ENT: #3 Neck lumps and cancer

• Neck lumps: Assessing a Neck Lump | Enlarged Lymph Nodes | Midline Neck Lumps | Lateral Neck Lumps | Investigating a Neck Lump
• Salivary glands: Salivary Stones | Parotitis and Mumps | Other Salivary Swellings | Salivary Gland Tumours
• Head and neck cancer: Head and Neck Cancer — Overview | Symptoms and Referral | Mouth Cancer | Oropharyngeal Cancer and HPV | Laryngeal Cancer | Hypopharyngeal Cancer | Nasopharyngeal Cancer | Treatment | Life After Treatment
• Revision: Drug Reference Table | Spot the Diagnosis | Exam-style Scenarios | Key Points | Guidelines and Further Reading

🩺 Neck lumps and head and neck cancer — most neck lumps in children and young adults are enlarged lymph nodes from infection. In adults over 40, a persistent neck lump is cancer until proven otherwise, often a lymph node spread from a mouth, throat or larynx cancer. Head and neck cancer is linked to smoking and alcohol, and increasingly to HPV in younger non-smokers. Early referral makes a big difference to survival and to how much treatment is needed.
Your four questions for every patient: How old are they, and how long has the lump been there? Where exactly is it — midline or lateral, and does it move with swallowing or tongue protrusion? Are there red flags (hard, fixed, growing, hoarseness, dysphagia, ear pain, weight loss, smoking)? Does this need a suspected cancer referral?

Assessing a Neck Lump

• History:
  • Duration — days (infection) versus weeks to months (cancer, congenital).
  • Size change; pain; recent infection (sore throat, dental).
  • Red flag symptoms — hoarseness, dysphagia, painful swallowing, referred ear pain, one-sided nasal blockage or bleeding, mouth ulcer, weight loss, night sweats, fevers.
  • Risk factors — smoking, alcohol, HPV exposure, betel or paan chewing, previous radiotherapy, immunosuppression, TB contact, HIV risk.
• Examination — from behind, chin slightly down:
  • Site — midline or lateral; anterior or posterior triangle; level (I–VI).
  • Size, consistency (soft, rubbery, hard), tenderness, fixity, skin changes.
  • Moves with swallowing — thyroid (or thyroglossal cyst).
  • Moves with tongue protrusion — thyroglossal cyst.
  • Pulsatile — carotid body tumour or aneurysm.
  • Examine the mouth, throat, ears, scalp and skin (primary sites) and other node areas, liver and spleen.
• Age guide:
  • Children — mostly reactive lymph nodes and congenital lesions; cancer is rare (but lymphoma, leukaemia, neuroblastoma).
  • Young adults — reactive nodes, glandular fever, congenital cysts, lymphoma, thyroid; HPV-related cancer is rising.
  • Over 40 — a persistent lump is malignant in a large proportion (metastatic squamous cell carcinoma, lymphoma, thyroid).

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Enlarged Lymph Nodes

• Reactive (the commonest) — after throat, dental, scalp or skin infections; tender, soft, under 2 cm; settle within 2–6 weeks.
• Infections:
  • Glandular fever (EBV) — posterior nodes, sore throat; CMV; toxoplasmosis.
  • TB ("scrofula") — matted, painless nodes, may discharge; people from high-TB countries, HIV.
  • Atypical mycobacteria — young children; violet skin over a painless node.
  • Cat-scratch disease (Bartonella).
  • HIV — generalised lymphadenopathy.
  • Bacterial lymphadenitis (abscess).
• Malignant:
  • Metastatic squamous cell carcinoma — hard, painless, often fixed; from the mouth, throat, larynx or skin.
  • Lymphoma — rubbery, painless, often several nodes; B symptoms (fever, night sweats, weight loss); alcohol-induced pain (Hodgkin).
  • Thyroid cancer (papillary spreads to nodes, often in young people).
  • Leukaemia (CLL in older people).
  • Metastases from below the neck — Virchow's node (left supraclavicular) from stomach or other abdominal cancers (Troisier's sign).
• Other — sarcoidosis, Kikuchi disease, Kawasaki disease (children), drugs (phenytoin).
• Red flags:
  • Persisting over 3–6 weeks, or growing.
  • Over 2 cm; hard; fixed; supraclavicular.
  • B symptoms; hepatosplenomegaly; generalised lymphadenopathy.
  • Smoker or drinker; head and neck symptoms.
• NICE NG12: Adults aged 45 or over with an unexplained persistent neck lump — suspected cancer pathway referral. Children and young people with unexplained lymphadenopathy or splenomegaly — very urgent FBC (leukaemia) and specialist assessment.

