Head and Neck Tumours: questions and answers

In detail

The evaluation covers a wide range of conditions because head and neck cancers arise from the mucosal epithelium of the upper aerodigestive tract, including the oral cavity, pharynx, and larynx. Thyroid nodules are common and most are benign, but a biopsy helps rule out cancer.

Salivary gland masses may be inflammatory or neoplastic. Risk factors such as tobacco, alcohol, and human papillomavirus (HPV) infection guide the clinical suspicion.

The service uses ultrasound-guided fine needle aspiration cytology (FNAC) for thyroid and neck nodes, flexible nasopharyngolaryngoscopy for direct visualisation, and contrast-enhanced CT or MRI for deep space staging.

In detail

Most head and neck cancers start in the mucosal lining of the oral cavity, pharynx, and larynx. Tobacco and alcohol use are major risk factors for these cancers. HPV infection, especially HPV-16, is increasingly linked to oropharyngeal cancers.

Thyroid nodules are very common; studies show 60 to 70 percent of biopsies are benign and only about 5 percent are cancerous, but a specialist must confirm this. Salivary gland masses can be tumours or infections. Early assessment allows timely biopsy or imaging, which improves treatment options.

In detail

Airway compromise is a life-threatening emergency. Large tumours in the larynx or pharynx, or a rapidly expanding haematoma or infection, can block the airway within hours. Stridor is a high-pitched sound caused by turbulent airflow through a narrowed airway and signals critical narrowing.

Massive bleeding may arise from tumour erosion into the carotid artery (carotid blowout). The hospital's 24×7 emergency department and ICU are equipped to secure the airway and stabilise you before any definitive tumour workup. Routine outpatient evaluation is for stable symptoms that have persisted for weeks.

In detail

The consultation follows a structured approach. The surgeon asks about symptom duration, tobacco and alcohol use, and any previous treatments. A thorough clinical examination includes palpation of the neck nodes, oral cavity inspection, and cranial nerve assessment.

Flexible nasopharyngolaryngoscopy is a key technique; a thin flexible scope passes through the nose to examine the nasopharynx, oropharynx, hypopharynx, and larynx. This takes a few minutes and uses topical anaesthesia.

If a thyroid nodule or neck node is felt, an ultrasound-guided FNAC may be offered the same day under local anaesthesia. The multidisciplinary tumour board reviews complex cases later to finalise a joint plan.

In detail

Test choice follows clinical reasoning. Ultrasound-guided FNAC is the first-line test for thyroid nodules and accessible neck nodes because it is minimally invasive and gives a cytology diagnosis. Flexible nasopharyngolaryngoscopy provides direct visualisation of the upper aerodigestive tract mucosa where most cancers arise.

If the examination suggests a deep space lesion, submucosal extension, or nodal involvement beyond what the scope shows, cross-sectional imaging with contrast-enhanced CT or MRI is ordered.

The 2017 AJCC/UICC staging system incorporates HPV status for oropharyngeal cancers, so biopsy tissue may be tested for HPV. Molecular testing on indeterminate thyroid biopsies can reduce unnecessary surgery. The multidisciplinary tumour board reviews all results to recommend the next step.

In detail

The care pathway branches at each result. For thyroid nodules, about 60 to 70 percent of biopsies are benign, 5 percent malignant, and 25 to 35 percent indeterminate. Benign nodules are usually watched with serial ultrasounds.

Indeterminate cases may get molecular testing for gene mutations to guide surgery decisions. Malignant cytology leads to staging with CT or MRI and tumour board discussion.

For head and neck squamous cell cancer, HPV status from the biopsy changes prognosis and treatment; HPV-positive oropharyngeal cancers have better survival with radiotherapy plus cisplatin.

The tumour board considers tumour size, location, stage, HPV status, and your fitness to recommend surgery, radiotherapy, chemoradiotherapy, or a combination. Palliative surgery may be advised for symptom relief in advanced disease.

In detail

The treatment algorithm follows established guidelines. Early-stage oral cavity cancers (Stage I or II) are often treated with surgery first, followed by radiotherapy or chemoradiotherapy based on pathology. Pharynx and larynx cancers frequently receive primary chemoradiotherapy to preserve organ function.

