Head and neck cancer treatment depends on where the cancer started, how far it has spread, and how treatment could affect speech, swallowing, or breathing. Surgery is often the first treatment for an operable mouth cancer, while radiation may be the main treatment for certain throat and voice box cancers. Chemotherapy can improve the effect of radiation in selected patients. If cancer returns or spreads to distant organs, immunotherapy, chemotherapy, and targeted therapy may be considered based on the cancer type, previous treatment, and biomarker results.
By Dr Raman Narang, Consultant Medical & Hemato-Oncologist, New Delhi
Two people may both be told they have “tongue cancer” and receive very different treatment plans. A tumour in the front of the tongue is an oral cavity cancer. A tumour at the base of the tongue is an oropharyngeal cancer, where HPV testing can affect staging and the discussion about treatment. If you are seeking head and neck cancer treatment in Delhi, start by asking your team to name the exact site and explain why it recommends a particular treatment first.
What are the symptoms of head and neck cancer?
Symptoms depend on where the cancer starts. A sore inside the cheek is easier to see than a tumour deeper in the throat, where a neck lump or persistent ear pain may be the first sign.
| Where symptoms appear | Changes that warrant assessment |
|---|---|
| Mouth, tongue, or inner cheek | An ulcer that does not heal, a persistent red or white patch, unexplained bleeding, a lump, or difficulty opening the mouth |
| Throat or neck | A persistent neck lump, pain or difficulty swallowing, a persistent sore throat, or unexplained pain in one ear |
| Voice box | Persistent hoarseness, a change in voice, or increasing difficulty breathing |
| Nose or sinuses | Persistent blockage on one side, repeated nosebleeds, or facial swelling |
| Salivary glands | A lump near the ear, under the jaw, or inside the mouth, especially if it is growing or accompanied by facial weakness |
These symptoms can have several causes. A mouth ulcer that persists for around three weeks, unexplained neck swelling, or ongoing hoarseness should be examined. Seek urgent medical care for significant breathing difficulty or heavy bleeding.
What are the risk factors, and which type of cancer do I have?
In India, a risk assessment includes smoked tobacco, smokeless tobacco, and areca nut. Cigarettes, bidis, and chewing tobacco increase risk. Areca nut, commonly called supari, also increases oral cancer risk when used in products without tobacco. Alcohol adds to the risk, particularly when combined with tobacco. Certain high-risk types of HPV are associated with cancers of the tonsil and base of the tongue. Epstein–Barr virus is associated with some nasopharyngeal cancers.
| Type | Where it starts |
|---|---|
| Oral cavity cancer | The front of the tongue, inner cheek, gums, floor of the mouth, or hard palate |
| Oropharyngeal cancer | The tonsils, base of the tongue, soft palate, or nearby throat |
| Laryngeal cancer | The voice box, including the vocal cords |
| Hypopharyngeal cancer | The lower throat around and behind the voice box |
| Nasopharyngeal cancer | The upper throat behind the nose |
| Sinonasal or salivary gland cancer | The nasal cavity, sinuses, or salivary glands. Treatment depends heavily on the specific tumour subtype. |
Many cancers of the mouth, throat, and voice box are squamous cell carcinomas. A biopsy confirms the diagnosis. Examination, endoscopy, and imaging such as CT or MRI help determine the extent of disease. PET-CT may be used when it can answer a staging or treatment-planning question. In oropharyngeal squamous cell carcinoma, p16 testing is commonly used to assess HPV association and helps determine the stage.
How is early-stage head and neck cancer treated?
Early-stage disease can often be treated with one main treatment, with the aim of cure. The choice depends on the site and what each option is likely to mean for function.
- Early oral cavity cancer. Surgery is often the first step for a removable cancer of the tongue, cheek, or gums. The surgeon may also recommend assessing or treating lymph nodes in the neck, depending on the tumour.
- Early vocal cord cancer. Selected patients may be offered focused radiation or surgery through the mouth. The decision includes what each option may mean for voice quality and how treatment would be delivered.
- Selected early oropharyngeal cancers. Radiation or surgery may be appropriate. Before choosing surgery, the team considers how likely the final pathology is to lead to additional radiation or chemoradiation. That possibility matters when comparing the overall effect on swallowing and recovery.
What are the roles of surgery, radiation, and chemotherapy in locally advanced cancer?
Locally advanced head and neck cancer may involve nearby structures, lymph nodes in the neck, or both. It can still be treated with the aim of cure. The team first determines whether the cancer can be removed safely and what surgery, radiation, or a combination would mean for function.
| Treatment | What it does and when it is used |
|---|---|
| Surgery | Removes the primary tumour and, when indicated, lymph nodes in the neck. It often leads the plan for operable oral cavity cancer. Reconstruction and rehabilitation may help restore speech, swallowing, and appearance. |
| Radiation therapy | Treats the tumour and selected areas of the neck. It may be the main treatment for certain throat or voice box cancers. After surgery, it may be advised to reduce the risk of recurrence when the pathology shows features that increase that risk. |
| Chemotherapy during radiation | Commonly given with cisplatin in eligible patients, it can improve the effectiveness of radiation. After surgery, concurrent chemotherapy is particularly relevant if cancer is present at a surgical margin or has grown through the capsule of a lymph node, called extranodal extension. |
| Chemotherapy before local treatment | Sometimes called induction chemotherapy, it has a role in specific situations. Its use depends on the cancer site and what the team aims to achieve before surgery or radiation. |
The decision about voice box preservation includes how well the larynx is working before treatment. Chemoradiation may preserve the larynx in selected patients. Surgery may be recommended when tumour extent or poor baseline function makes that approach unsuitable. Ask what each option is likely to mean for breathing, voice, and swallowing after recovery.
