Head and Neck Cancer: Know the Warning Signs 

A mouth ulcer that is not healing. A small lump in the neck. A change in your voice. Difficulty swallowing. Blood coming from the mouth or nose.

It is easy to think, “It is probably nothing. I will wait for a few more days.”

Most of the time, these symptoms are indeed caused by conditions other than cancer. But when a symptom does not go away, keeps coming back, or gradually becomes worse, I would rather have you get it checked than continue waiting.

Head and neck cancers can develop in the mouth, tongue, gums, throat, tonsils, voice box, nose, sinuses and salivary glands. 

The important message is simple:

Do not panic about every symptom—but do not ignore a persistent one either.

What symptoms should you watch for?

1. A mouth ulcer that does not heal

Almost everyone develops a mouth ulcer occasionally. Most ordinary ulcers heal.

But please consult a doctor or dentist if you have:

• An ulcer or sore that does not heal

• An ulcer that gradually becomes larger

• Repeated bleeding from the area

• Persistent pain or burning

• A growth or thickened area inside your mouth

2. A white or red patch inside your mouth

Look occasionally at your tongue, gums, cheeks and floor of the mouth.

A persistent white patch, red patch or mixed red-and-white patch deserves examination—particularly if you use tobacco, gutkha, mawa, khaini or other chewing products. 

Do not try to diagnose the patch yourself from photographs on the internet. Let a doctor examine it.

3. Difficulty opening your mouth

If you notice that your mouth is gradually opening less than before, especially if you regularly chew tobacco, gutkha, mawa or areca nut/supari, please get examined.

You may first notice this while eating, brushing your teeth or trying to put several fingers between your teeth.

Progressively decreasing mouth opening should not simply be accepted as a normal effect of chewing tobacco or supari.

4. A lump or swelling in your neck

A neck swelling can occur for many reasons, including infections.

However, a persistent or enlarging neck lump, particularly in an adult, needs medical evaluation.

Sometimes a cancer beginning in the tonsil, base of tongue or another part of the throat may first become noticeable because of a lump in the neck. 

5. Difficulty or pain while swallowing

Please pay attention if:

• Food seems to get stuck

• Swallowing becomes progressively difficult

• Swallowing is painful

• You repeatedly cough or choke while eating

• You constantly feel that something is stuck in your throat

Persistent swallowing difficulty is an important head and neck cancer warning symptom. 

6. Persistent change in your voice

A temporary hoarse voice during a cold or throat infection is common.

But if your voice remains hoarse or different for weeks, particularly if you smoke or use tobacco, it needs examination.

The voice box, or larynx, is one of the sites where head and neck cancer can develop. 

7. Persistent sore throat or unexplained ear pain

Sometimes the problem is in the throat even though you feel pain in the ear.

Please consult a doctor if you have:

• Persistent throat pain

• Persistent pain while swallowing

• Unexplained pain in one ear

• Ear pain associated with difficulty swallowing or a neck swelling

These symptoms do not automatically mean cancer, but persistent symptoms need evaluation. 

8. Unexplained bleeding

Repeated or unexplained:

• Bleeding from the mouth

• Blood in saliva

• Nosebleeds

• Bleeding from a mouth ulcer or growth

should be investigated, especially if accompanied by another persistent symptom. 

9. Persistent blocked nose or sinus symptoms

Cancer of the nose and sinuses is much less common, but warning symptoms can include:

• Persistent blockage, particularly on one side

• Repeated nosebleeds

• Sinus symptoms that do not improve with appropriate treatment

• Facial pain or swelling

• Swelling around the eye

• Persistent upper-tooth pain 

10. Unexplained weight loss

Weight loss can have many causes. But unintentional weight loss, particularly together with difficulty swallowing, persistent mouth/throat symptoms or a neck lump, should be discussed with your doctor.

Who is at higher risk?

Having a risk factor does not mean that you will definitely develop cancer. Similarly, someone without obvious risk factors can still develop cancer.

But some factors clearly increase the risk.

Tobacco is one of the biggest risk factors

This includes:

• Cigarettes

• Bidis

• Cigars

• Hookah

• Chewing tobacco

• Gutkha

• Mawa

• Khaini and other smokeless tobacco products

Both smoked and smokeless tobacco are associated with head and neck cancers. 

There is no “safe” tobacco product for your mouth and throat.

Alcohol

Alcohol increases the risk of cancers of the mouth, throat and voice box. Using both tobacco and alcohol increases the risk further. 

All alcoholic beverages can contribute to cancer risk; changing from one type of alcohol to another does not remove that risk. 

Supari/areca nut and tobacco-containing chewing products

Do not assume that something is harmless simply because it is chewed rather than smoked.

If you use gutkha, mawa, tobacco or similar products and notice burning while eating spicy food, stiffness inside the mouth or progressively reduced mouth opening, get examined.

HPV infection

For cancers of the tonsils and base of the tongue.

This is important because a person can develop HPV-associated throat cancer even without the traditional history of tobacco use. 

Other risk factors

Depending on the particular type of head and neck cancer, risk may also be influenced by increasing age, ultraviolet exposure for lip cancer, certain occupational exposures and Epstein-Barr virus infection for particular cancers. 

When should you consult a doctor?

You do not need to assume cancer whenever you develop an ulcer or sore throat.

But please arrange an examination if a suspicious symptom:

persists for around 2–3 weeks, repeatedly returns, progressively worsens, or has no satisfactory explanation.

And do not wait for 2–3 weeks if you have something clearly concerning such as an enlarging neck lump, significant bleeding, increasing difficulty swallowing or breathing, rapidly increasing swelling, or severe deterioration.

You may need evaluation by a dentist, ENT specialist, head-and-neck surgeon, oral surgeon or oncologist depending on the problem.

Remember:

Pain is not required for cancer to be present.

A painless lump or painless mouth lesion can still require investigation.

“I use tobacco, but I find it very difficult to stop.”

Tell me.

Do not hide your tobacco use because you are worried that I will judge you.

Nicotine dependence is an addiction, and treatment is available.

You do not necessarily have to quit through willpower alone.

Options for de-addiction

Treatment may include:

• Behavioural counselling — identifying triggers, planning a quit date and learning how to handle cravings.

• Nicotine-replacement therapy — such as nicotine gum when medically appropriate.

• Tobacco Cessation Centres — counselling and pharmacological treatment are available.

If you have tried to quit before and restarted, that does not mean treatment has failed permanently. Tobacco dependence commonly requires repeated attempts and continued support.

One message I want you to remember

Do not wait for a mouth lesion to become very large or painful before showing it to a doctor.

Do not wait until swallowing becomes impossible.

Do not wait until a small neck swelling becomes a large one.

And do not avoid consultation because you are frightened that it might be cancer.

Many of these symptoms will ultimately have a non-cancerous explanation. But if cancer is present, earlier diagnosis generally gives us more treatment options and a better opportunity to treat it effectively.

So if something in your mouth, throat, neck, voice or swallowing does not feel right and is not going away, get it examined.

Checking it does not mean you have cancer.
It means you are taking the symptom seriously.