Cancers arising in the mouth, jaws and neck make up around 2% of all cancers diagnosed annually. Head and neck cancers can involve the tongue, mouth, salivary glands, soft tissue such as skin and mucous membranes of the mouth, cancer of the bony structures of the jaw and cancers of the muscles in the head and neck.

What are the symptoms of head & neck cancer?

• An ulcer or lump affecting the lip, tongue, palate or floor of mouth.
• A red or white patch on the lip, tongue palate or floor of mouth.
• A painful mouth and difficulty eating or swallowing.
• Swelling of the jaw.
• A painful or numb jaw.
• A lump in the neck.

What are the risk factors for head & neck cancer?

Activities that increase the risk of head & neck cancer include:

• Smoking, both tobacco and marijuana
• Frequent alcohol use.
• Sun exposure for lip and skin cancer.
• Chronic infection and dental irritation may also be factors.
• The human papilloma virus, is particular risk factor for oropharyngeal cancers.

Head and neck cancers are known to have a significant potential to spread to the regional lymph nodes in the neck, and prompt diagnosis and treatment is key in the management of these cancers.

How are head and neck cancers treated?

Surgery is ususally the treatment of choice for patients with cancers involving the oral cavity, salivary glands and skin, however obtaining a diagnosis is the first important step and you will need a consultation with one of the Surgeons.

If you have been referrred to Scott Clinic with a suspicion of a head or neck cancer, you will be seen as promptly as we can. At the first appointment at the clinic, the Surgeon will take a full medical history and examine the area of concern. Diagnostic tests you may need to have include a cone beam CT scan, biopsy of tissue or bone, ultrasound scan, CT scan or MRI, and you may also be referred to a multi-disciplinary team for consensus on the recommended treatment.

Mr Goodisson can treat most head & neck cancers in Hawke’s Bay, but occasionally patients are referred to a larger hospital for very specialised treatment.

Management of head and neck cancers can involve a number of health professionals and the Registered Nurses at the clinic work closely with Mr Goodisson to ensure your treatment is timely and you are fully informed about the process.

The neck is an area rich in important anatomical structures; muscles, nerves, arteries, salivary glands and lymph nodes (sometimes called lymph glands) and as such, assessment of problems in this area by a specialist head and neck Doctor is important.

There can be a number of reasons why you may have a lump in the neck; infection, inflammation, blocked salivary glands, cysts and tumours. A tumour is an abnormal growth of tissue that can be either benign (non cancerous) or malignant ( cancerous).

What do I do if I have a neck lump?

See your GP first as they may be able to assess your lump and manage it for you. If the GP feels that a specialist opinion is needed they will refer you to see one of the Surgeons at Scott Clinic.

We will arrange for you to have a consultation as soon as we can. At the first appointment at the clinic, the Surgeon will take a full medical history and examine the lump. He may also look in your mouth, nose and ears, and possibly take a Cone Beam CT scan. Most patients with a neck lump will be sent for blood tests and other diagnostic tests such as an ultrasound of the neck, CT scan, a MRI scan or a biopsy (removal of a small piece of tissue or some cells) from the lump.

What happens after the tests are done?

Once all the test results are back, you will be booked to see the Surgeon to discuss these, and what, if any, treatment is required.

Will I need surgery to remove the neck lump?

Surgery is not always needed, but there can be a few reasons why the Surgeon may suggest surgical excision of the lump; if the tests have shown the lump to be malignant, if the lump is found to be benign, but is causing functional problems or if the tests have been inconclusive. The need for surgery will clearly explained to you and you will have the opportunity to ask as many questions a you wish.

If you decide to proceed with the surgery recommended, you will be given all the information you need to prepare. Surgery to remove a neck lump is almost always done under general anaesthesia, either at Royston Hospital or Hawkes Bay Soldiers Memorial Hospital in Hastings.

Surgery to remove a neck lump is quite specialised and you will usually stay in hospital for one to two nights afterwards. You will need to have at least two weeks off from work or study to recover.

What will happen if I don’t need or choose not to have surgery?

It is important to know that you can choose not to have surgery to remove your neck lump. This decision will be respected, and the risks of not proceeding will be carefully explained to you.

Sometimes if the results of the tests are not worrying, the Surgeon may recommend clinical observation. This may involve repeat ultrasound scans or CT scans of the area to monitor the lump, further blood tests and regular follow up with him.

Salivary glands produce saliva which helps a person chew and swallow food. Saliva moistens the mouth which helps to keep our teeth & tongue healthy. Saliva also contains substances (enzymes) that begin the breakdown of food.

The three main salivary glands are:

• The parotid glands – located between the ear and the jaw.
• The submandibular glands – located under the jaw.
• The sublingual glands – located on the floor of the mouth under the tongue.

The most common disorders of salivary glands involve mucous cysts, blockage by calcified stones, infection and abnormal growths.

How would I know if I had a salivary gland problem?

Salivary gland tumours usually occur as a lump, which are usually benign.

An enlarged parotid gland may present with a lump under the skin just in front of and below your ear.

An enlarged submandibular gland may present with a lump under the skin under your lower jaw.

A blocked sublingual gland may present with a swelling inside your mouth, under the tongue.

What do I do if I think I have a salivary gland problem?

See your GP first as they may be able to assess your lump on your skin or in your mouth and manage it for you. If the GP feels that a specialist opinion is needed they will refer you to see one of the Surgeons at Scott Clinic.

We will arrange for you to have a consultation as soon as we can. At the first appointment at the clinic, the Surgeon will take a full medical history and examine the area of concern. He may also look in your mouth, nose and ears, and take a Cone Beam CT scan. Most patients with a potential salivary gland problem or lump will be sent for blood tests and other diagnostic tests such as an ultrasound of the neck, CT scan, a MRI scan or a biopsy ( removal of a small piece of tissue or some cells) from the lump.

What happens next?

Once all the test results are back, you will be booked to see the Surgeon again to discuss these, and what, if any, treatment is required.

Will I need surgery for my salivary gland problem?

Surgery is not always needed, but there can be a few reasons why the Surgeon may suggest surgical excision of the salivary gland; if the tests have shown the gland to be malignant, if the gland is found to be benign, but is causing functional problems or if the tests have been inconclusive. The need for surgery will clearly explained to you and you will have the opportunity to ask as many questions a you wish.

If you decide to proceed with the surgery recommended, you will be given all the information you need to prepare. Surgery to remove a parotid or submandibular gland is almost always done under general anaesthesia, either at Royston Hospital or Hawkes Bay Soldiers Memorial Hospital in Hastings.

Sublingual glands can sometimes be removed at Scott Clinic under local anaesthesia with intravenous sedation if desired.

New Zealand has one of the highest rates of skin cancer, and in particualar, melanoma, in the world.

Skin cancers on the head and neck often require a specialist approach to removing them as they are often in difficult and anatomically critical areas.

At Scott Clinic we specialise in the management of head and neck skin cancer and commonly see patients with skin cancers on their lips, nose, ears and around the eye.

We employ a management protocol that starts with a consultation & photographs of the lesion, diagnostic biopsy then margin controlled surgery if indicated. The Registered Nurses provide wound care, removal of sutres and scar management.

There are a number of different surgical approaches to managing skin cancers on the head and neck, which are utilised on an indivual basis. These are discussed in more detail in the skin cancer page on the website.

If you have referred for a head & neck skin cancer you will be seen promptly.

If you are worried about a head and neck skin cancer please feel free to contact the clinic to speak with one of the Registered Nurses.