HPV-positive oropharyngeal cancer has high survival with radiotherapy plus cisplatin. For HPV-negative disease or patients unfit for chemotherapy, cetuximab with radiation is an alternative. Recurrent or metastatic disease may receive immunotherapy such as pembrolizumab or targeted agents like lenvatinib for thyroid cancer.

Reconstructive surgery restores appearance and function after major resections. Endoscopic approaches can reduce recovery time for selected throat and nasal tumours. Palliative surgery relieves obstruction or pain when heal is not possible.

In detail

Studies show 60 to 70 percent of thyroid biopsies are benign, so observation is common. For indeterminate nodules with low cancer probability, the doctor may continue monitoring rather than operate. Molecular testing reduces unnecessary surgeries. In advanced thyroid cancer, lenvatinib is an oral targeted medicine.

For head and neck cancer survivors, rehabilitation by physiotherapists and speech therapists helps restore function. Lifestyle change is critical: tobacco and alcohol drive many of these cancers, and continued use worsens outcomes. HPV vaccination may prevent future pharynx cancers. The team coordinates all these aspects through the tumour board and supportive care services.

In detail

Surgery is typically indicated for early-stage cancers (Stage I or II) that are amenable to complete resection, or when a tumour causes significant symptoms such as difficulty swallowing, breathing issues, or severe pain that need relief.

The specific cancer type, such as squamous cell carcinoma, and the patient's overall fitness for anaesthesia also guide the decision. If previous chemotherapy or radiation has not controlled the disease, an operation may be recommended to remove residual cancerous tissue.

The tumour board reviews imaging, pathology, and clinical status together to ensure the plan balances cancer control with function preservation.

In detail

For a fine needle aspiration biopsy under local anaesthesia, you can resume normal activities the same day. The bandage stays on for about four hours and you should keep the area dry for 24 hours.

After major tumour resection, neck dissection, or reconstructive surgery, hospital stay is longer and recovery takes weeks. Swallowing, speech, and breathing may need rehabilitation. Chemoradiotherapy side effects such as fatigue, mucositis, and skin reaction peak during treatment and improve over several weeks after completion.

HPV-positive oropharyngeal cancers treated with radiotherapy plus cisplatin show high survival in studies, but functional recovery varies. The multidisciplinary team at Jaipur Hospital coordinates supportive care including nutrition, physiotherapy, and speech therapy to help you regain function.

In detail

After biopsy, mild discomfort or bruising is common and usually settles with paracetamol and ice packs. However, signs of infection such as increasing redness, warmth, or pus at the site need medical review.

After major surgery or chemoradiotherapy, late effects can include fibrosis, hypothyroidism, or recurrence. Studies show that treatment-related adverse events vary by therapy; for example, hypothyroidism is common with pembrolizumab while fatigue is frequent with standard chemoradiation.

Regular surveillance with imaging and clinical examination is part of the follow-up protocol. The tumour board at Jaipur Hospital reviews any new findings and adjusts the management plan. Do not wait for the next scheduled visit if something feels wrong.

In detail

After ultrasound-guided FNAC, you can resume normal activities the same day. Major resections involving the jaw, larynx, or pharynx may affect speech, swallowing, and breathing, requiring rehabilitation before returning to physically demanding jobs.

Studies report that indirect expenditure during radiotherapy, including travel and lost wages, averaged INR 18,588. Fatigue, mucositis, and skin reactions during chemoradiotherapy limit exercise capacity. Air travel may be restricted after recent surgery due to air pressure changes affecting healing tissues.

The multidisciplinary team at Jaipur Hospital provides guidance on activity modification, dietary needs, and speech therapy to support functional recovery. Financial counselling is available regarding scheme coverage such as RGHS, MAA Yojana, CGHS, and private insurers.

In detail

Both spellings describe abnormal growths arising in the oral cavity, pharynx, larynx, thyroid, salivary glands, and other structures of the head and neck region. Most head and neck cancers are derived from the mucosal epithelium lining these areas.

