What neck lump features in an adult should trigger immediate referral?

Any new neck lump in an adult aged over 40 that persists for more than 3 weeks warrants urgent referral to head and neck surgery or ENT — do not reassure and review in 4 to 6 weeks. Concerning features that raise the urgency further: firm, fixed, or non-tender; associated with weight loss, dysphagia, hoarseness, or otalgia; increasing in size; or in a patient with significant smoking and alcohol history. The most common site for an occult primary presenting as a cervical node metastasis is the oropharynx (base of tongue, tonsil) or nasopharynx. p16 immunohistochemistry and HPV testing on fine-needle aspirate cytology or core biopsy provides the initial aetiological signal — this guides workup and eventual surgical approach. In Australia, urgent cancer referral through the GP is appropriate; do not wait for initial radiology before referring.

What is HPV-positive oropharyngeal cancer and how is it different from tobacco-related head and neck cancer?

HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is caused by integration of human papillomavirus type 16 (HPV-16) DNA into oropharyngeal mucosal cells, typically in the palatine or lingual tonsils. It presents differently from tobacco-related HNC: patients are younger (45–65), often non-smokers, and commonly present with a painless, cystic-feeling neck mass rather than throat symptoms. The primary lesion in the oropharynx can be very small (< 1 cm) and invisible on routine oral examination, yet the cervical lymph node metastasis is already large (≥ 3 cm) at presentation. HPV-positive OPSCC has a 3-year overall survival of approximately 85–90% versus approximately 50–60% for HPV-negative OPSCC treated comparably. ASTRO 2024 guidelines support treatment de-escalation (reduced radiation dose or surgical minimisation via transoral robotic surgery, TORS) for low-risk HPV-positive OPSCC in appropriate candidates. In Australia, the Gardasil 9 NIP vaccination programme (single dose from 2023 for eligible ages) is the long-term prevention strategy.

Why is adult unilateral otitis media with effusion (OME or 'glue ear') a red flag?

Unilateral OME in an adult — characterised by a unilateral conductive hearing loss and flat tympanogram without preceding acute otitis media — is not a benign finding. The Eustachian tube orifice sits in the lateral wall of the nasopharynx; tumours of the nasopharynx (nasopharyngeal carcinoma, NPC) can obstruct Eustachian tube drainage and present with unilateral middle ear effusion before any visible oropharyngeal lesion appears. Bilateral OME in an adult is usually benign (allergic, chronic sinonasal disease), but **unilateral OME must be presumed NPC until endoscopy proves otherwise**. In Australian clinical guidelines (Cancer Australia, CICADA), nasopharyngoscopy is the mandated investigation for adult unilateral OME. NPC is more prevalent in Southeast Asian and Pacific Islander communities in Australia; clinical history should include ethnicity, EBV exposure, and smoking history. Do not insert a ventilation tube until NPC is excluded.

Is Gardasil 9 effective against head and neck cancer?

Gardasil 9 (9-valent HPV vaccine) protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 — including HPV-16, the type responsible for approximately 90% of HPV-positive oropharyngeal cancer. Immunogenicity and efficacy data from the FUTURE II programme and systematic reviews (Stanley, BMJ Best Practice) confirm that Gardasil 9 prevents HPV-16 infection and related mucosal disease with > 95% efficacy in antibody-naïve individuals. Population-level prevention of OPSCC is the goal; the lag from vaccination to cancer reduction is expected to be 20–30 years (as cancers reflect infections acquired decades earlier). From 2023, the National Immunisation Program (NIP) changed to a single-dose schedule for adolescents aged 12–13 (previously 2 doses). Catch-up is available to age 19 under the NIP; the vaccine can be administered to older adults at private cost. In Australia, Gardasil 9 is TGA-approved for males and females aged 9–45 years.

What happens during survivorship after head and neck cancer treatment — what does the GP need to know?