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Midline Neck Lumps

• Thyroid swelling — moves up with swallowing:
  • Diffuse goitre, multinodular goitre, single nodule, cyst.
  • Tests — TFTs, ultrasound (U1–U5 grading), fine needle aspiration (FNA) if suspicious.
  • See the Thyroid Disease chapter.
• Thyroglossal duct cyst:
  • A remnant of the thyroid's path of descent from the tongue base.
  • Children and young adults; smooth, round, midline (usually just below the hyoid).
  • Moves up when the tongue is stuck out (and on swallowing).
  • Can become infected.
  • Treatment — Sistrunk operation (removes the cyst, the track, and the middle of the hyoid bone); check that normal thyroid tissue is present first.
• Dermoid cyst — midline, doesn't move with tongue protrusion; children.
• Lymph nodes — submental (under the chin) from lip, chin or front of mouth.
• Laryngeal or tracheal tumours; thymus (children).

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Lateral Neck Lumps

• Lymph nodes — the commonest (see above).
• Branchial cyst:
  • A congenital cyst at the front edge of the sternocleidomastoid, junction of its upper and middle thirds.
  • Young adults (20s–30s); smooth, soft, may swell with infections.
  • Aspirate contains cholesterol crystals.
  • Surgical removal.
• Cystic lymph node in an adult — a "branchial cyst" appearing after age 35–40 is a metastatic HPV-positive oropharyngeal cancer (or papillary thyroid cancer) until proven otherwise.
• Carotid body tumour (paraganglioma):
  • At the carotid bifurcation (angle of the jaw); may be pulsatile, with a bruit.
  • Moves side to side, but not up and down (Fontaine's sign).
  • Splays the internal and external carotids on imaging ("lyre sign").
  • Don't biopsy (bleeding) — imaging and genetic testing (SDH mutations); surgery or watch.
• Salivary glands — parotid (in front of the ear, at the jaw angle) and submandibular (under the jaw).
• Cystic hygroma (lymphatic malformation) — babies and young children; soft, transilluminates; posterior triangle; sclerotherapy or surgery.
• Laryngocele — air-filled sac that swells on blowing (trumpet players); can hide laryngeal cancer.
• Cervical rib — hard lump above the clavicle; may cause thoracic outlet symptoms.
• Sternocleidomastoid "tumour" — firm swelling in a baby's neck muscle; torticollis; physiotherapy.
• Lipoma; sebaceous cyst; neurofibroma; schwannoma.

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Investigating a Neck Lump

• ENT examination — including flexible nasendoscopy to look at the nasopharynx, tongue base, larynx and hypopharynx.
• Ultrasound — first-line imaging; shows whether the lump is solid or cystic, its nature, and guides biopsy.
• Ultrasound-guided FNA or core biopsy — diagnosis with HPV (p16) testing, or lymphoma typing (core biopsy is better for lymphoma).
• Avoid open excision biopsy of a suspected squamous cell carcinoma node — it spreads tumour and makes later treatment harder. Excision biopsy is reserved for suspected lymphoma when a core isn't enough.
• CT or MRI neck — staging; CT chest (lung metastases and second primary).
• PET-CT — finds the primary site in "unknown primary" cancer; staging; checking response after treatment.
• Examination under anaesthetic — with biopsies (tonsillectomy, tongue base) if the primary site isn't found.
• Bloods — FBC and film, ESR, LFTs, TFTs, EBV and HIV serology as appropriate.
• Most hospitals have one-stop neck lump clinics (ENT consultation, ultrasound and FNA in one visit).

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Salivary Stones

• Sialolithiasis — about 80% in the submandibular gland (its saliva is thicker and its duct runs uphill).
• Features:
  • Pain and swelling under the jaw with eating (or even the thought of food), settling over an hour or two.
  • A stone may be felt in the floor of the mouth.
  • Infection — persistent swelling, redness, pus from the duct (sialadenitis).
• Tests: Ultrasound; X-ray (most submandibular stones are radio-opaque); sialography or CT.
• Treatment:
  • Hydration, massage, warm compresses, sialogogues (sour sweets, lemon) to flush small stones.
  • Antibiotics if infected (e.g. co-amoxiclav or flucloxacillin).
  • Removal — through the mouth, sialendoscopy (tiny camera), lithotripsy, or gland removal for recurrent problems.

