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If you have difficulty breathing, noisy breathing, or cannot swallow your own saliva, seek emergency care now. Airway obstruction from a head and neck tumour is an emergency. Also seek urgent care for heavy bleeding from the mouth or throat, or fever during chemotherapy.

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Head and neck cancer: oral, throat and voice box

Cancers of the mouth, tongue, throat, voice box and salivary glands. Treatment must remove the cancer while preserving the ability to eat, swallow, speak and breathe — which is what makes this the most reconstruction-dependent area in oncology.

Oral cancer is markedly more common in South Asia than in Europe, largely because of tobacco chewing, betel quid and areca nut. Indian surgeons consequently see and operate on more of it than almost anyone in the world, and the reconstructive expertise that goes with it is a genuine reason to treat here.

Clinically reviewed by Dr. Annie Varughese, Consultant Medical Oncologist Clinical oversight Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Main cause in South Asia
Tobacco and betel
Chewing tobacco, betel quid and areca nut
Function matters
Speech and swallowing
Reconstruction is part of the cancer operation
Often multimodal
Surgery plus radiotherapy
Sometimes with chemotherapy alongside
Time in India
6 to 10 weeks
Surgery plus a radiotherapy course
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What head and neck cancer involves

The term covers cancers of the lip and oral cavity, the tongue, the floor of the mouth, the gums and cheek lining, the throat, the voice box, the nose and sinuses, and the salivary glands. Most arise from the squamous cells lining these surfaces.

Tobacco in all its forms is the dominant cause, and in South Asia chewed tobacco, betel quid and areca nut are particularly implicated in cancers of the cheek lining and gums. Alcohol multiplies the risk when combined with tobacco. A distinct group of throat cancers is caused by human papillomavirus, and these tend to occur in younger patients and respond better to treatment.

What makes this area different from most cancer surgery is that the structures being removed are the ones you use to eat, speak and breathe. A technically successful operation that leaves a patient unable to swallow is not a good outcome. This is why reconstruction — often using tissue transferred with its own blood supply from the forearm, thigh or leg — is an integral part of the operation rather than an optional refinement.

Many patients from our source markets present late, with larger tumours and involved neck nodes. That makes treatment harder but frequently still curative, and it makes the surgical and reconstructive expertise available in Delhi NCR particularly relevant.

Symptoms

Symptoms and warning signs

Common symptoms
  • A mouth ulcer or sore that has not healed within three weeks
  • A lump or thickening in the cheek, tongue or neck
  • A white or red patch in the mouth that persists
  • Persistent sore throat or a sensation of something stuck
  • Hoarseness lasting more than three weeks
  • Difficulty or pain on swallowing
  • Loose teeth, ill-fitting dentures, or reduced mouth opening
Warning signs of an emergency
  • Difficulty breathing or noisy breathing
  • Unable to swallow saliva
  • Heavy bleeding from the mouth or throat
  • Fever during chemotherapy or radiotherapy
  • Rapid swelling of the neck
  • Severe unrelieved pain

Reduced mouth opening is a warning sign that is often ignored

Progressive difficulty opening the mouth — trismus — in someone who chews tobacco or betel is a serious sign. It may indicate submucous fibrosis, a premalignant condition, or a tumour infiltrating the muscles. It is frequently dismissed as a dental problem for months. If you have it, ask for an examination by a head and neck specialist rather than a dentist alone.

Diagnosis

How it is diagnosed

Examination and biopsy establish the diagnosis; imaging defines how far the tumour extends.

Initial tests

  • Biopsy of the lesion — the definitive diagnostic test
  • Examination under anaesthesia with endoscopy — maps the full extent, including areas not visible in clinic
  • Ultrasound of the neck with needle sampling of suspicious nodes
  • Blood tests and dental assessment before radiotherapy

The deciding tests

  • CT or MRI of head and neck — MRI shows soft tissue and tongue involvement best; CT shows bone invasion
  • PET-CT — for staging in advanced disease and to search for a second primary tumour
  • HPV or p16 testing — for throat cancers, since HPV-related disease behaves and is treated differently
  • Swallowing and speech assessment — baseline function before treatment begins

Dental assessment before radiotherapy is not optional

Radiotherapy to the head and neck permanently reduces the blood supply to the jaw. Teeth that need extraction should be removed before radiotherapy begins, because extraction afterwards carries a risk of serious bone damage that is difficult to treat. Any plan that goes straight to radiotherapy without a dental review is incomplete, and we check for it.

Options

Treatment options

Most patients need more than one treatment. Which comes first depends on the site, the size and whether function can be preserved.