Head and neck cancer treatment (surgery + radiotherapy ± chemotherapy) causes long-term sequelae that require active GP management. Key areas: (1) **Hypothyroidism** — occurs in 25–50% after neck irradiation or thyroid surgery; annual TSH is standard. (2) **Dental complications** — osteoradionecrosis of the mandible (ORN) is a serious late effect of mandibular irradiation; patients must never have dental extractions without specialist dental liaison after neck XRT; referral to a maxillofacial surgeon before any dental procedure is essential. (3) **Swallowing dysfunction** — dysphagia and aspiration pneumonia are common after laryngeal and hypopharyngeal cancer treatment; speech pathology follow-up and regular monitoring for aspiration signs. (4) **Lymphoedema** — cervical lymphoedema causes facial and neck swelling; lymphoedema physiotherapy and graduated compression. (5) **Psychosocial** — body image, depression, and social isolation are prevalent; GP-based mental health care plans and Cancer Council Australia support services are first-line. (6) **Recurrence surveillance** — typically shared between ENT/head and neck surgery and medical oncology for 5 years; GPs provide between-appointment monitoring.

Head and neck cancer (oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, salivary gland)

Head and neck cancer: the 2-week rule and HPV-positive OPSCC

Q: Why is adult unilateral otitis media with effusion (OME or 'glue ear') a red flag?

Unilateral OME in an adult — characterised by a unilateral conductive hearing loss and flat tympanogram without preceding acute otitis media — is not a benign finding. The Eustachian tube orifice sits in the lateral wall of the nasopharynx; tumours of the nasopharynx (nasopharyngeal carcinoma, NPC) can obstruct Eustachian tube drainage and present with unilateral middle ear effusion before any visible oropharyngeal lesion appears. Bilateral OME in an adult is usually benign (allergic, chronic sinonasal disease), but **unilateral OME must be presumed NPC until endoscopy proves otherwise**. In Australian clinical guidelines (Cancer Australia, CICADA), nasopharyngoscopy is the mandated investigation for adult unilateral OME. NPC is more prevalent in Southeast Asian and Pacific Islander communities in Australia; clinical history should include ethnicity, EBV exposure, and smoking history. Do not insert a ventilation tube until NPC is excluded.

Q: Is Gardasil 9 effective against head and neck cancer?

Gardasil 9 (9-valent HPV vaccine) protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 — including HPV-16, the type responsible for approximately 90% of HPV-positive oropharyngeal cancer. Immunogenicity and efficacy data from the FUTURE II programme and systematic reviews (Stanley, BMJ Best Practice) confirm that Gardasil 9 prevents HPV-16 infection and related mucosal disease with > 95% efficacy in antibody-naïve individuals. Population-level prevention of OPSCC is the goal; the lag from vaccination to cancer reduction is expected to be 20–30 years (as cancers reflect infections acquired decades earlier). From 2023, the National Immunisation Program (NIP) changed to a single-dose schedule for adolescents aged 12–13 (previously 2 doses). Catch-up is available to age 19 under the NIP; the vaccine can be administered to older adults at private cost. In Australia, Gardasil 9 is TGA-approved for males and females aged 9–45 years.

By Dr HB Lo, FACRRM Reviewed 16 September 2026 9 min read

Head and neck cancers (HNC) — oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, salivary glands — affect ~5,000 Australians per year (AIHW). HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) now exceeds 70% of oropharyngeal cancers, presenting as a painless neck lump in men aged 45–65 with better prognosis than tobacco-driven HNC. The GP's key role is the **2-week rule**: urgent ENT referral for neck lump > 3 weeks, non-healing oral lesion, hoarseness > 3 weeks, or adult unilateral middle-ear effusion (nasopharyngeal cancer excluded first). Gardasil 9 (NIP single-dose from 2023) is primary prevention.

Head and neck cancers are heterogeneous malignancies that together affect the upper aerodigestive tract — oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, and major salivary glands — as well as the thyroid. The GP role is pivotal: most of these cancers first present to general practice as a neck lump, voice change, difficulty swallowing, or non-healing mucosal lesion. The difference between Stage I and Stage IV at diagnosis can be a 4-week delay in referral.

This guide is written for Australian GPs, covering the red-flag recognition toolkit, the changing epidemiology driven by HPV, and the survivorship needs the GP manages long-term.

A. Core clinical — what every GP needs to recognise

The 2-week rule: when to refer urgently

Any of the following in an adult warrants urgent same-week ENT or head and neck surgery referral, not a watch-and-wait approach:

Symptom / sign	Minimum duration before urgent referral
New neck lump (cervical lymphadenopathy)	> 3 weeks, any size
Oral mucosal lesion (ulcer, leukoplakia, erythroplakia)	> 3 weeks, failing to heal
Hoarseness or voice change	> 3 weeks, no upper respiratory infection explanation
Dysphagia or odynophagia	> 3 weeks, no GORD or infective explanation
Unilateral otalgia without otoscopic findings	Any duration with associated neck symptoms
Unilateral OME in an adult	Immediate — nasopharyngeal carcinoma excluded first
Epistaxis with nasal obstruction (unilateral)	Immediate if persistent

Imaging before referral is not required and should not delay referral. ENT specialists will organise panendoscopy ± FDG-PET-CT ± fine-needle aspiration cytology (FNAC) as part of their workup. If an urgent ultrasound is already available before referral, it is helpful but not mandatory.

