What initial investigations should be conducted in primary care for a patient with symptoms suggestive of head and neck cancer?

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 ¹.

For adults aged 25 years and older, an urgent neck ultrasound scan should be arranged within 2 weeks ¹.

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 ¹.

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 ¹.

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 ¹.