Three weeks is the threshold — for an ulcer, for hoarseness, for a neck lump. Your dentist finds more of these than anyone.
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Head and neck cancer covers the mouth, tongue, throat, voice box, salivary glands, sinuses and nose. They behave differently but they share one useful feature: most of them are visible or audible early, if someone knows to look.
A mouth ulcer that has not healed in three weeks. A hoarse voice lasting three weeks. A neck lump lasting three weeks. Each of those warrants assessment.
All three are far more often something harmless — ordinary ulcers, viral laryngitis, a reactive lymph node. But three weeks is the point at which "it will settle" stops being a plan.
Dentists examine the inside of your mouth more thoroughly and more often than any doctor does, and they detect a meaningful share of mouth cancers at an early stage.
Attending regularly is a real cancer check, which is not how most people think about it.
We cannot examine your mouth, throat or neck properly, and this needs examining. We do not diagnose or treat these cancers.
Persistent one-sided earache with a normal-looking ear.
Pain from the throat or base of the tongue is felt in the ear through a shared nerve supply. Earache with no ear problem found, lasting more than three weeks, deserves a look at the throat rather than another course of ear drops.
Mouth ulcers, laryngitis, reflux and reactive glands account for the overwhelming majority. The three-week rule exists to separate them without frightening everyone.
HPV-related throat cancer is rising, particularly at the base of the tongue and the tonsils. It occurs in younger people who have never smoked and drink little, which is exactly the group nobody suspects.
These cancers generally respond better to treatment than smoking-related ones, which is genuinely good news — but they are frequently diagnosed late because the person does not fit the expected picture.
The HPV vaccine, given free in schools to boys and girls, is expected to reduce these over time.
These carry substantial oral cancer risk and are often not thought of as tobacco use at all.
They are worth mentioning to any doctor or dentist, because it changes the threshold for looking closely.
Examination of the mouth, throat and neck — including under the tongue and along its sides, which is where mouth cancers most often start and where a quick look misses them.
Nasendoscopy — a thin flexible camera passed through the nose to see the throat and voice box. It takes a couple of minutes with local anaesthetic spray, and it is the test that examines the parts nobody can see from outside.
Biopsy of any suspicious area is what makes the diagnosis.
For a neck lump, fine needle aspiration under ultrasound is standard — and an important point: a neck lump should not simply be cut out without assessment first, because that can complicate later treatment.
Ultrasound of the neck, then CT or MRI where cancer is suspected, for staging.
No blood test. And a course of antibiotics settling a sore throat does not exclude anything — symptoms that recur after treatment still need looking at.
We cannot examine your mouth, throat or neck adequately, and we cannot perform nasendoscopy. We do not diagnose or treat these cancers.
A three-week ulcer, hoarseness or neck lump needs someone looking in person — your NHS GP or your dentist, both free.
See a dentist. If you have not been in years, book — and if cost is the barrier, NHS dental charges are considerably lower than private, and some people are exempt.
A dental examination is the closest thing there is to mouth cancer screening, and it happens alongside something you were going to need anyway.
Ask specifically for an urgent head and neck referral.
Repeated antibiotics for a sore throat that keeps coming back without anyone looking at it properly.
Hoarseness put down to reflux for months without the voice box being examined.
Once a month, in good light with a mirror. Look at your tongue — including the sides and underneath — the inside of your cheeks, your gums, and the roof and floor of your mouth.
The sides and underside of the tongue matter most, because that is where mouth cancers commonly start and where nobody looks.
HPV vaccination is given free in Year 8 to boys and girls, and catch-up is free up to 25.
It is expected to reduce HPV-related throat cancers, which are the rising part of this picture.
NHS dental charges are banded and considerably cheaper than private, and some people are exempt — including those on certain benefits, pregnant women and new mothers.
It is worth checking rather than assuming.
This is an NHS pathway, and the NHS does it well. Suspected head and neck cancer goes down the urgent two-week-wait referral route, which is fast, free, and staffed by people with the equipment to look properly — flexible nasendoscopy, imaging and biopsy. Nothing a private online GP offers improves on that, and we will not pretend otherwise.
What we can genuinely do is recognise the pattern and write the referral the same day. That is not a small thing. The features that matter — a neck lump lasting more than three weeks, a mouth ulcer that will not heal, persistent hoarseness, one-sided sore throat or earache, difficulty swallowing — are frequently attributed to something ordinary for months, and the delay is where the harm is.
Where paying makes a real difference is speed of recognition: a same-day twenty-minute conversation that ends in a letter to your NHS GP requesting urgent referral, rather than a three-week wait for an appointment to have the conversation at all.
Private ENT can shorten a wait for a non-urgent opinion. It cannot jump the urgent cancer pathway, which is already the fastest route available, and we would not suggest it could.
If you have any of the features above, the right action is a referral, not a treatment.
NICE NG12, Suspected cancer: recognition and referral, is the governing guideline and defines the criteria used on this page — urgent referral for an unexplained neck lump in an adult, unexplained persistent ulceration in the oral cavity lasting more than three weeks, a persistent unexplained lump in the mouth, and unexplained hoarseness or persistent sore throat in people over 45.
NG12 also specifies urgent dental assessment for unexplained oral swelling or ulceration, since a great many of these present to dentists first.
ENT UK and the Royal College of Surgeons head and neck cancer guidance cover the diagnostic pathway, including flexible nasendoscopy, imaging and biopsy.
The recognised risk factors — smoking, alcohol, and human papillomavirus — are set out in NICE and Cancer Research UK guidance, with HPV-associated oropharyngeal cancer now accounting for a rising share of cases in younger non-smokers, which is why age alone does not exclude the diagnosis.
Three weeks. Most ulcers heal in ten to fourteen days.
One that has not healed in three weeks needs looking at, particularly if it is painless, firm, or on the side of the tongue.
Usually not — but it needs checking at three weeks.
Hoarseness that has been attributed to reflux for months without anyone examining the voice box is a common route to late diagnosis. Ask for nasendoscopy.
This is one of the most useful things on the page.
Pain from the throat or base of the tongue is felt in the ear through a shared nerve. Persistent one-sided earache with a normal ear examination warrants looking at the throat, not more ear drops.
Most neck lumps are reactive lymph nodes from infection and settle within a few weeks.
A lump lasting three weeks or more, particularly if painless and firm, needs assessing.
And it should be assessed rather than simply removed — taking a neck lump out without proper assessment first can complicate later treatment.
Yes, and this is the group most often diagnosed late.
HPV-related throat cancers are rising in younger people who have never smoked, and because they do not fit the expected picture, symptoms get attributed elsewhere for longer.
The reassuring part is that these generally respond better to treatment.
Yes — dentists detect a meaningful share of mouth cancers.
They examine your mouth more thoroughly and more often than any doctor does, including the parts you cannot see. Regular attendance is a genuine check.
Very much so, and it carries substantial oral cancer risk.
It is often not thought of as tobacco use at all, so it goes unmentioned — tell your doctor or dentist, because it changes how closely they look.
No national programme exists, which is precisely why dental attendance and the three-week rule carry so much weight here.
Worth questioning. Recurrent one-sided throat symptoms, particularly with earache or a neck lump, warrant someone looking at the throat directly.
Antibiotics settling something does not establish what it was.
August 30, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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