Head and Neck Cancer

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What is Head and Neck Cancer ?

Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body).

Head and neck cancer is a term used to describe a range of malignant tumors that can appear in or around the throat, larynx (voice box), nose, sinuses, and mouth.

Most head and neck cancers are squamous cell carcinomas, meaning they begin in the flat, squamous cells that make up the thin, surface layer (called the epithelium) of the structures in the head and neck. Directly beneath this lining, some areas of the head and neck have a layer of moist tissue, called the mucosa. If a cancer is limited to the squamous layer of cells, it is called carcinoma in situ. If the cancer has grown beyond this cell layer and moved into deeper tissue, then it is called invasive squamous cell carcinoma. If the cancer starts in the salivary glands, the tumor will usually be classified as an adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma.

Types of head and neck cancer

There are five main types of head and neck cancer, named by the part of the body where they begin. For more information on each type, select a name below.

Laryngeal and Hypopharyngeal Cancer: The larynx (commonly called the voice box) is a tube-shaped organ in the neck that is important for breathing, talking, and swallowing. It is located at the top of the windpipe, or trachea. The hypopharynx (also called the gullet) is the lower part of the throat that surrounds the larynx. 

Nasal Cavity and Paranasal Sinus Cancer: The nasal cavity is the space just behind the nose where air passes on the way to the throat. The paranasal sinuses are the air-filled areas that surround the nasal cavity.

Nasopharyngeal Cancer: The nasopharynx is the air passageway at the upper part of the throat behind the nose.

Oral and Oropharyngeal Cancer: The oral cavity includes the mouth and tongue. The oropharynx includes the middle of the throat from the tonsils to the tip of the voice box.

Salivary Gland Cancer: The salivary gland is tissue that produces saliva, which is the fluid that is released into the mouth to keep it moist and that contains enzymes that begin breaking down food.

Symptoms and Signs

People with head and neck cancer often experience the following symptoms or signs. Sometimes, people with head and neck cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.

Swelling or sore that does not heal (the most common symptom)

Red or white patch in the mouth

Lump, bump, or mass in the head or neck area (with or without pain)

Persistent sore throat

Foul mouth odor not explained by hygiene

Hoarseness or change in voice

Nasal obstruction or persistent nasal congestion

Frequent nose bleeds and/or unusual nasal discharge

Difficulty breathing

Double vision

Numbness or weakness of a body part in the head and neck region

Pain or difficulty chewing, swallowing, or moving the jaws or tongue

Ear and/or jaw pain

Blood in the saliva or phlegm (mucus discharged in mouth from respiratory passages)

Loosening of teeth

Dentures that no longer fit

Unexplained weight loss

Fatigue

People who notice any warning signs should talk with a doctor and/or dentist right away. Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. When detected early, cancers of the head and neck have a much better chance of cure.

Because many of these symptoms can be caused by other, noncancerous health conditions, as well, it is important to receive regular health and dental screenings; this is particularly important for people who routinely drink alcohol or currently use tobacco products or have used them in the past.

In fact, people who use alcohol or tobacco should receive a general screening examination at least once a year. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination using one or more of the procedures mentioned in Diagnosis.

If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. 

Risk Factors and Prevention

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop the disease, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

Two risk factors greatly increase the risk of head and neck cancer:

Use of tobacco (including cigarettes, cigars, pipes, chewing tobacco, and snuff), which is the single largest risk factor for head and neck cancer

Frequent and heavy consumption of alcohol

Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Using alcohol and tobacco together increases this risk. Recent research suggests that people who have used marijuana may be at higher risk for head and neck cancer. Secondhand smokemay also increase a person’s risk of head and neck cancer.

Other factors that can raise a person’s risk of developing head and neck cancer include the following:

Prolonged sun exposure. This is especially linked to cancer in the lip area (as well as skin cancer of the head and neck and other chronically sun-exposed areas, such as the hands).