Comprehensive head and neck examination

The full examination relevant to HNC in general practice includes:

Oral cavity inspection — floor of mouth (most common site for oral SCC in AU), ventral and lateral tongue, buccal mucosa, hard palate, gingival tissue. Use a torch and tongue depressor; bimanual palpation of the floor of mouth detects submandibular lesions.
Oropharynx — tonsillar fossae, soft palate, posterior pharyngeal wall, base of tongue (visible in cooperative patients with a good tongue depressor technique; best assessed by ENT with nasopharyngoscopy).
Cervical lymph nodes — Level I (submental, submandibular), Level II (upper jugular), Level III (mid-jugular), Level IV (lower jugular), Level V (posterior triangle), Level VI (anterior), Level VII (superior mediastinal). Note: lymph node level correlates with primary site.
Larynx/hypopharynx — hoarseness suggests laryngeal involvement; indirect laryngoscopy via nasopharyngoscope in the surgery context.
Salivary glands — parotid, submandibular; note any masses.

Any asymmetry, mucosal colour change, induration, or mass should be documented precisely (size, site, consistency, mobility, border).

Subsite-specific patterns

Subsite	Typical presentation	Key risk factors
Oral cavity (lip, tongue, floor of mouth)	Non-healing ulcer, leukoplakia	Tobacco, alcohol, chronic sun (lip)
Oropharynx (tonsil, base of tongue)	Painless neck lump, dysphagia	HPV-16 (> 70% of cases in AU), tobacco
Larynx	Hoarseness > 3 weeks, stridor (late)	Tobacco (dominant)
Hypopharynx	Dysphagia, weight loss (late presentation)	Tobacco + alcohol
Nasopharynx	Unilateral OME, epistaxis, cranial nerve palsies	EBV, Southeast Asian/Pacific Islander ancestry
Salivary gland (parotid)	Parotid mass, ± VII nerve weakness	Often no clear risk factor

B. The HPV-positive OPSCC epidemic in Australia

Epidemiology

HPV-positive OPSCC has risen from roughly 40% of oropharyngeal cancers in Australia in the 1990s to more than 70% currently (AIHW). The incidence in Australian men aged 50–70 has increased year on year. It predominantly affects:

Men aged 45–65 (4:1 male:female ratio)
Non-smokers or light smokers with no conventional HNC risk factors
Multiple lifetime sexual partners (HPV-16 transmission is primarily oropharyngeal-sexual)

Clinical presentation pattern

HPV-positive OPSCC typically presents as:

A painless, rubbery or cystic neck mass (Level II — upper jugular) with no obvious pharyngeal symptoms
Incidentally found lingual tonsillar asymmetry
Rarely: dysphagia or foreign-body sensation (late)

The primary lesion in the lingual or palatine tonsil is often < 1 cm and invisible to standard oral inspection; it requires nasopharyngoscopy or MRI for identification.

p16 as a surrogate marker

p16 immunohistochemistry on FNAC or core biopsy of the neck node is a practical surrogate for high-risk HPV status. A p16-positive result (strong and diffuse nuclear + cytoplasmic staining in > 70% of tumour cells) is consistent with HPV-driven OPSCC and alters:

Staging (TNM 8th edition uses separate staging for p16-positive OPSCC — more favourable stage groupings)
Treatment planning (de-escalation trials, TORS, reduced-dose XRT)
Prognosis counselling (3-year overall survival > 85% versus ~55% p16-negative)

Treatment de-escalation (ASTRO 2024)

ASTRO 2024 evidence-based guidelines support de-escalated treatment for low-risk HPV-positive OPSCC (T1-T2, N1, non-smokers or < 10 pack-year history). Options include:

Transoral robotic surgery (TORS) to the primary site with selective neck dissection, potentially avoiding radiotherapy in pathologically favourable disease
Reduced-dose radiotherapy (60 Gy vs standard 70 Gy) in patients achieving complete response to induction chemotherapy

These decisions are made in multidisciplinary tumour board settings, not in general practice. GPs should know de-escalation exists — it is relevant for prognosis counselling and managing patient expectations about treatment intensity.

