Head and neck cancer treatment: start with the site, HPV result and function

Get a precise name for the cancer

Head and neck cancer is a broad label covering several different sites and tumor types. A cancer at the front of the tongue belongs to the oral cavity; one at the base of the tongue belongs to the oropharynx. Nasopharyngeal and salivary-gland cancers also have their own treatment pathways.

Ask the team to write down the exact primary site, tissue diagnosis and stage. A drawing or an image can make the location easier to understand. Use that full diagnosis when seeking another opinion so the discussion starts with the right disease.

Sources and references: [1] [2] [3]

Understand what HPV testing changes

HPV status is particularly important in oropharyngeal squamous cell cancer, including many tonsil and base-of-tongue cancers. It affects staging and prognosis. Ask whether p16 or HPV testing has been performed and how the result is being interpreted for your tumor site.

A favorable HPV-associated prognosis can inform the discussion, while the recommended treatment still depends on tumor extent, nodes, general health and other factors. If a reduced-intensity regimen is offered, ask which evidence supports it for your situation and whether it is part of a clinical trial.

Sources and references: [2]

Compare complete treatment pathways

Depending on the site and stage, treatment may involve surgery, radiation or combined chemoradiation. The most useful comparison includes what comes afterward. An operation may be followed by radiation or chemoradiation if the final pathology shows risk features.

Ask both the surgeon and radiation oncologist how the proposed sequence is likely to affect eating, speech and work. Find out whether the aim is to preserve an organ, preserve its function, or both. Include the rehabilitation and follow-up visits when comparing the burden of different plans.

Sources and references: [1] [2]

Use the postoperative report to understand additional treatment

After surgery, the margins and lymph-node findings help determine whether further treatment is recommended. Cancer at a margin or extension beyond a lymph node can be especially important. Other features and the tumor site also contribute to the decision.

Request the final pathology in full and ask the team to identify the findings that changed the plan. If additional treatment is advised, clarify its purpose, the intended start date and what recovery or dental preparation needs to happen first. This keeps the recommendation connected to a manageable schedule.

Sources and references: [1] [2]

Place immunotherapy in the correct setting

Immunotherapy is used in selected recurrent or metastatic head and neck cancers. There is also a newer perioperative option: in June 2025, the FDA approved pembrolizumab before and after surgery for adults with resectable locally advanced squamous cell cancer expressing PD-L1 CPS of at least 1.

That regimen includes surgery and postoperative radiation, with or without cisplatin, within a defined sequence. If it is discussed, ask how your site, stage and PD-L1 result match the proposed plan. A Shanghai consultation should also confirm the applicable Chinese indication and practical access route.

Sources and references: [2] [4]

Prepare swallowing, nutrition and dental care early

Tell the team if meals take longer, food sticks, you cough when drinking or your weight is falling. A swallowing assessment and nutrition plan can support treatment and recovery. Dental review is also important before radiation involving the mouth and jaw.

Ask which exercises are appropriate, when to begin them and how pain will be managed. If a feeding tube or temporary airway is discussed, ask what problem it would solve and what milestones guide removal. These conversations are easier before treatment begins than during a crisis.

Sources and references: [5] [6]

Plan for the effects that may last

Dry mouth, altered taste, jaw stiffness, neck or shoulder problems and speech changes can persist after treatment. The likely pattern depends on the operation and radiation field. Rehabilitation should respond to the actual functional problem and be adjusted as healing progresses.

Before leaving the treatment center, agree on follow-up for cancer surveillance and recovery. Ask who will manage dental problems, nutrition and swallowing after you return home. Keep the pathology, operation and radiation records together so another clinician can understand what has been treated.

Sources and references: [5] [6]

Choose a Shanghai review by the unresolved question

Fudan University Shanghai Cancer Center has head and neck and radiation oncology services. Shanghai Ninth People's Hospital has oral and maxillofacial head and neck oncology services. The best referral question may concern treatment sequence, an operation or functional recovery.

Send EastMedGo your biopsy, imaging, HPV or p16 and PD-L1 results where available, and previous treatment details. Describe current eating and speech problems. We can organize a consultation request around the decision you face and coordinate the records and practical arrangements needed for the review.

Sources and references: [7] [8]

Common questions