We follow Temu a 62y old Maori kaumatua’s journey from his first presentation in primary care through to referral to a head and neck specialist. I'm delighted to be joined by two expert Head and Neck Surgeons from Southern Cross Head and Neck Services. Along the way, we'll discuss the risk factors and changing epidemiology of head and neck cancer, the importance of recognising red flags, appropriate investigation and referral, the value of a neck lump clinic, and the role primary care can play in improving outcomes, for Māori and Pacific peoples. This podcast is eligible for equity CME points.

Practical clinical pearls:

1. A persistent neck lump is cancer until proven otherwise

Any neck lump in an adult that persists for more than three weeks, particularly if it is firm, enlarging, or non-tender, should be considered malignant until proven otherwise. Avoid repeated courses of antibiotics without a clear indication.

2. Head and neck cancer is changing

HPV-related oropharyngeal cancer is increasingly common and often presents as a painless neck lump in younger adults, many without a history of smoking or heavy alcohol use. Do not rely on traditional risk factors to determine who needs investigation.

3. Refer first, investigate in parallel

If you suspect head and neck cancer, make an urgent HSOC/Faster Cancer Treatment referral immediately. If you arrange ultrasound or fine-needle aspiration, do so alongside the referral—never let investigations delay specialist assessment. Avoid open biopsy of a neck lump in primary care.

4. Equity requires proactive follow-up

Māori experience poorer outcomes from head and neck cancer because of later diagnosis and barriers to care. A low threshold for referral, active follow-up of missed appointments, and early involvement of Māori Cancer Navigators can make a meaningful difference.

5. Every HPV vaccination is cancer prevention

The HPV vaccine prevents multiple cancers, including cervical and HPV-related throat cancers. Use every opportunity to recommend vaccination to eligible young people and their whānau. Increasing HPV vaccine coverage is one of the most effective strategies we have to reduce the future burden of head and neck cancer. With Aotearoa aiming for 90% HPV vaccination coverage by 2030, every recommendation from primary care counts.

Resources:

1. Te Aho o Te Kahu (Cancer Control Agency). Optimal Cancer Care Pathways / Faster Cancer Treatment Indicators.
2. Weaver, A., Twine, S., Bather, M., Dowley, A., & Slough, C. M. (2024). Ethnic Disparities for Survival and Mortality in New Zealand Patients With Head and Neck Cancer. JAMA Network Open, 7(6), e2413004.
3. Lucas-Roxburgh, R. A. (2018). Human papillomavirus (HPV) associated oropharyngeal cancer: Case prevalence, diagnosis, and the potential for screening in New Zealand. Massey University.
4. New Zealand Guidelines / HealthPathways. Head and Neck Cancer & High Suspicion of Cancer Criteria.
5. Koh, S. P., et al. (2026). Economic burden of human papillomavirus-related cancers in New Zealand. BMJ Public Health, 4(2), e003800. https://bmjpublichealth.bmj.com/content/4/2/e003800

Bio:

Dr Nick Lilic is a New Zealand-trained Otolaryngologist, Head and Neck Surgeon. Following fellowship training in Edinburgh and a Master of Science from the University of London, he completed advanced fellowship training in Auckland, developing expertise in head and neck oncology, thyroid surgery and complex reconstruction. Nick is a consultant surgeon at Auckland City Hospital, a lecturer at the University of Auckland, and Clinical Director of Southern Cross Head and Neck Services.

Dr John Chaplin is a New Zealand-trained Head and Neck Surgeon with more than 20 years' experience managing thyroid and parathyroid disease, neck lumps and head and neck cancer. Following specialist training, he completed prestigious fellowships in New York and Sydney, gaining expertise in complex head and neck oncology and reconstructive surgery. John is a consultant surgeon at Auckland City Hospital, a founding member of the Australian and New Zealand Head and Neck Society, and a surgeon at Southern Cross Head and Neck Services, where he continues to play a major role in surgical education and fellowship training.

Listen here:

https://podcasts.apple.com/nz/podcast/neck-lumps-w-drs-nick-lilic-and-john-chaplin/id1845748299?i=1000779189426

https://open.spotify.com/episode/4xVblAc8y2GbsJXPWZ20gL?si=1a58aa28748344e0

Disclaimer:

This podcast was supported by an unrestricted educational grant from Southern Cross Healthcare. The content was developed by the Specialist GP and the views are those of our expert speakers.