The aim of this study was to determine whether the incidence of advanced stage (T4) head and neck tumours has increased. We analysed retrospectively 3178 patients diagnosed with oral, pharyngeal or laryngeal cancer in the period 1980-2000 at the University Medical Center Utrecht (UMCU), The Netherlands. There was a statistically significant increase in the proportion of T4 head and neck tumours compared with non-T4 tumours over the period 1980-2000. Linear regression analysis estimated an increase of 0.9% every year. The observed increase in T4 tumours at UMCU shows up in figures from the Netherlands Regional Cancer Registry (IKMN) and the National Cancer Registration (NCR). Although these bodies report for fewer years, this finding refutes the possibility of selected referral to the University Medical Center Utrecht. In conclusion, the number of head and neck cancer patients presenting with an advanced stage carcinoma (T4) has increased over a period of 21 years.