Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Threatened airway or major tumour haemorrhage
Stridor, inability to handle secretions, rapidly increasing work of breathing, expanding neck swelling or brisk oral or tracheostomy bleeding can precede complete obstruction or exsanguination.
Action: Call anaesthesia, ENT or maxillofacial surgery and major-haemorrhage support immediately, keep the patient upright with oxygen and suction, avoid sedation or supine transfer that may close a marginal airway and secure the airway or control bleeding in a theatre or interventional setting with a shared rescue plan.
Synopsis
Recognise persistent mucosal and neck-node presentations, protect the airway and nutrition, obtain diagnosis without compromising the neck, stage HPV- and site-specific disease and coordinate curative or palliative multidisciplinary treatment.
Persistent unexplained oral ulceration, unilateral throat symptoms, hoarseness, dysphagia, referred otalgia or adult neck lump requires urgent head-and-neck assessment; pain is not required.
First-line specialist assessment is full oral and neck examination plus flexible nasendoscopy; image and sample a suspicious node without proceeding to an unplanned open neck biopsy.
Ultrasound-guided fine-needle aspiration is often the first nodal sample; core biopsy is useful when cytology is non-diagnostic or lymphoma is possible.
Stridor, secretion intolerance, rapid respiratory fatigue or sentinel tumour bleeding requires immediate multidisciplinary rescue rather than routine clinic investigation.
Investigation priorities
01
First-line examination and flexible nasendoscopyFirst stepFirst line
Inspect all accessible mucosa, vocal-cord movement and the upper airway and identify a primary or synchronous lesion.
02
First-line ultrasound-guided nodal samplingFirst line
Obtain cytology from a suspicious cervical node while defining its solid, cystic and vascular features.
Management branches
Urgent presentationProtect airway and circulation first
The patient has stridor, secretion intolerance, respiratory fatigue, expanding swelling or major bleeding.
Call senior anaesthesia and head-and-neck surgical teams and move to a monitored area while keeping the patient upright, calm and oxygenated with suction available.
Agree a primary airway or haemorrhage plan and a failed-plan rescue before sedation, transfer or instrumentation; use theatre and interventional radiology support where indicated.
Key medicines
Cisplatin with radiotherapyA common definitive or postoperative radiosensitising protocol gives cisplatin 100 mg/m² intravenously on radiotherapy days 1, 22 and 43; some specialist protocols use 40 mg/m² weekly. Use the exact local regimen and eligibility criteria.
PembrolizumabUse the licensed fixed intravenous schedule, commonly 200 mg every 3 weeks or 400 mg every 6 weeks, alone or with protocol chemotherapy only when the recurrent or metastatic indication and current NICE biomarker criteria are met.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.