Symptoms, Risk and Diagnosis of Head and Neck Cancer

Symptoms of Head and Neck Cancers

The symptoms of head and neck cancer depend on where the cancer is located. Here are some general symptoms that patients should be aware of.

Any mass or lump in the neck in an adult should be regarded as cancer until proven otherwise. See your doctor immediately if you notice a neck mass so cancer can be ruled out as quickly as possible.

Keep in mind that these symptoms can also be caused by benign conditions. Experiencing one or even multiple symptoms does not mean you have a head and neck cancer. However, if you notice something out of the ordinary that does not go away after a week or so, it’s always a good idea to schedule a visit with your doctor.

  • A sore throat lasting more than two weeks
  • Pain or difficulty swallowing
  • A voice change that lasts more than two weeks
  • A lump on the face, neck, or nose
  • A sore on the skin of the face, the eyelids, the nose, cheek, tongue, roof of the mouth, throat or lip that does not heal
  • A white spot in the mouth or on the tongue
  • Trouble breathing, especially noisy breathing
  • Nosebleeds
  • Difficulty moving the tongue or tongue pain
  • Blocked sinuses that do not clear
  • Persistent headaches or pain in the sinus areas
  • Loose teeth or painful teeth
  • Changes in how dentures fit

There are a number of risk factors that may predispose someone to head and neck cancer. Having one or more of these factors does not mean that you will develop a head and neck cancer, but it’s important to be aware of your risk so you and your physician can better monitor your health.

In addition, you can take steps to reduce your risk, including quitting smoking and getting vaccinated for human papillomavirus (HPV).


What are the risk factors for head and neck cancers?

Head and neck cancers are more likely to occur in males who are over 40 years old. Other major risk factors include:

  • Smoking or chewing tobacco
  • Frequent and excessive consumption of alcohol
  • Infection with human papillomavirus (HPV)
  • Being exposed to the Epstein-Barr virus
  • Exposure to the chemicals used in trades such as shoemaking, carpentry, furniture construction, and metal-plating
  • Prior radiation therapy to the head and neck

Reducing your risk

Some risk factors for head and neck cancer cannot be changed. But others, such as smoking and consuming alcohol, can be, even if you have already been diagnosed with cancer. It is never too late to take steps to improve your health.

If you are looking to make a lifestyle change, we can help connect you with the support you need and help you achieve your goals.


Vaccination for HPV

One of the most effective ways to prevent HPV-positive head and neck cancer is to receive the HPV vaccine. These vaccines have been well tested and shown to be safe. Patients are usually offered this vaccine in adolescence or young adulthood. If you have not received the HPV vaccine, ask your doctor if you could still benefit.


Quitting smoking

Many people who smoke, and especially those who’ve smoked for a period of years, believe that little good could come from quitting. But this couldn’t be further from the truth. Quitting smoking is incredibly beneficial, even to patients who’ve already been diagnosed with cancer.

Learn more about smoking cessation resources at Siteman Cancer Center.

Reducing alcohol consumption

Limiting alcohol is a good way to reduce your risk of head and neck cancer. For those who have already received a cancer diagnosis, cutting back on alcohol could help reduce certain treatment side effects.

If you want to stop drinking or need help controlling your alcohol consumption, talk to your Siteman treatment team. They can connect you with the resources you need to get started.


Diagnosing Head and Neck Cancer

Some patients with head and neck cancer notice troubling symptoms that send them to their doctor for a diagnosis. Other patients only learn that something is wrong after their doctor or dentist identifies an unusual spot or lump.

Lumps or masses in the neck, in particular, should be assessed by a doctor right away. While cancer is not the only cause of neck masses in adults, it is the most common one. Any neck mass in an adult patient should be regarded as cancer until proven otherwise.

When you come to Siteman, you may have already received a diagnosis of head and neck cancer from another provider. Our specialist team of Washington University Physicians will confirm that your diagnosis is correct. Identifying the type and stage of the tumor is crucial for developing a successful treatment plan.

Many patients travel great distances to be seen at Siteman, so we try to make your time with us as efficient as possible. You may be scheduled for multiple tests and appointments on the same day to spare you from having to make additional trips to our facility.

How are head and neck cancers diagnosed?

The diagnostic process for head and neck cancer often starts with an exam conducted in your doctor’s office. Your doctor will look and feel in your mouth, throat, and nose, checking for sores and lumps. He or she may also perform a neurological exam to assess how well the nerves in your head, face, and neck are functioning. This involves asking you to follow simple commands, such as shrugging your shoulders or moving your face.

If your physician identifies a sore, spot, or lump that needs further evaluation, he or she will recommend one or more additional tests. These might include imaging tests, blood work, endoscopies, or biopsies.

Imaging tests

During imaging tests, pictures are taken of the inside of the body. Imaging tests used to diagnose head and neck cancers include:

  • CT scans
  • MRIs
  • Ultrasound (especially for patients with tumors located on the tongue)
  • PET scans, which use a special glucose solution to track how far cancer cells have spread in the body
  • PET-CT scans, which combine PET and CT technology for a comprehensive exam
  • Other highly specialized nuclear scans for rare tumors


An endoscopy is a procedure in which an endoscope (a tiny camera on the end of a tube) is inserted into the body, allowing physicians to get a closer look at a tumor or other suspicious area. For patients undergoing testing for head and neck cancer, the endoscope may be placed in the nose or mouth

During an endoscopy, patients receive topical nasal spray to help keep them comfortable. This procedure is minimally invasive and typically very well tolerated. It is often performed awake while in the doctor’s office. If necessary, it can be performed in an operating room with anesthesia, which may allow the surgeon to collect, or biopsy, tissue samples through the endoscope.



A biopsy is a procedure in which tissue is collected and examined for abnormal cells.

There are different types of biopsies. If only a small amount of tissue needs to be collected, the physician might be able to perform a fine needle aspiration (FNA) or core needle biopsy, using a thin needle to extract a sample of cells.

In other cases, a biopsy may need to take place under anesthesia in an operating room. If a patient is already undergoing surgery to remove a tumor or lump, a biopsy will be performed then. All biopsies, including those performed before you initiate your care at Siteman, are requested and reviewed by our team to ensure that our diagnoses are confirmed by an expert in head and neck cancer pathology.