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Parotitis and Mumps

• Acute bacterial parotitis:
  • Older, frail, dehydrated patients; after surgery; poor oral hygiene; anticholinergic drugs.
  • Painful, red, swollen parotid, fever, pus from the parotid duct (opposite the upper second molar) on massage.
  • Usually Staphylococcus aureus.
  • Treatment — rehydration, oral hygiene, sialogogues, antibiotics (flucloxacillin, or per local policy); drain an abscess.
• Mumps (paramyxovirus):
  • Bilateral (sometimes one-sided) painful parotid swelling with fever, malaise; ear lobes pushed out.
  • Outbreaks in young adults (students) who missed MMR doses.
  • Complications — orchitis (painful testes, after puberty; rarely infertility), oophoritis, pancreatitis, viral meningitis, encephalitis, sensorineural deafness.
  • Diagnosis — saliva swab (PCR) or oral fluid test.
  • Notifiable; supportive care; exclude from school or work for 5 days after swelling starts.
  • Prevention — 2 doses of MMR.
• Recurrent parotitis of childhood — repeated swelling; usually settles by puberty.

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Other Salivary Swellings

• Sjögren's syndrome — dry eyes and mouth with salivary gland swelling; anti-Ro and anti-La; raised risk of lymphoma (MALT) — new firm gland swelling needs investigation.
• Sarcoidosis — bilateral parotid swelling; Heerfordt syndrome (with uveitis, fever and facial palsy).
• HIV — bilateral cystic parotid swelling (lymphoepithelial cysts).
• IgG4-related disease — firm, bilateral submandibular gland swelling (Küttner tumour) or lacrimal and salivary swelling (Mikulicz disease); raised IgG4; responds to steroids.
• Sialosis — painless, bilateral, soft parotid enlargement: alcohol, diabetes, bulimia, malnutrition, cirrhosis, drugs.
• Ranula — a bluish mucus cyst in the floor of the mouth (sublingual gland).
• Mucocele — small cyst on the inner lower lip after biting.
• Drooling (sialorrhoea) — in Parkinson's disease, MND, cerebral palsy — hyoscine patches, glycopyrronium, botulinum toxin.

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Salivary Gland Tumours

• Rule of 80s (roughly): about 80% occur in the parotid, and about 80% of parotid tumours are benign. The smaller the gland, the more likely a tumour is malignant (sublingual and minor salivary gland tumours are mostly malignant).
• Benign:
  • Pleomorphic adenoma — the commonest; middle-aged women; slow-growing, painless, firm lump. Can recur if not removed fully and can rarely turn malignant after many years.
  • Warthin tumour — older male smokers; soft, sometimes bilateral or multiple; lower pole of the parotid.
• Malignant:
  • Mucoepidermoid carcinoma — the commonest malignant type.
  • Adenoid cystic carcinoma — spreads along nerves (perineural) — pain and facial palsy; late recurrence.
  • Acinic cell carcinoma, salivary duct carcinoma, lymphoma, metastases (skin cancers of the scalp and face spread to parotid nodes).
• Signs of malignancy:
  • Facial nerve weakness.
  • Pain.
  • Rapid growth.
  • Fixed to skin or deep tissues; skin ulceration.
  • Neck nodes.
• Investigation: Ultrasound with FNA or core biopsy; MRI.
• Treatment:
  • Superficial or total parotidectomy, preserving the facial nerve if possible; radiotherapy for malignant tumours.
  • Complications of parotidectomy — facial nerve weakness (usually temporary), numb earlobe (great auricular nerve), Frey syndrome (sweating and flushing of the cheek when eating — "gustatory sweating"), salivary fistula.

