At least three of the precancerous signs promulgated by the American Cancer Society are about the head and neck: speech difficulties, chronic ulcers, and neck masses. However, 2/3 of patients with head and neck cancer, are not detected early, basically because of early neglect, sometimes due to misdiagnosis by the primary care physician. Symptoms vary depending on the location of the lesion. Some tumors may show symptoms at an early stage, such as vocal cord tumor, which has hoarseness at an early stage, but nasopharyngeal cancer or hypopharyngeal cancer may not have any early symptoms. Common symptoms of oral cancer patients are painful ulcers, rapid and unclear speech, bleeding from the mouth, and outwardly bulging lumps. A small number of oral cancers can also be diagnosed by the dentist or oral surgeon through routine examination. Patients with early stage nasopharyngeal cancer may have unilateral otitis media. Oropharyngeal and pharyngeal tumors mostly have painful swallowing, speech difficulties, voice changes, and occasional airway obstruction. Unexplained weight loss is an important symptom of head and neck cancer. A few patients ignore voice changes or minor airway obstruction until acute airway obstruction occurs, requiring emergency tracheotomy. Nasal tumors and paranasal sinus tumors may go undetected for a long time or be misdiagnosed as sinusitis or allergic rhinitis. Recurrent rhinorrhea, zygomatic augmentation, and diplopia are extremely common in patients with advanced maxillary sinus tumors, and these symptoms may go undiagnosed for a long time. Pain is a late symptom in patients with head and neck tumors and is usually caused by the trigeminal or glossopharyngeal nerves. Damage to the glossopharyngeal and vagus nerves due to pharyngeal tumors can cause ear involvement pain. Hypopharyngeal tumors or tumors of the base of the tongue can cause otalgia through the ear branch of the vagus nerve. Patients with advanced tumors may present with acute airway obstruction, severe speech difficulties, weight loss, damage to the facial skin, neck skin, and occasionally damage to the mandible with loose ground movement of the teeth. Advanced oral cancer tumors may invade skin and subcutaneous tissues with oral skin fistula. Concurrent and heterochronic occurrence of primary tumors Patients with head and neck cancer are at risk for the presence of a second primary tumor. Smoking and alcohol consumption have carcinogenic effects throughout the GI airway. When a patient is found to have a primary tumor, there is a 15% chance that a second primary tumor, including lung cancer and esophageal cancer, will also be present. As the risk of second primary tumors increases, patients with head and neck cancer need to be carefully followed up with a thorough evaluation of the entire upper GI airway, including chest radiographs and barium esophageal fluoroscopy in cases of unexplained wasting.