Human papillomavirus (HPV). Research indicates that infection with this virus is a risk factor for head and neck cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. HPV vaccines protect against certain strains of the virus.  

Epstein-Barr virus (EBV). Exposure to EBV, which is more commonly known as the virus that causes mononucleosis, plays a role in causing nasopharyngeal cancer to develop.

Gender. Men are two to three times more likely than women to develop head and neck cancer. However, the rate of head and neck cancer in women has been rising for several decades.

Age. People over 40 are at higher risk for head and neck cancer.

Race. Black people are more likely than white people to develop certain types of cancer of the head and neck.

Poor oral/dental hygiene. Poor care of the mouth and teeth has been suggested as a factor that may increase the risk of head and neck cancer.

Environmental/occupational inhalants. Exposure to asbestos, wood dust, paint fumes, and certain chemicals may increase a person’s risk of head and neck cancer.

Poor nutrition. A diet low in A and B vitamins can raise a person’s risk of head and neck cancer.

Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD). Reflux of stomach acid into the upper airway and throat has been suggested as a factor associated with the development of head and neck cancer.

Weakened immune system. A weakened immune system can raise a person’s risk of head and neck cancer.

Prevention

Although some of the risk factors of head and neck cancer cannot be changed, such as age, several can be avoided by making lifestyle changes. Stopping the use of all tobacco products is the most important thing a person can do, even for people who have been smoking for many years. Other steps that can reduce the risk of head and neck cancer include:

Avoiding alcohol

Avoiding marijuana (Discuss marijuana as a risk factor with your doctor.)

Using sunscreen regularly, including lip balm with an adequate sun protection factor (SPF)

Reducing your risk of HPV infection by limiting the number of sexual partners, because having many partners increases the risk of HPV infection. Using a condom cannot fully protect you from HPV during sex.

Maintaining proper care of dentures. Poorly fitting dentures can trap tobacco and alcohol’s cancer-causing substances. Denture wearers should have their dentures evaluated by a dentist at least every five years to ensure a good fit. Dentures should be removed every night and cleaned and rinsed thoroughly every day.

Diagnosis

Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy (see definition below) is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

Age and medical condition

Type of cancer suspected

Severity of symptoms

Previous test results

If a person has symptoms and signs of head and neck cancer, the doctor will take a complete medical history, noting all symptoms and risk factors. In addition, the following tests may be used to diagnose head and neck cancer:

Physical examination/blood and urine tests. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. Also, the doctor will inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and a mirror for a clearer view. Blood and urine tests may be performed to help diagnose cancer. Testing for viral infections, including HPV, may also be done.

Endoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The tube is gently inserted through the nose into the throat and down the esophagus to examine the head and neck areas. The examination has different names depending on the area of the body that is examined, such as laryngoscopy (larynx), pharyngoscopy (pharynx), or a nasopharyngoscopy (nasopharynx). When these procedures are combined, they are sometimes referred to as a panendoscopy.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). One common type of biopsy is called a fine needle aspiration. In this procedure, cells are withdrawn using a thin needle inserted directly into the tumor. The cells are examined under a microscope for cancer cells (called cytologic examination).

Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy .

X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A barium swallow may be required to identify abnormalities along the swallowing passage. A special type of barium swallow called a modified barium swallow may be needed to evaluate specific swallowing difficulties. A dentist may also take x-rays of the teeth and mandible and maxilla, including a panorex (panoramic view). If there are signs of cancer, the doctor may recommend a computed tomography (CT) scan (see below).

Panorex. This is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect cancer or to evaluate teeth before radiation therapy or chemotherapy.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. This test may be done to see if cancer has spread to the bones.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Stages

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis (chance of recovery). There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and whether the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer: 

How large is the primary tumor, and where is it located? (Tumor, T)

Has the tumor spread to the lymph nodes? (Node, N)

Has the cancer metastasized to other parts of the body? (Metastasis, M)

There is a different staging system for each type of head and neck cancer; detailed information about staging for each head and neck cancer can be found in the specific cancer type section.

Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

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