For some adults with resectable, locally advanced head and neck squamous cell carcinoma and a PD-L1 combined positive score (CPS) of at least 1, the KEYNOTE-689 trial supports a pembrolizumab regimen that starts before surgery and continues afterward with the planned postoperative treatment. The US FDA approved this approach in 2025. For care in Delhi, the team should verify the applicable Indian prescribing indication and access before recommending it. The discussion needs to happen before surgery if this option is being considered.
How are recurrent and metastatic head and neck cancers treated?
If cancer returns in the mouth, throat, or neck, the first question is whether it can still be treated locally. Salvage surgery, meaning surgery to remove cancer that remains or returns after earlier treatment, can be considered in selected patients. Repeat radiation is an option in some circumstances, depending on the area previously treated and the risks to nearby tissues. If the cancer has spread to distant organs or cannot be treated with a curative local approach, treatment usually focuses on controlling disease, relieving symptoms, and maintaining day-to-day function.
- Immunotherapy. In recurrent or metastatic squamous cell carcinoma, PD-L1 CPS helps determine whether pembrolizumab alone is an option. Pembrolizumab with chemotherapy may be considered for eligible patients. The pace of disease, symptoms, prior treatment, and overall health also matter.
- Targeted therapy. Cetuximab targets EGFR and has a role in selected head and neck squamous cell carcinoma regimens, including some chemotherapy combinations. Routine EGFR mutation testing is generally unnecessary to select cetuximab in this setting.
- Biomarker-driven therapy. Each test answers a different question. p16 helps classify and stage oropharyngeal cancer. PD-L1 CPS can inform immunotherapy decisions. Broader molecular profiling may be useful when a rare tumour subtype or a specific clinical question makes the result likely to change treatment.
Supportive care can begin alongside cancer treatment. Pain, weight loss, difficulty swallowing, and changes in speech can affect whether someone can complete treatment and how well they recover. Dental assessment, nutrition support, and speech and swallowing rehabilitation are part of planning when relevant.
What I look for clinically before recommending the first treatment
I ask three questions. Where exactly did the cancer start? Can the team treat it with the aim of cure? What will each realistic option mean for speech, eating, and breathing? For an operable cheek cancer, the immediate discussion may be about the extent of surgery and reconstruction. For a throat cancer where chemoradiation is being considered, it may be about baseline swallowing, nutrition, kidney function, and hearing. Those details often change the recommendation or what needs to be put in place before treatment starts.
How the next step is decided
| If the reports show… | The next discussion is about… |
|---|---|
| A suspicious lesion without a confirmed diagnosis | Where to take a biopsy and what imaging is needed |
| A removable oral cavity cancer | Surgery, management of neck lymph nodes, and reconstruction |
| A throat or voice box cancer with more than one feasible approach | Expected speech and swallowing after each treatment, and the likelihood of needing combined treatment |
| High-risk features after surgery | Whether postoperative radiation or concurrent chemoradiation is appropriate |
| Recurrence after previous treatment | Whether salvage surgery or another local treatment is feasible |
| Distant spread or recurrence unsuitable for curative local treatment | PD-L1 testing where relevant, systemic therapy choices, and symptom support |
What to bring to a head and neck cancer consultation in Delhi
- Biopsy and pathology reports, including any p16, HPV, or PD-L1 results.
- CT, MRI, or PET-CT reports and the original images, if available.
- Endoscopy notes or images and any prior operation or reconstruction records.
- The previous radiation plan or dose summary and a list of medicines used for cancer treatment, if applicable.
- A note of recent weight loss, difficulty eating or swallowing, changes in speech, or breathing symptoms.
- The proposed treatment plan and the questions you need answered before deciding.
Frequently asked questions
Can head and neck cancer be treated without surgery?
Yes. Radiation alone can be appropriate for some early voice box cancers, and chemoradiation is a main treatment for selected locally advanced throat cancers. For many operable oral cavity cancers, surgery is the usual first treatment.
Does a cancerous neck lymph node mean the disease is metastatic?
A cancerous lymph node in the neck usually represents regional spread. Distant metastasis means the cancer has spread beyond the regional lymph nodes, for example to the lungs. Regional disease can still be treated with the aim of cure.
Why might I need chemotherapy after surgery?
If the final pathology shows a positive surgical margin or extranodal extension, chemotherapy given during postoperative radiation may improve cancer control for patients who can receive it. Ask your team which finding in your report is driving the recommendation.
Does HPV-positive throat cancer need less treatment?
HPV association affects staging and can provide information about prognosis. Decisions about treatment intensity still depend on the extent of disease and the planned approach. Any proposal to reduce treatment intensity should be discussed with the multidisciplinary team.
Before agreeing to a plan, ask your team to explain the aim of treatment, why the first step comes first, and what you can expect for speech and swallowing afterward. If your plan involves several treatments, ask which pathology or scan findings would change the sequence.
This page is for general education. Individual treatment decisions require review of your pathology, scans, symptoms, and overall health by your treating team.
Clinical references
- National Cancer Institute. Head and Neck Cancers fact sheet and Head and Neck Cancer Treatment Summaries.
- National Cancer Institute. Oropharyngeal Cancer Treatment (PDQ).
- American Society of Clinical Oncology. Immunotherapy and Biomarker Testing in Recurrent and Metastatic Head and Neck Cancers.
- SEOM–TTCC. Clinical Guidelines for the Treatment of Head and Neck Cancer.
- US Food and Drug Administration. Perioperative pembrolizumab for resectable locally advanced head and neck squamous cell carcinoma.