Symptoms of head and neck cancer

Presenting clinical features/ what brings the patient to the doctor. The presenting symptom that brings the patient to the doctor depends on the site of the primary tumour. If the tumour arises in the larynx, then the patient usually presents with a hoarse voice (a symptom that should never be ignored if it persists and requires a laryngoscopy). If the patient has a cancer in the mouth then he may present with a lump or an ulcer – for example on the tongue or in the floor of the mouth. If the cancer arises in the pharynx then the patient may complain of pain or difficulty in swallowing or where the primary tumour arises in the nasopharynx, nasal obstruction or pain referred to the ear may cause the patient to come to the doctor. Sometimes and this is most frequent with nasopharyngeal primary tumours, the patient may present because he has developed a lump/node mass in the neck.

 

It is a general truth that most head and neck primary tumours spread to neck nodes as their first ‘port of call’ after they leave the primary site, and only later to more distant sites, notably next the lungs. In nasopharynx cancer, the neck nodes are involved relatively early and sometimes the patient presents to the doctor with large lumps in the neck nodal chain(s) and yet a relatively small primary tumour in the nasophaynx itself.