The medical evaluation, staging, and treatment options are identical regardless of spelling. The American Thyroid Association guidelines and the AJCC/UICC staging system apply equally.

At Jaipur Hospital, the multidisciplinary tumour board evaluates neck lumps, thyroid nodules, salivary masses, and cancer screening using the same protocols whether the referral letter uses "tumour" or "tumour".

The techniques offered include ultrasound-guided FNAC, flexible nasopharyngolaryngoscopy, contrast-enhanced CT or MRI neck, and joint surgical, radiation, and medical oncology planning.

In detail

Type refers to the cell of origin, such as squamous cell carcinoma, adenocarcinoma, or thyroid cancer subtypes. Grade describes how abnormal the cells look under the microscope and how quickly they may grow.

Stage combines tumour size (T), lymph node involvement (N), and distant spread (M) into an overall category from I to IV. The 2017 AJCC/UICC system incorporates additional information relevant to HPV-positive disease, which has a better prognosis.

Early-stage cancers (Stage I or II) are often more amenable to surgical removal. Treatment is generally multimodal: surgery followed by chemoradiotherapy for oral cavity cancers, and primary chemoradiotherapy for pharynx and larynx cancers.

HPV-positive oropharyngeal carcinoma treated with radiotherapy plus cisplatin shows high survival in studies. The multidisciplinary tumour board at Jaipur Hospital integrates type, grade, stage, and HPV status to recommend the most appropriate sequence of surgery, radiation, and systemic therapy.

In detail

Staging follows the tumour-node-metastasis (TNM) system updated by the 2017 AJCC/UICC guidelines. Contrast-enhanced CT or MRI neck provides cross-sectional staging for deep space lesions and lymph node involvement. Flexible nasopharyngolaryngoscopy visualises the upper aerodigestive tract for mucosal spread.

For thyroid cancer, ultrasound of the neck and chest imaging may be used. PET-CT is considered for advanced stages or when distant metastasis is suspected. Blood tests such as thyroglobulin for differentiated thyroid cancer or HPV-related biomarkers for oropharyngeal cancer add information.

The multidisciplinary tumour board at Jaipur Hospital reviews all staging investigations together to assign an accurate stage and plan treatment. Studies show that traditional staging has been supplemented by the 2017 system which incorporates HPV status for oropharyngeal disease.

In detail

The tumour board follows a structured approach used in major cancer centres. Each case is presented with clinical findings, imaging reports, and pathology slides.

Specialists then discuss the optimal sequence of treatment, weighing factors such as tumour location, stage, HPV status where relevant, and the patient's overall health. Evidence from studies shows that multidisciplinary discussion improves treatment coordination and can reduce delays between diagnosis and the start of therapy.

The board also considers whether the patient may be eligible for clinical trials or targeted therapies based on molecular profiling.

In detail

Treatment intent is guided by established protocols. For localised tumours, surgery or radiotherapy aims for local control. For locally advanced disease, combined modality treatment such as surgery followed by chemoradiotherapy or primary chemoradiotherapy is standard.

In recurrent or metastatic settings, systemic therapy with chemotherapy, targeted agents, or immunotherapy may be used to slow progression and manage symptoms. Studies show that HPV-positive oropharyngeal cancers have higher survival rates with radiotherapy plus cisplatin.

The tumour board tailors the approach to balance tumour control with functional outcomes, considering factors like tumour biology, patient fitness, and organ preservation.

In detail

A neck lump in an adult is considered suspicious until proven otherwise. Common causes include reactive lymph nodes, thyroid nodules, salivary gland tumours and metastatic deposits from mucosal cancers. Ultrasound helps characterise the lump as solid, cystic or vascular.

FNAC provides a cytological diagnosis with minimal discomfort under local anaesthesia. Evidence shows most thyroid nodules are benign, but 5 percent of biopsies return malignant and 25 to 35 percent are indeterminate, sometimes requiring molecular testing or repeat biopsy.

Early evaluation allows timely staging and treatment planning if cancer is found. Delaying assessment can lead to upstaging and more extensive treatment.

