Context

Guidance

Upper aerodigestive tract cancers are found at various sites in the airways of the head and neck: the oral cavity, oropharynx, nasopharynx, hypopharynx, larynx and nasal sinuses. The majority are squamous cell cancers. The major risk factors for upper aerodigestive tract squamous cell cancer in the UK are tobacco smoking and alcohol consumption.

There is currently variation or uncertainty in the investigations used to assess neck lumps; who needs systemic staging, the most effective treatment for early stage and advanced disease, how to best identify HPV‑positive disease, how to optimise function and rehabilitation, the most effective follow‑up and the management of osteoradionecrosis of the jaw. This guideline aims to make recommendations that address these areas of variation or uncertainty.

This guideline will cover adults and young people (16 years and older):

referred from primary care with suspected cancer of the upper aerodigestive tract
with newly‑diagnosed or recurrent cancer of the upper aerodigestive tract.

It will not cover:

adults and young people with cancers of the thyroid, orbit, middle ear, cutaneous lip, skull base or salivary gland
adults and young people with sarcoma or lymphoma
children and young people under 16 years.

Since publication, new evidence was identified on the use of fluorodeoxyglucose positron emission tomography (FDG PET)-CT scanning to inform decisions about surgery for nodal metastases after radical chemoradiotherapy. This less invasive approach to management has the potential to reduce unnecessary surgery for people with locally advanced head and neck cancer. In 2018 we reviewed this evidence and added new recommendations.