The treatment of head and neck cancer represents an interface between several disciplines. Of crucial relevance to case selection, early response monitoring and monitoring after surgery is the information provided by imaging modalities. Advances in imaging, in particular PET, offer a non-invasive molecular imaging method with which surgical treatments can be evaluated and treatment algorithms adapted. Indeed PET/CT has been considered to be one of the most significant advances in medicine and is now in common use in many multidisciplinary head and neck cancer units around the globe. As experience is gained in its use however, it is becoming increasingly clear that PET images in head and neck cancer require judicious interpretation before influencing treatment protocols and the role of surgery especially. We present the experiences of one of the busiest major regional head and neck cancer centres in the United Kingdom illustrating the obvious benefits of PET scanning but also the caveats that have been generated over the last 5 years. We discuss the role of PET-CT in diagnosis, treatment planning, treatment selection and monitoring of response and after treatment in the assessment of the primary tumour and neck. Contentious issues pertaining to the timing of treatment and the omission of surgical treatment of the neck are also discussed. Finally, the latest advances in PET scanning are outlined.

Conflict of interest: None declared.