the team will have established whether this has happened in your case or you are at risk of it developing. We often undertake the removal of the lymph glands which are at risk and this is done using a procedure called a neck dissection. Your surgeon and team will be to explain this in more detail.
1:02 Mr Simon Whitley: 
That's our hour up! Thank you for all your questions, we hope you found it useful. Keep an eye on the new head and neck cancer website for updates and news within the team:


My final point would be to say that we realise how frightening it can be to have a diagnosis of head and neck cancer. It can be overwhelming at times. Don't be afraid to ask questions. All of the team are here to help. Your clinical nurse specialist is a great point of contact and source of support.

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