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Head and Neck Cancer — Overview

• How common: About 12,000 new cases a year in the UK; incidence is rising, mainly because of HPV-related oropharyngeal cancer.
• Type: About 90% are squamous cell carcinomas.
• Sites:
  • Oral cavity (lips, tongue, floor of mouth, gums, cheek).
  • Oropharynx (tonsils, tongue base, soft palate).
  • Larynx.
  • Hypopharynx.
  • Nasopharynx.
  • Nose and sinuses; salivary glands.
• Risk factors:
  • Smoking — the biggest.
  • Alcohol — and smoking with alcohol multiplies the risk.
  • HPV (especially HPV-16) — oropharyngeal cancer; oral sex and number of partners.
  • Betel quid, paan and gutka chewing (South Asian communities) — mouth cancer.
  • EBV and diet (salted fish) — nasopharyngeal cancer in Southern Chinese, South-East Asian and North African populations.
  • Sun exposure — lip cancer.
  • Wood dust (sinonasal); previous radiotherapy; immunosuppression; Fanconi anaemia; poor diet; deprivation.
• Prevention:
  • Stop smoking; reduce alcohol.
  • HPV vaccination — offered to all children aged 12–13 (girls and, since 2019, boys); a single dose since 2023; also to men who have sex with men up to age 45.
  • Regular dental checks (dentists spot many mouth cancers).
• Field cancerisation — the whole lining of the mouth and throat is exposed to carcinogens, so second primary cancers (head and neck, lung, oesophagus) are common.

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Symptoms and Referral

Symptoms that should raise suspicion (especially if over 3 weeks, in smokers and drinkers):

• Persistent hoarseness.
• Neck lump.
• Mouth ulcer that doesn't heal; red or white patch; lump in the mouth.
• Difficulty or pain swallowing.
• One-sided sore throat; referred ear pain with a normal ear.
• One-sided nasal blockage, bloody discharge or nosebleeds; one-sided glue ear in an adult.
• Stridor (late); haemoptysis.
• Loose teeth or poorly fitting dentures; numbness of the tongue or lip.
• Weight loss.

NICE NG12 — suspected cancer pathway referrals:

• Laryngeal cancer — consider for people aged 45 or over with persistent unexplained hoarseness or an unexplained neck lump.
• Oral cancer — consider for unexplained mouth ulceration for more than 3 weeks or a persistent unexplained neck lump; GPs refer red or red-and-white patches or mouth lumps (or arrange an urgent dental review).
• Thyroid cancer — unexplained thyroid lump.

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Mouth Cancer

• Sites: Side of the tongue (the commonest), floor of the mouth, gums, cheek lining, hard palate, lip.
• Features:
  • Non-healing ulcer with raised, hard edges; often painless at first.
  • Red or white patch (erythroplakia, leukoplakia).
  • Lump; bleeding; loose teeth; ill-fitting dentures.
  • Pain, ear pain, numbness (later).
  • Neck nodes.
• Precancerous conditions: Leukoplakia, erythroplakia (highest risk), erosive lichen planus, oral submucous fibrosis (betel nut chewers — stiff mouth, trismus).
• Lip cancer — usually the lower lip; sun exposure; good prognosis.
• Treatment: Surgery (often with neck dissection and reconstruction with a free tissue flap); radiotherapy or chemoradiotherapy after surgery for high-risk features.

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Oropharyngeal Cancer and HPV

• Sites: Tonsils, tongue base, soft palate.
• Two types:
  • HPV-positive (now most UK cases):
    • Younger (40s–50s), often non-smokers or light drinkers.
    • Often presents with a neck lump (cystic node) with a small or hidden primary.
    • Much better prognosis and response to treatment.
    • Shown by p16 staining on biopsy.
  • HPV-negative — smokers and drinkers; older; worse outcomes.
• Features:
  • Neck lump.
  • Persistent one-sided sore throat; ear pain.
  • Painful or difficult swallowing.
  • One-sided enlarged tonsil.
  • "Hot potato" voice (tongue base); weight loss.
• Treatment: Chemoradiotherapy (radiotherapy with cisplatin) or transoral surgery (robotic or laser) with neck dissection for smaller tumours; trials of reducing treatment intensity in HPV-positive disease.

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Laryngeal Cancer

• Who: Older men; smoking and alcohol.
• Sites and features:
  • Glottic (vocal cords) — the commonest. Hoarseness early, and the cords have little lymphatic drainage, so it is often found early with a good prognosis.
  • Supraglottic (above the cords) — swallowing problems, throat pain, ear pain, neck nodes; hoarseness later; spreads to nodes early.
  • Subglottic (below the cords) — rare; stridor; late presentation.
• Late features: Stridor, haemoptysis, weight loss, neck nodes.
• Diagnosis: Nasendoscopy; biopsy under general anaesthetic (microlaryngoscopy); CT neck and chest.
• Treatment:
  • Early — radiotherapy or transoral laser surgery (both aim to preserve the voice).
  • Advanced — chemoradiotherapy, or total laryngectomy (permanent neck stoma — see the ENT Emergencies chapter).
  • Voice after laryngectomy — voice prosthesis (tracheo-oesophageal valve), electrolarynx, oesophageal speech.