Option one

Surgery with reconstruction

The tumour is removed with a margin, the neck nodes are addressed, and the defect is reconstructed — commonly with a free flap of tissue transferred with its blood supply from the forearm, thigh or fibula, the last of which can rebuild a removed section of jaw. Reconstruction is what determines whether you eat and speak afterwards, and the surgeon's experience with it matters as much as their cancer clearance.

Usually appropriate whenOral cavity cancers in particular, where surgery is usually the primary treatment, and for tumours invading bone.
Option two

Radiotherapy, alone or with chemotherapy

Daily treatment over six to seven weeks. For cancers of the voice box and throat it is often the primary treatment because it preserves the organ and its function. Chemotherapy given alongside improves control in more advanced disease but increases side effects considerably. You must remain in India for the whole course.

Usually appropriate whenLaryngeal and pharyngeal cancers where organ preservation is the goal, or after surgery where the pathology shows higher risk features.
Option three

Combined treatment after surgery

Where the removed specimen shows involved margins, multiple positive nodes or spread beyond a node capsule, radiotherapy with or without chemotherapy follows surgery to reduce recurrence. This is common and should be anticipated in the plan from the start, because it determines how long you need to stay.

Usually appropriate whenThe final pathology from surgery shows high-risk features.
Option four

Rehabilitation — part of treatment, not an afterthought

Swallowing therapy, speech therapy, dental rehabilitation and nutritional support determine whether you recover a normal life. Feeding through a tube may be needed temporarily during radiotherapy. Any plan that does not include this is incomplete.

Usually appropriate whenAlways, alongside whatever else is done.
The decision

How the choice is made

Site and stage

Oral cavity cancers are generally treated by surgery first. Laryngeal and pharyngeal cancers are often treated with radiotherapy to preserve the organ. This distinction drives most of the plan.

Function after treatment

A larger operation that removes more tissue may control the cancer better but cost speech or swallowing. The best plans weigh both, and the reconstructive options available shape what is possible.

HPV status in throat cancer

HPV-related throat cancers respond better and occur in younger patients, and testing changes the discussion about intensity of treatment. Ask whether p16 testing has been done.

Ask the surgeon what reconstruction they plan and how many free flaps they perform each year. In this area that question tells you more than any hospital brochure.

Urgency

How urgent is your case

Usually safe to plan travel
  • Recently diagnosed and well
  • Completed biopsy and imaging locally
  • Stable and eating adequately
  • Planning surgery after local investigation
Needs local assessment before travel
  • Any breathing difficulty or noisy breathing
  • Unable to swallow saliva
  • Bleeding from the tumour
  • Fever during treatment
  • Rapidly enlarging neck mass with airway concern

We will tell you which column you are in

Airway compromise is the emergency in head and neck cancer. Everything else generally allows time to plan properly and get the reconstruction right.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • Biopsy and pathology report
  • CT or MRI of head and neck
  • PET-CT if performed
  • Photographs of the visible lesion if you can take them

Also helpful

  • Ultrasound of the neck and any node sampling
  • p16 or HPV testing result for throat cancers
  • Dental assessment if done
  • Details of tobacco, betel or alcohol use, and current weight and any recent weight loss
Send my reports for review See published cost ranges
Questions

Questions patients ask

That is exactly the question to ask before treatment, and the honest answer depends on the site and size of the tumour and on the reconstruction. Many patients regain good speech and swallowing, particularly with skilled free flap reconstruction and proper rehabilitation. Some do not fully. A surgeon who will not discuss this frankly is the wrong surgeon.

Chewed tobacco, betel quid and areca nut, often combined and used from a young age. These directly damage the lining of the mouth. Areca nut also causes submucous fibrosis, which stiffens the mouth and is itself premalignant. Stopping is the single most effective thing anyone with a premalignant lesion can do.

It should be assessed properly rather than attributed to a dental problem. Reduced mouth opening in someone who chews tobacco or betel can indicate submucous fibrosis or a tumour infiltrating the muscles. It is a common reason for delayed diagnosis and is worth an urgent specialist examination.

Possibly, and if so it must be done beforehand. Radiotherapy reduces the blood supply to the jaw permanently, so extractions afterwards risk serious bone damage. A dental assessment before radiotherapy begins is standard practice and its absence is a sign the plan is incomplete.

For surgery with reconstruction, around four weeks. If radiotherapy follows — which is common — add six to seven weeks, because it is given daily and cannot be done at home. Plan for six to ten weeks in total and bring an attendant.

Often, yes. For many laryngeal cancers, radiotherapy with or without chemotherapy is given specifically to preserve the voice box and gives comparable cancer control. For very advanced tumours, or where the larynx is no longer functional, removal may give the better outcome. Ask specifically whether organ preservation is an option in your case.

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Contact

Send us your reports

Send the biopsy report and the CT or MRI of the head and neck. Photographs of the lesion are genuinely useful — take them in good light.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

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