In primary care, initial investigations for a patient with symptoms suggestive of head and neck cancer include considering a neck ultrasound scan, especially if there is an unexplained neck lump that is increasing in size NICE NG36.
For adults aged 25 years and older, an urgent neck ultrasound scan should be arranged within 2 weeks NICE NG36.
If the ultrasound findings are uncertain or suggestive of soft tissue sarcoma, an urgent referral using a 2-week suspected cancer pathway should be considered NICE NG36.
In cases where a primary site is not identified, a fluorodeoxyglucose positron emission tomography (FDG PET)‑CT scan may be considered as the first investigation to detect the primary site in metastatic nodal squamous cell carcinoma of unknown origin NICE NG36.
Further assessment may include fine-needle aspiration cytology (FNAC) or core biopsy, with ultrasound guidance if appropriate, and assessment of sample adequacy by a cytopathologist or biomedical scientist NICE NG36.