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Hypopharyngeal Cancer

• Sites: Pyriform fossa (the commonest), post-cricoid region, posterior pharyngeal wall.
• Features: Painful or difficult swallowing, referred ear pain, voice change, a neck lump (often the first sign), weight loss. Usually presents late, so prognosis is poor.
• Post-cricoid cancer — linked to Plummer–Vinson (Paterson–Brown-Kelly) syndrome: iron deficiency anaemia, dysphagia from an oesophageal web, glossitis — mostly in women.
• Treatment: Chemoradiotherapy or surgery (pharyngolaryngectomy with reconstruction).

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Nasopharyngeal Cancer

• Who: Much more common in people of Southern Chinese, South-East Asian and North African origin; EBV is involved; salted fish diet.
• Features — often subtle:
  • Neck lump (upper neck, posterior triangle) — the commonest presentation.
  • One-sided glue ear and hearing loss in an adult (blocked Eustachian tube).
  • Nasal blockage; blood-stained nasal discharge or nosebleeds.
  • Cranial nerve palsies — especially VI (double vision) and V (facial numbness) from skull base spread.
  • Headache.
• Diagnosis: Nasendoscopy and biopsy; MRI; EBV DNA in blood (also used to monitor).
• Treatment: Radiotherapy (very radiosensitive) with chemotherapy; surgery is rarely used.

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Treatment

• Multidisciplinary team (MDT) — ENT and maxillofacial surgeons, oncologists, radiologists, pathologists, specialist nurses, speech and language therapists, dietitians, restorative dentists, psychologists.
• Before treatment:
  • Dental assessment — remove unhealthy teeth before radiotherapy (to prevent osteoradionecrosis).
  • Nutrition — feeding tube (gastrostomy) may be placed if swallowing is expected to be badly affected.
  • Stop smoking (improves treatment response and survival); alcohol support.
• Treatment options:
  • Surgery — removal of the tumour (often transoral for smaller tumours), neck dissection, and reconstruction (free flaps).
  • Radiotherapy — intensity-modulated radiotherapy (IMRT) to spare salivary glands; daily over about 6 weeks.
  • Chemoradiotherapy — radiotherapy with cisplatin (or cetuximab if cisplatin isn't suitable).
  • Recurrent or metastatic disease — immunotherapy (pembrolizumab, alone or with chemotherapy, for tumours expressing PD-L1; nivolumab after platinum chemotherapy), chemotherapy, cetuximab, palliative care.
• Early-stage disease — often single treatment (surgery or radiotherapy) with good cure rates.
• Advanced disease — combined treatment; 5-year survival varies widely by site and HPV status.

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Life After Treatment

• Dry mouth (xerostomia) — from radiotherapy to the salivary glands; often permanent. Saliva substitutes, frequent sips, sugar-free gum, pilocarpine tablets in some.
• Dental decay — fluoride toothpaste (high strength) and trays; regular dental review.
• Osteoradionecrosis — exposed, dead jaw bone after radiotherapy; often triggered by tooth extraction. Avoid extractions after radiotherapy where possible; specialist dental care.
• Swallowing problems — speech and language therapy (swallowing exercises before and after treatment); some need long-term tube feeding; aspiration pneumonia risk.
• Mucositis (during treatment) — painful mouth ulcers; analgesia (including opioids), mouthwashes, nutrition support.
• Trismus — stiff jaw; jaw-stretching exercises.
• Hypothyroidism — common after neck radiotherapy; check TFTs yearly.
• Carotid artery stenosis — raised stroke risk years after neck radiotherapy.
• Lymphoedema of the face and neck; neck fibrosis.
• Shoulder problems — damage to the accessory nerve (XI) during neck dissection: shoulder drop, pain, difficulty lifting the arm. Physiotherapy.
• Changes in voice, appearance, eating and taste — big psychological and social impact; depression; support groups.
• Follow-up — typically for 5 years: recurrence and second primaries (head and neck, lung, oesophagus); keep off tobacco.