In detail

Salivary gland tumours are uncommon but the parotid is the most frequent site. About 80 percent of parotid tumours are benign, most often pleomorphic adenoma, but they can grow and carry a small risk of malignant transformation.

Submandibular gland tumours have a higher proportion of malignancy. Ultrasound or MRI defines the extent and relationship to the facial nerve. FNAC guides the surgical plan. Surgery typically involves superficial or total parotidectomy with facial nerve preservation, or submandibular gland excision.

The decision for surgery depends on the tumour type, size, and risk features. Early surgical removal of benign tumours prevents growth and reduces the complexity of later surgery.

• About 80 percent of parotid tumours are benign, most often pleomorphic adenoma, but they can grow and carry a small risk of malignant transformation.

In detail

Laryngeal cancer typically presents with voice change because the vocal cords are affected early. Flexible nasopharyngolaryngoscopy in the clinic provides a direct view of the larynx and helps stage the tumour. Biopsy under anaesthesia confirms the diagnosis.

Treatment depends on stage: early glottic cancers (T1-T2) are often treated with radiotherapy alone or transoral laser surgery, both aiming for voice preservation. Advanced tumours may require partial or total laryngectomy, sometimes with chemoradiotherapy.

Studies show HPV-positive oropharyngeal cancers have better outcomes with radiotherapy plus cisplatin. The multidisciplinary tumour board at Jaipur Hospital reviews each case to balance cancer control with speech and swallowing function.

In detail

Tumours in the nasopharynx can block the Eustachian tube causing hearing loss or middle ear effusion. Skull base involvement may affect cranial nerves controlling balance, facial movement, swallowing or tongue function.

Oropharyngeal and laryngeal tumours can narrow the airway, impair vocal cord mobility and cause aspiration. Oral cavity tumours may restrict tongue movement affecting speech articulation and swallowing. Large neck masses can compress the trachea or oesophagus.

Treatment itself such as surgery, radiotherapy or chemoradiotherapy can cause temporary or long-term changes in these functions. The multidisciplinary team aims to select approaches that preserve function while achieving disease control. Baseline assessment by speech-language pathologists and audiologists is often part of the workup.

In detail

These symptoms are recognised red flags for head and neck malignancy. Hoarseness suggests vocal cord involvement. A neck lump in an adult is metastatic until proven otherwise. Dysphagia or odynophagia may indicate oropharyngeal or hypopharyngeal growth.

Referred ear pain often comes from base of tongue or laryngeal lesions via shared nerve pathways. Haemoptysis signals mucosal erosion. Stridor or dyspnoea suggests airway compromise. Oral ulcers that persist beyond two weeks need biopsy.

Tobacco and alcohol users and those with HPV exposure are at higher risk. Early detection allows less radical treatment and better functional outcomes. Delayed presentation is a major reason for advanced stage at diagnosis in India.

In detail

Costs vary widely based on the stage, treatment modality, and hospital setting. Published data from India show that the average out-of-pocket expenditure for head and neck cancer patients is around ₹37,845 at six months, but this rises significantly with multimodal treatment.

Surgery followed by radiotherapy or chemoradiotherapy incurs the highest drug and consumable costs (24 to 37 percent of total). Radiotherapy alone costs approximately ₹31,000 to ₹42,000 depending on technique (2D vs IMRT). Travel and indirect expenses add substantially, especially for patients travelling from outside Jaipur.

Jaipur Hospital is empaneled under RGHS, MAA Yojana, CGHS, and several private insurers and TPAs, which can reduce out-of-pocket expenditure. The hospital provides estimates after the tumour board finalises the treatment plan.

In detail

The estimate covers the 30 to 45 minute consultation with our surgical team. If the surgeon advises an ultrasound-guided FNAC, flexible nasopharyngolaryngoscopy, or contrast-enhanced CT or MRI neck, those investigations carry their own charges.

A multidisciplinary tumour board review, if needed, is also a separate cost. The final bill depends on the specific diagnostic steps your case needs, which the surgeon decides after examining you.