C. Gardasil 9 and primary prevention

NIP schedule (from 2023)

Since 2023, the Australian National Immunisation Program (NIP) has moved to a single-dose Gardasil 9 schedule for adolescents aged 12–13 (Year 7 school programme), replacing the previous 2-dose schedule. This is based on immunogenicity equivalence data showing robust antibody responses after a single dose in adolescents.

Catch-up provisions:

Ages 14–19: single dose, NIP-funded through schools and immunisation providers
Ages 20+: Gardasil 9 is TGA-approved up to age 45 (males and females) but at private cost (~ $210–$250 for 1–3 doses depending on age at first dose)
GPs should proactively offer catch-up for eligible patients who were unvaccinated in adolescence

Counselling on vaccine and cancer prevention

Gardasil 9 does not treat or clear existing HPV infection; it prevents new infection in antibody-naïve individuals.
It protects against HPV-16 and -18 (responsible for approximately 70% of cervical cancer and 90% of HPV-positive OPSCC).
Population-level impact on OPSCC will not be measurable for 20–30 years because HNC develops decades after initial infection.
Routine HPV testing is not recommended as a standalone screen for OPSCC (unlike cervical cancer, there is no validated OPSCC screening programme).

D. Australian clinical operations

Referral pathways

Urgent head and neck surgical referral (public hospital system):

Category 1 referral (seen within 30 days): any suspected cancer or malignant neck node
Public HNC specialist centres: Royal Prince Alfred (Sydney), Peter MacCallum (Melbourne), Royal Brisbane and Women’s (Brisbane), RAH (Adelaide), Sir Charles Gairdner (Perth)
GP referral letter should include duration of symptoms, examination findings with node level, smoking and alcohol history, Indigenous status, and relevant imaging already performed

Multidisciplinary tumour boards (MDT):

All HNC treated within an MDT (surgery, radiation oncology, medical oncology, speech pathology, dietetics, maxillofacial, social work) — Cancer Australia Optimal Care Pathway requirement
GP role: provide complete background history to the MDT via shared record or referral summary

MBS items for GP billing

Service	Item
Long consultation (urgent cancer workup)	36 or 44
Oral mucosa examination (preventive)	23
FNAC interpretation review	— (done by specialist)
Gardasil 9 vaccine administration	4054 (NIP-eligible)
Cancer care planning consultation	132/133 (GP Management Plan + Team Care Arrangement)

PBS anticancer drugs

KEYNOTE-048 (Burtness, Lancet 2019) established pembrolizumab + chemotherapy as the standard first-line treatment for recurrent/metastatic PD-L1 positive SCCHN. Pembrolizumab is PBS-listed for eligible patients; specialist prescribing only.

E. Special populations

Aboriginal and Torres Strait Islander people

HNC incidence and mortality are disproportionately higher in Aboriginal and Torres Strait Islander populations, partly driven by higher tobacco and alcohol use and later-stage presentation. Oral health services are often limited in remote communities, and GP-based opportunistic oral cavity examination is therefore more impactful. Culturally safe communication about tobacco cessation (Quitline 13 7848; free nicotine replacement for Aboriginal and Torres Strait Islander people through state health services) is integral to the GP interaction. Ensure NIP vaccination documentation is up to date at each encounter.

Patients with a history of heavy tobacco and alcohol use

The tobacco–alcohol synergistic effect is multiplicative for laryngeal and hypopharyngeal cancer (relative risk up to 20× versus neither). These patients warrant annual opportunistic oral cavity and oropharyngeal inspection in general practice, as there is no formal screening programme. Any mucosal change should be biopsied or referred without delay. Tobacco cessation (Quitline, NRT, varenicline, bupropion) and alcohol reduction counselling are primary prevention.

Nasopharyngeal carcinoma in Southeast Asian and Pacific Islander communities

NPC has a distinct aetiology involving EBV integration alongside genetic susceptibility (HLA-A*33:03). In Australia, NPC is over-represented in Cantonese-speaking Chinese, Vietnamese, Filipino, and Pacific Islander Australians. GPs serving these communities should have a lower threshold for nasopharyngoscopy referral for any persistent nasal or unilateral ear symptoms. EBV viral load (PCR) is an established surveillance marker for NPC post-treatment; GPs may be asked to monitor this in survivorship.

