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ukmla 2026

Head and Neck Cancer (Laryngeal, Pharyngeal, Oral)

SCC of the upper aerodigestive tract — smoking + alcohol are major risk factors. HPV-related oropharyngeal cancer rising. 2WW for hoarseness >3 weeks, oral ulcer >3 weeks, unexplained neck lump

Review date
reviewed 2026-04-05
Reading time
6 min read
Author
Dr Kola Tytler MBBS CertHE MBA MSt MRCGP
ENTless-commonchronic
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Condition details
ENT
less-common
6 min read
reviewed 2026-04-05
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About This Page

This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.

Key points

  • Predominantly SCC (>90%) — oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, sinonasal
  • Risk factors: smoking + alcohol (synergistic). HPV-16 causes rising oropharyngeal cancer in younger non-smokers
  • NICE NG12 2WW: hoarseness >3 weeks (≥45 + smoker), oral ulcer >3 weeks, unexplained neck lump, unexplained dysphagia
  • Investigation: nasendoscopy, CT/MRI staging, biopsy ± HPV/p16 testing
  • MDT management: surgery, radiotherapy, chemoradiotherapy (cisplatin), or combination
  • 5-year survival: early laryngeal >80%, advanced pharyngeal <40%

Overview

Head and neck cancers comprise malignancies of the oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, and sinonasal region. Over 90% are squamous cell carcinomas. Smoking and alcohol act synergistically. HPV-16-related oropharyngeal cancer is increasing, affecting younger patients with better prognosis. Laryngeal cancer is the most common subsite. Treatment is MDT-decided.

Epidemiology

Approximately 12,400 new cases/year in the UK — 8th most common cancer. Male predominance (2:1), peak 60–70 years. HPV-related oropharyngeal cancer increased >50% in recent decades. Risk factors: smoking (10–25× risk), alcohol, HPV, betel nut, poor dental hygiene, wood dust exposure (sinonasal adenocarcinoma).

Clinical Features

Symptoms
Persistent hoarseness >3 weeks — laryngeal cancer
Non-healing oral ulcer >3 weeks
Persistent sore throat with referred otalgia
Progressive dysphagia
Unexplained neck lump >3 weeks
Persistent unilateral nasal obstruction/bloody discharge — sinonasal
Weight loss, referred otalgia (normal otoscopy)
Signs
Oral lesion: ulcer, leukoplakia, erythroplakia
Firm non-tender cervical lymphadenopathy
Stridor — advanced laryngeal cancer
Vocal cord paralysis on laryngoscopy
Cranial nerve deficits — advanced/nasopharyngeal cancer

Investigations

First-line
Flexible nasendoscopyVisualises larynx, pharynx, nasopharynx — identifies primary tumour
BiopsyTissue diagnosis essential — clinic or EUA biopsy
Second-line
CT neck + chest with contrastStaging: tumour extent, nodes, pulmonary metastases
MRISuperior soft tissue detail for oropharyngeal/nasopharyngeal tumours
HPV/p16 immunohistochemistryOropharyngeal SCC — HPV-positive has better prognosis
Specialist
PET-CTOccult primary, distant metastases, recurrence surveillance
USS + FNA of neck lumpCytology of suspicious nodes
Panendoscopy (EUA)Full upper aerodigestive tract assessment under GA

Management

NICE NG12 (Suspected cancer referral)
1
2WW referral (NICE NG12)
  • Hoarseness >3 weeks (≥45, smoker)
  • Oral ulcer >3 weeks
  • Unexplained neck lump
  • Erythroplakia/erythroleukoplakia (via dentist)
  • Unilateral nasal obstruction with bloody discharge
2
Treatment — MDT
  • Early (T1–T2): surgery or radiotherapy alone — >80% cure for early laryngeal
  • Locally advanced: chemoradiotherapy (cisplatin) or surgery + adjuvant RT ± chemo
  • Organ preservation: chemoRT preferred for laryngeal/pharyngeal where possible
  • Immunotherapy: pembrolizumab for recurrent/metastatic SCC
3
Supportive care
  • SALT: voice rehab post-laryngectomy (TEP valve, oesophageal speech)
  • Dietician: PEG if dysphagia/weight loss
  • Dental assessment before RT (osteoradionecrosis risk)
  • Smoking cessation, psychological support

Complications

  • Airway obstruction: Advanced laryngeal cancer — emergency tracheostomy
  • Osteoradionecrosis: Mandible after radiotherapy
  • Hypothyroidism: After neck RT — screen TSH annually
  • Second primary: Field cancerisation from smoking/alcohol
  • Dysphagia and malnutrition
UKMLA Exam Tips
  • 1Hoarseness >3 weeks in smoker >45 = 2WW. Do NOT attribute to reflux without investigation
  • 2Oral ulcer >3 weeks: biopsy — especially raised/rolled edges, indurated
  • 3HPV oropharyngeal cancer: younger non-smoker + tonsillar/tongue base mass + node → p16/HPV. Better prognosis
  • 4Unexplained neck lump in adult: USS + FNA, nasendoscopy to find primary
  • 5Referred otalgia (normal otoscopy) + sore throat = pharyngeal/laryngeal pathology
  • 6Unilateral middle ear effusion in adult: rule out nasopharyngeal ca obstructing ET — especially Chinese/SE Asian ethnicity

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Verified Sources & References

NICE NG12 — Suspected cancer referral
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