Head and Neck Cancer Treatment in Sydney

Head and neck cancer encompasses a group of cancers that develop in the mouth, throat, voice box (larynx), nose, sinuses or salivary glands. Most are squamous cell carcinomas linked to tobacco use, alcohol consumption or human papillomavirus (HPV) infection. Early diagnosis by an ENT specialist significantly improves outcomes.

What Is Head and Neck Cancer?

Head and neck cancers are classified by their site of origin. The major subsites include:

Oral cavity: cancers of the tongue, floor of mouth, gums, palate and inner cheek lining
Oropharynx: cancers of the tonsils and base of tongue, frequently HPV-related
Hypopharynx: cancers of the lower throat behind the voice box
Larynx: cancers of the voice box affecting speech and breathing
Nasopharynx: cancers of the upper part of the throat behind the nose
Nasal cavity and sinuses: cancers arising within the nose or paranasal sinuses
Salivary glands: cancers of the parotid, submandibular or minor salivary glands

In Australia, approximately 5,500 people are diagnosed with head and neck cancer each year. While historically more common in older men who smoke and drink, HPV-related oropharyngeal cancer is increasingly seen in younger non-smoking adults.

Symptoms of Head and Neck Cancer

Symptoms depend on where the cancer is located but commonly include:

A persistent sore throat lasting more than three weeks
A non-healing ulcer in the mouth or on the tongue
Difficulty swallowing (dysphagia) or painful swallowing (odynophagia)
Persistent hoarseness or voice change lasting more than three weeks
A lump in the neck that does not resolve
One-sided nasal obstruction or blood-stained nasal discharge
Unexplained ear pain, particularly on one side
Unexplained weight loss
Numbness or weakness of the face, tongue or jaw

Any of these symptoms persisting beyond three weeks should prompt an urgent GP referral to an ENT specialist. Early-stage cancers are far more treatable and have significantly better outcomes than late-stage disease.

Causes and Risk Factors

The major risk factors for head and neck cancer include:

Tobacco use: cigarette smoking, cigar smoking, pipe smoking and chewing tobacco all significantly increase risk
Alcohol consumption: heavy drinking compounds the risk, especially when combined with tobacco use
Human papillomavirus (HPV): HPV-16 is strongly linked to oropharyngeal cancers of the tonsils and base of tongue
Epstein-Barr virus (EBV): associated with nasopharyngeal carcinoma, more common in Southeast Asian populations
Betel nut chewing: a significant risk factor in South Asian and Pacific Island populations
Occupational exposure: wood dust, nickel, asbestos and formaldehyde are linked to sinonasal cancers
Sun exposure: a risk factor for lip cancer, particularly in outdoor workers

Diagnosis

At Central Sydney ENT, our head and neck surgeons follow a structured diagnostic pathway:

Clinical examination: A thorough examination of the mouth, throat, neck, nose and ears. This includes flexible nasendoscopy (a thin camera passed through the nose) to visualise the throat and voice box directly in the clinic.

Biopsy: A tissue sample is obtained for histological examination. This may be performed in the clinic, under local anaesthesia, or as a formal examination under anaesthesia (panendoscopy) in hospital.

Imaging: CT scan of the head, neck and chest, MRI of the primary site, and PET-CT scan are used to determine the extent of disease and whether it has spread to lymph nodes or distant sites.

HPV testing: For oropharyngeal cancers, p16 immunohistochemistry is performed on the biopsy specimen to determine HPV status, which has important implications for treatment and prognosis.

Multidisciplinary team discussion: All cases are presented at a multidisciplinary head and neck tumour board meeting attended by ENT surgeons, radiation oncologists, medical oncologists, radiologists, pathologists, speech pathologists and dietitians to formulate the optimal treatment plan.