Elderly patients and functional status

Many HNC treatments (chemoradiotherapy for laryngeal/hypopharyngeal cancer) cause severe mucositis, xerostomia, and dysphagia requiring nasogastric or gastrostomy tube feeding. In patients over 75 or those with significant comorbidity, the GP’s input to the MDT about functional status, social support, and goals of care is essential before radical treatment decisions. Some elderly patients with limited functional reserve are better served by palliative-intent radiotherapy or best supportive care — this is a shared decision requiring GP input.

When to escalate

Call 000 or send to emergency immediately:

Acute airway compromise — stridor, progressive dyspnoea, dysphonia in a patient with known or suspected laryngeal mass
Carotid blowout — massive oral or neck haemorrhage in a patient with known HNC (rare; associated with radiotherapy and necrosis)

Same-day emergency referral:

New cranial nerve palsy (III, IV, VI, VII, XII) in a patient with known or suspected HNC — suggests skull base involvement
Acute dysphagia with inability to manage secretions

Urgent (within 1 week) ENT referral:

Any of the 2-week rule criteria listed above — same-week referral, not 4–6 week review
Unilateral OME in an adult (nasopharyngeal carcinoma excluded first)

Routine referral:

Mucosal lesion present < 3 weeks with plausible cause (trauma, aphthous ulcer) — review at 3 weeks; if not resolved, refer
Persistent hoarseness in a smoker — refer if > 3 weeks regardless of other explanations

What this article is and is not

This article is an evidence-based educational summary for Australian general practitioners, drawing on AIHW data, Cancer Australia Optimal Care Pathways, eTG, RANZCR/COSA guidelines, and international peer-reviewed literature including KEYNOTE-048 and ASTRO 2024 guidance. It is written to help GPs identify red-flag presentations for early referral and to support ongoing HNC survivorship management.

This article does not replace a formal medical consultation, nor does it substitute for the judgment of a head and neck surgeon, radiation oncologist, or medical oncologist managing specific cases. Drug and vaccine information is current at date of publication; verify current NIP schedule, PBS listings, and doses in official Australian sources before prescribing or vaccinating.

No individual is mentioned in this article, and no personal testimonials are cited.

Sources cited

AIHW — Head and neck cancers in Australia (cancer series). aihw.gov.au
Cancer Australia — Optimal care pathway for head and neck cancers. canceraustralia.gov.au
eTG — Head and neck malignancies. Therapeutic Guidelines Limited. tg.org.au
RANZCR/COSA — Evidence-based guidelines for the management of head and neck cancer. cosa.org.au
Burtness B et al. (KEYNOTE-048). Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic SCCHN. Lancet 2019;394:1915–1928. thelancet.com
Gillison ML et al. — ASTRO 2024: evidence-based practice guidelines for de-escalation of therapy for HPV-positive oropharyngeal cancer. Int J Radiat Oncol Biol Phys. redjournal.org
Ang KK et al. — Human papillomavirus and survival of patients with oropharyngeal cancer. NEJM 2010;363:24–35. nejm.org
TGA — Gardasil 9 product information (9-valent HPV vaccine). tga.gov.au
National Immunisation Program — Gardasil 9 single-dose schedule from 2023. health.gov.au
Cancer Council Australia — Head and neck cancer patient guides. cancer.org.au
Healthdirect — Head and neck cancers. healthdirect.gov.au
Better Health Channel — Head and neck cancers. betterhealth.vic.gov.au
MBS Online — Cancer care consultation items. mbsonline.gov.au

Frequently asked questions

What neck lump features in an adult should trigger immediate referral?

Any new neck lump in an adult aged over 40 that persists for more than 3 weeks warrants urgent referral to head and neck surgery or ENT — do not reassure and review in 4 to 6 weeks. Concerning features that raise the urgency further: firm, fixed, or non-tender; associated with weight loss, dysphagia, hoarseness, or otalgia; increasing in size; or in a patient with significant smoking and alcohol history. The most common site for an occult primary presenting as a cervical node metastasis is the oropharynx (base of tongue, tonsil) or nasopharynx. p16 immunohistochemistry and HPV testing on fine-needle aspirate cytology or core biopsy provides the initial aetiological signal — this guides workup and eventual surgical approach. In Australia, urgent cancer referral through the GP is appropriate; do not wait for initial radiology before referring.
What is HPV-positive oropharyngeal cancer and how is it different from tobacco-related head and neck cancer?

HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is caused by integration of human papillomavirus type 16 (HPV-16) DNA into oropharyngeal mucosal cells, typically in the palatine or lingual tonsils. It presents differently from tobacco-related HNC: patients are younger (45–65), often non-smokers, and commonly present with a painless, cystic-feeling neck mass rather than throat symptoms. The primary lesion in the oropharynx can be very small (< 1 cm) and invisible on routine oral examination, yet the cervical lymph node metastasis is already large (≥ 3 cm) at presentation. HPV-positive OPSCC has a 3-year overall survival of approximately 85–90% versus approximately 50–60% for HPV-negative OPSCC treated comparably. ASTRO 2024 guidelines support treatment de-escalation (reduced radiation dose or surgical minimisation via transoral robotic surgery, TORS) for low-risk HPV-positive OPSCC in appropriate candidates. In Australia, the Gardasil 9 NIP vaccination programme (single dose from 2023 for eligible ages) is the long-term prevention strategy.
Why is adult unilateral otitis media with effusion (OME or 'glue ear') a red flag?

Unilateral OME in an adult — characterised by a unilateral conductive hearing loss and flat tympanogram without preceding acute otitis media — is not a benign finding. The Eustachian tube orifice sits in the lateral wall of the nasopharynx; tumours of the nasopharynx (nasopharyngeal carcinoma, NPC) can obstruct Eustachian tube drainage and present with unilateral middle ear effusion before any visible oropharyngeal lesion appears. Bilateral OME in an adult is usually benign (allergic, chronic sinonasal disease), but **unilateral OME must be presumed NPC until endoscopy proves otherwise**. In Australian clinical guidelines (Cancer Australia, CICADA), nasopharyngoscopy is the mandated investigation for adult unilateral OME. NPC is more prevalent in Southeast Asian and Pacific Islander communities in Australia; clinical history should include ethnicity, EBV exposure, and smoking history. Do not insert a ventilation tube until NPC is excluded.
Is Gardasil 9 effective against head and neck cancer?

Gardasil 9 (9-valent HPV vaccine) protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 — including HPV-16, the type responsible for approximately 90% of HPV-positive oropharyngeal cancer. Immunogenicity and efficacy data from the FUTURE II programme and systematic reviews (Stanley, BMJ Best Practice) confirm that Gardasil 9 prevents HPV-16 infection and related mucosal disease with > 95% efficacy in antibody-naïve individuals. Population-level prevention of OPSCC is the goal; the lag from vaccination to cancer reduction is expected to be 20–30 years (as cancers reflect infections acquired decades earlier). From 2023, the National Immunisation Program (NIP) changed to a single-dose schedule for adolescents aged 12–13 (previously 2 doses). Catch-up is available to age 19 under the NIP; the vaccine can be administered to older adults at private cost. In Australia, Gardasil 9 is TGA-approved for males and females aged 9–45 years.
What happens during survivorship after head and neck cancer treatment — what does the GP need to know?

Head and neck cancer treatment (surgery + radiotherapy ± chemotherapy) causes long-term sequelae that require active GP management. Key areas: (1) **Hypothyroidism** — occurs in 25–50% after neck irradiation or thyroid surgery; annual TSH is standard. (2) **Dental complications** — osteoradionecrosis of the mandible (ORN) is a serious late effect of mandibular irradiation; patients must never have dental extractions without specialist dental liaison after neck XRT; referral to a maxillofacial surgeon before any dental procedure is essential. (3) **Swallowing dysfunction** — dysphagia and aspiration pneumonia are common after laryngeal and hypopharyngeal cancer treatment; speech pathology follow-up and regular monitoring for aspiration signs. (4) **Lymphoedema** — cervical lymphoedema causes facial and neck swelling; lymphoedema physiotherapy and graduated compression. (5) **Psychosocial** — body image, depression, and social isolation are prevalent; GP-based mental health care plans and Cancer Council Australia support services are first-line. (6) **Recurrence surveillance** — typically shared between ENT/head and neck surgery and medical oncology for 5 years; GPs provide between-appointment monitoring.

Source quality

Sources grouped by evidence tier. AU primary tier first; international where AU is silent or lagging; named-author reconstruction where guidelines have not yet caught up. How tiers work.