What to Expect: Your First Head and Neck Cancer Consultation

Being told you may have cancer of the head or neck is one of the most frightening experiences a person can face. The diagnosis often comes suddenly — a biopsy result from your dentist or ENT, an unexpected finding on imaging, or a neck mass that won’t go away. What happens next can feel overwhelming, and one of the most common sources of anxiety is simply not knowing what to expect.

This article walks you through what a typical first consultation with a head and neck surgeon looks like — from how to prepare, to what happens during the visit, to what comes next. My hope is that understanding the process makes it a little less daunting.

Before Your Visit: What to Bring and How to Prepare

When you are referred for a head and neck cancer consultation, our office will typically work to gather your records before you arrive. However, it helps to be proactive. If you can, bring or arrange to have the following sent ahead of time:

Your biopsy pathology report. This is the single most important document. It tells us exactly what type of cancer you have, and in the case of oropharyngeal cancer, whether it is HPV-positive — which significantly affects both staging and prognosis.

Any imaging studies (CT scans, MRI, PET scans) and their reports. We need to review the actual images, not just the radiology report. If imaging has not yet been done, we may order it prior to or on the day of your appointment.

Office notes from referring physicians — your ENT, dentist, primary care doctor, or any specialist who has already been involved.

A list of your current medications, medical history, and prior surgeries.

If you have dental concerns or have not seen a dentist recently, this is worth mentioning, as dental health becomes important in treatment planning, particularly if radiation therapy may be part of your treatment.

Finally, bring someone with you. A spouse, family member, or close friend. There is a lot of information discussed at a cancer consultation, and it is very helpful to have a second set of ears. People often find it difficult to absorb everything in the moment, and having a support person there allows you to revisit the conversation afterward.

What Happens During the Consultation

A first consultation for a possible head and neck cancer typically takes 30 to 60 minutes. Here is what to expect:

A thorough review of your history. I will ask you about your symptoms — when they started, how they have progressed, and whether you have pain, difficulty swallowing, voice changes, weight loss, or other concerns. I will also ask about your medical history, including prior cancers, surgeries, smoking and alcohol history, and overall health status.

A physical examination of the head and neck. This includes a careful inspection of the mouth, throat, and neck. I will feel for masses in the neck, examine the oral cavity, and assess the range of motion of the tongue and jaw. In many cases, I will perform a flexible fiberoptic laryngoscopy — a thin, flexible camera passed through the nose to visualize the throat, voice box, and base of tongue. This takes about 30 seconds and is mildly uncomfortable but well tolerated. It provides critical information about the extent of the tumor and the function of surrounding structures.

A review of your imaging and pathology. I will review your CT or MRI images with you, pointing out the tumor and any involved lymph nodes. If a biopsy has been done, we will discuss the pathology results and what they mean. If additional biopsies or imaging are needed, we will arrange those.

A discussion of your diagnosis, stage, and treatment options. This is the core of the consultation. I will explain what type of cancer you have, where it is located, how far it has spread (the stage), and what your treatment options are. For many head and neck cancers, there may be more than one reasonable treatment approach — for example, surgery versus radiation, or surgery followed by radiation. I will explain the advantages and trade-offs of each option, including expected side effects, recovery time, and likely impact on speech, swallowing, and quality of life.

I believe strongly in shared decision-making. My job is not simply to tell you what to do — it is to give you the information and the recommendation, and then work with you to arrive at a plan you understand and feel comfortable with.

The Multidisciplinary Tumor Board

At our cancer program at Aurora St. Luke’s Medical Center, every new head and neck cancer case is presented at a weekly multidisciplinary tumor board conference. This means your case is reviewed not just by me, but by a team that includes radiation oncologists, medical oncologists, pathologists, and radiologists. Together, we discuss the diagnosis, review the imaging and pathology, and arrive at a consensus treatment recommendation.

This collaborative approach is considered the standard of care for head and neck cancer. Research consistently demonstrates that multidisciplinary tumor board review improves treatment planning and outcomes for head and neck cancer patients. It ensures that no single physician’s perspective determines your care — the recommendation reflects the collective expertise of the entire team.

You may not attend the tumor board in person, but I will communicate the team’s recommendation to you and explain the reasoning behind it.

Common Questions Patients Ask

Over the years, I have found that patients and families tend to ask very similar questions at a first consultation. Here are some of the most common:

"Is this curable?" In many cases, yes. The answer depends on the type and stage of cancer, but many head and neck cancers — particularly HPV-positive oropharyngeal cancers — have excellent cure rates. I will give you an honest assessment of your specific situation.

"Will I need surgery?" Not necessarily. Some head and neck cancers are best treated with radiation (with or without chemotherapy), while others are best treated with surgery, and some require a combination. This depends on the location, size, and stage of the tumor.

"Will I be able to eat and talk normally?" This is understandably one of the biggest concerns. The answer depends on the specific treatment, but preserving function — swallowing, speech, and appearance — is always a central goal of treatment planning. I will discuss what you can realistically expect.

"How long is recovery?" Recovery time varies widely depending on the treatment. A patient undergoing transoral robotic surgery for a small tonsil cancer has a very different recovery than a patient undergoing a major resection with free flap reconstruction. I will outline the expected timeline for your specific situation.

"Should I get a second opinion?" I always encourage second opinions if a patient wants one. A cancer diagnosis is life-changing, and you should feel confident in your treatment plan. I will never be offended by this request.

After the Consultation: What Comes Next

Following your first visit, there are typically a few things that happen:

If additional workup is needed — such as an examination under anesthesia, additional biopsies, a PET scan, or dental evaluation — these will be arranged.

Your case will be presented at our tumor board for multidisciplinary review.

Once a treatment plan is established, I will discuss it with you in detail, and we will begin coordinating the next steps — whether that is scheduling surgery, referring you to a radiation oncologist, or both.

Throughout this process, our team is available to answer questions. We understand that the period between diagnosis and the start of treatment is one of the most stressful times for patients and their families. Do not hesitate to call us if something is on your mind.

If you have been diagnosed with a head and neck cancer and would like to schedule a consultation, please contact our clinic at 414-649-3920. We commonly see patients for new evaluations, second opinions, and management of complex cases.

Dr. Steven Sperry is a fellowship-trained head and neck surgeon specializing in head and neck cancer surgery and microvascular free flap reconstruction at Aurora St. Luke’s Medical Center in Milwaukee, Wisconsin.