Treatment Options

Treatment is tailored to the cancer's site, stage, HPV status and the patient's overall health. Options include:

Surgery

Surgical excision is the primary treatment for many oral cavity cancers and selected throat, laryngeal and salivary gland cancers. This may include removal of the primary tumour, neck dissection to remove involved lymph nodes, and reconstructive surgery when needed. Minimally invasive approaches such as transoral robotic surgery (TORS) and transoral laser microsurgery are used where appropriate to reduce morbidity.

Radiotherapy

Radiation therapy uses high-energy beams to destroy cancer cells. It may be used as primary treatment (particularly for early laryngeal and nasopharyngeal cancers), as adjuvant treatment after surgery, or in combination with chemotherapy for advanced disease.

Chemoradiotherapy

For advanced-stage cancers, chemotherapy (typically cisplatin) is given concurrently with radiotherapy to enhance the radiation effect. This is the standard treatment for many advanced oropharyngeal, hypopharyngeal and nasopharyngeal cancers.

Immunotherapy

Immune checkpoint inhibitors such as pembrolizumab and nivolumab are now available for recurrent or metastatic head and neck squamous cell carcinoma. These medications help the body's immune system recognise and attack cancer cells.

Our head and neck surgical oncologists, including Dr Alexander Zhang, Dr Arjuna Ananda, Dr Jareen Ebenezer and Dr Sam Hwang, work within multidisciplinary teams at major Sydney teaching hospitals to deliver comprehensive cancer care.

When to See an ENT Specialist

Seek an urgent referral to an ENT specialist if you experience:

A persistent sore throat, hoarseness or mouth ulcer lasting more than three weeks
A new lump in the neck that has not resolved after three weeks
Difficulty swallowing that is worsening over time
Unexplained one-sided ear pain or nasal symptoms
Unexplained weight loss alongside any of the above symptoms
A suspicious lesion identified by your GP or dentist

Related Conditions

Head and neck cancer is related to several other conditions managed at Central Sydney ENT:

Skin Cancer of the Head and Neck: cutaneous malignancies requiring specialist surgical excision and reconstruction
Parotid Tumours: salivary gland tumours requiring surgical management with facial nerve preservation
Neck Lumps: a neck lump can be the first presentation of head and neck cancer and requires thorough investigation

Common Questions

Head and Neck Cancer FAQ

What are the early warning signs of head and neck cancer? +

Early warning signs include a persistent sore throat lasting more than three weeks, a lump in the neck that does not resolve, difficulty or pain when swallowing, persistent hoarseness or voice change, a non-healing mouth ulcer, one-sided nasal blockage with blood-stained discharge, or unexplained ear pain. Any of these symptoms persisting beyond three weeks warrants urgent specialist review.

What causes head and neck cancer? +

The main risk factors are tobacco use (smoking and chewing), heavy alcohol consumption, and human papillomavirus (HPV) infection, particularly HPV-16. HPV-related oropharyngeal cancer is increasing in younger non-smoking adults. Other risk factors include betel nut chewing, occupational exposures such as wood dust and nickel, and previous radiation to the head and neck.

How is head and neck cancer treated? +

Treatment depends on the cancer's location, stage and type. Options include surgery to remove the tumour, neck dissection to remove involved lymph nodes, radiotherapy, combined chemoradiotherapy, and immunotherapy. Most patients are managed by a multidisciplinary team including ENT surgeons, radiation oncologists, medical oncologists, speech pathologists and dietitians.

What is HPV-related head and neck cancer? +

HPV-related head and neck cancer, primarily oropharyngeal squamous cell carcinoma, is caused by the human papillomavirus rather than smoking or alcohol. It typically affects the tonsils and base of tongue, tends to occur in younger adults, and generally has a better prognosis than HPV-negative cancers. HPV vaccination is expected to reduce rates of this cancer in coming decades.

Does Central Sydney ENT treat head and neck cancer? +

Yes. Central Sydney ENT has fellowship-trained head and neck surgical oncologists who diagnose and surgically manage cancers of the mouth, throat, voice box, nose, sinuses and salivary glands. Our surgeons participate in multidisciplinary tumour board meetings and coordinate care with radiation and medical oncology teams across Sydney.