⚠️ Safety Pearl: Before a tooth extraction in someone who has had head and neck radiotherapy, involve a specialist dentist — extractions in irradiated bone can cause osteoradionecrosis of the jaw.

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Drug Reference Table

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Spot the Diagnosis

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Exam-style Scenarios

1. A 52-year-old non-smoker has had a painless lump in the right upper neck for 6 weeks. It is 3 cm and partly cystic on ultrasound. Examination of the mouth looks normal.
Answer: Suspected metastatic HPV-positive oropharyngeal cancer.

• Suspected cancer pathway referral; nasendoscopy.
• Ultrasound-guided FNA or core biopsy with p16/HPV testing; avoid open excision.
• CT or MRI neck, CT chest, PET-CT if primary not found; examination under anaesthetic with tonsil and tongue base biopsies.

2. A 64-year-old smoker has had a hoarse voice for 8 weeks and left ear pain. The ear looks normal.
Answer: Suspected laryngeal (or hypopharyngeal) cancer with referred ear pain.

• Suspected cancer pathway referral to ENT for laryngoscopy.
• Urgent chest X-ray.
• Smoking cessation.

3. A 46-year-old woman has a slowly growing painless lump in front of her right ear for 2 years. Facial nerve function is normal.
Answer: Probable pleomorphic adenoma of the parotid.

• Ultrasound with FNA or core biopsy; MRI.
• Superficial parotidectomy (risk of facial nerve weakness, Frey syndrome).
• Explain the small risk of malignant change if left.

4. A 7-year-old has a smooth midline lump just below the hyoid that moves up when he sticks out his tongue.
Answer: Thyroglossal duct cyst.

• Ultrasound (confirm normal thyroid tissue elsewhere); TFTs.
• Sistrunk operation (cyst, track and middle of hyoid).

5. A man treated with chemoradiotherapy for tonsil cancer 3 years ago now has tiredness and weight gain. He also needs a lower molar removed.
Answer: Likely post-radiotherapy hypothyroidism; high risk of osteoradionecrosis.

• Check TFTs; start levothyroxine if hypothyroid; then yearly TFTs.
• Refer to a specialist (restorative or oral surgery) dentist for the extraction.
• Continue surveillance for recurrence and second primaries.

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Key Points

• A persistent neck lump in an adult over 40–45 is cancer until proven otherwise — suspected cancer referral.
• Examine the mouth, throat, ears, scalp and skin in every neck lump; ENT will do nasendoscopy.
• Ultrasound with FNA or core biopsy is first line; avoid open biopsy of a suspected squamous cell carcinoma node.
• Thyroglossal cyst moves with tongue protrusion; thyroid lumps move with swallowing.
• A "branchial cyst" in an adult over 35–40 may be a cystic HPV-positive cancer node.
• Carotid body tumours move side to side and shouldn't be biopsied.
• Submandibular stones cause swelling with meals; acute parotitis affects dehydrated frail patients.
• Most parotid tumours are benign (pleomorphic adenoma); facial weakness, pain, rapid growth or fixity suggest cancer.
• Head and neck cancer: smoking, alcohol and HPV; HPV-positive oropharyngeal cancer has a better prognosis.
• Persistent hoarseness, mouth ulcer over 3 weeks, one-sided sore throat or ear pain, and dysphagia are red flags.
• Glottic laryngeal cancer presents early with hoarseness and has a good prognosis.
• Nasopharyngeal cancer: Southern Chinese origin, one-sided glue ear, neck lump, cranial nerve palsies.
• After head and neck radiotherapy: dry mouth, dental decay, osteoradionecrosis, swallowing problems, hypothyroidism (yearly TFTs), carotid disease.
• HPV vaccination (single dose, boys and girls at 12–13) helps prevent oropharyngeal cancer.

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Guidelines and Further Reading

• NICE NG36: Cancer of the upper aerodigestive tract — assessment and management in people aged 16 and over
• NICE NG12: Suspected cancer — recognition and referral (head and neck, thyroid, lymphoma)
• ENT UK and the British Association of Head and Neck Oncologists (BAHNO): UK multidisciplinary guidelines for head and neck cancer
• UKHSA: HPV vaccination programme; mumps guidance
• NICE technology appraisals for pembrolizumab, nivolumab and cetuximab in head and neck cancer
• BNF — for current doses

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