Head and Neck Cancer Metastatic

When cancer from the head and neck region spreads to other parts of the body, it becomes a complex disease requiring specialized care and understanding of how it behaves differently than cancer that stays in one place.

Table of contents

• What Is Metastatic Head and Neck Cancer
• Metastatic Squamous Neck Cancer with Occult Primary
• Signs and Symptoms
• How and Where Cancer Spreads
• Diagnosis and Testing
• Treatment Approaches
• Factors Affecting Prognosis

What Is Metastatic Head and Neck Cancer

Metastatic head and neck cancer refers to cancer that originally formed in the head and neck region but has spread to other parts of the body. Most head and neck cancers begin in squamous cells, which are thin, flat cells that line the moist surfaces inside the mouth, throat, voice box, and nasal passages^[1].

Head and neck cancers can spread through the blood or lymph system (a network of vessels and nodes that help fight infection) to other parts of the body. When squamous cell cancer spreads to lymph nodes (small bean-shaped structures that filter harmful substances) in the neck or around the collarbone, it is called metastatic squamous neck cancer^[1].

Metastatic head and neck cancer typically spreads to the lymph nodes, lungs, liver, and bones^[6]. The cancer has an aggressive nature and a tendency to spread, which makes treatment more complex than when cancer remains in its original location^[6].

Metastatic Squamous Neck Cancer with Occult Primary

Sometimes doctors find cancer in the lymph nodes of the neck, but cannot determine where in the body the cancer first began to grow. When tests cannot find the original tumor, it is called an occult primary tumor, meaning hidden primary tumor. This condition is known as metastatic squamous neck cancer with occult primary^[1][9].

In 20 to 35 percent of cases, finding cancer that has spread to the head and neck may be the first sign of an otherwise hidden cancer elsewhere in the body^[8]. The doctor will try to find the primary tumor because treatment for metastatic cancer is the same as treatment for the original tumor. For example, when lung cancer spreads to the neck, the cancer cells in the neck are lung cancer cells and are treated the same as the cancer in the lung^[1][9].

In many cases, the primary tumor is never found. Tests will include checking for a primary tumor in the organs and tissues of the respiratory tract, the upper part of the digestive tract (including the lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus), and the genitourinary system^[1][9].

Signs and Symptoms

The most common sign of metastatic squamous neck cancer with occult primary is a lump or pain in the neck or throat that doesn’t go away. You should check with your doctor if you have these symptoms^[1][9].

Head and neck cancer symptoms can be mild and may resemble less serious conditions like a cold or sore throat. A sore throat that doesn’t get better is the most common sign^[3][11][18].

Depending on the type and location of head and neck cancer, you may experience persistent sore throat, persistent earaches, frequent headaches, pain in your face or neck that won’t go away, pain in your upper teeth, pain when you chew or swallow, hoarseness or voice changes, or trouble breathing or speaking^[3][11][18].

You may also notice a lump in your throat, mouth or neck, a mouth or tongue sore that doesn’t heal, frequent nosebleeds or bloody saliva, a white or red patch on your gums or tongue or inside your mouth, or swelling in your jaw, neck, or side of your face^[3][11][18].

How and Where Cancer Spreads

When head and neck cancer is going to spread, it almost always does so locally (to nearby tissues) or to the lymph nodes in the neck. Sometimes cancerous squamous cells can be found in the lymph nodes of the upper neck when there is no evidence of cancer in other parts of the head and neck^[4].

The most frequent sites where head and neck cancers spread beyond the local area include the breast, lung, prostate, gastrointestinal tract, kidney, and skin. Metastases to the head and neck can occur in various locations including the orbit (eye socket), nasal cavity and paranasal sinuses, with the maxillary sinus being most frequently involved^[8].

Metastatic head and neck cancer can spread to the lungs, liver, and bones^[6]. The pattern and likelihood of spread depend on several factors including the original location of the tumor, its size, and how aggressive it is.

Diagnosis and Testing

Tests that examine the tissues of the neck, respiratory tract, and upper part of the digestive tract are used to detect and diagnose metastatic squamous neck cancer and try to find the primary tumor^[1][9].

In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform several types of tests. A biopsy, which involves taking a small tissue sample, is the only way to definitively diagnose cancer^[5].

Imaging scans provide detailed pictures of the inside of your body. Common scans include computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans. These help determine the tumor’s size, location, and whether it has spread to other parts of the body^[5].

In some cases, a thin, flexible tube with a camera, called an endoscopy, may be used to look inside the throat or voice box to get a closer look at the tumor and surrounding tissue^[5].

Treatment Approaches

Treatment for metastatic head and neck cancer requires a multidisciplinary approach. Doctors consider factors such as the location of the primary cancer, the extent of spread (metastasis), and the patient’s general health status when preparing an individualized treatment plan^[6].

Treatment for metastatic cancer is the same as treatment for the primary tumor. The treatment options depend on many factors including the cancer’s type, location, stage, and the patient’s overall health^[1][5].

Surgery aims to remove the tumor and some surrounding healthy tissue. For small tumors, this may be straightforward, but for larger or more advanced cancers, surgery can be more complex and may require reconstructive procedures^[5][17].

Radiation therapy uses high-energy rays or particles to kill cancer cells. It is often used in combination with other treatments to manage head and neck cancer^[5][6].

Immunotherapy is an innovative treatment that enhances the body’s immune system to target and destroy cancer cells. It has shown promise in increasing overall survival for patients with head and neck cancers and has been transformative for patients with recurrent or metastatic disease^[6][10].

Targeted therapy focuses on specific molecules involved in cancer growth and spread. This treatment can effectively slow or stop the progression of metastatic head and neck cancer^[6].

While early-stage disease remains primarily managed with surgery or radiation therapy, immunotherapy and antibody-based therapy have been practice-changing for patients with recurrent or metastatic disease. Unfortunately, many patients ultimately develop resistance to these approaches, with limited options for subsequent treatment^[10].

Factors Affecting Prognosis

Several factors affect prognosis (chance of recovery) and treatment options for patients with metastatic head and neck cancer^[1][9].

The prognosis depends on the natural history of the specific tumor based on staging, histology (how the cells look under a microscope), and other health conditions. The ability to control disease through treatment such as surgery, radiation therapy, immunotherapy, or chemotherapy also plays an important role^[19].

The cause of the cancer matters for prognosis. For example, head and neck cancers associated with human papillomavirus (HPV), a type of sexually transmitted infection, have a better prognosis than those not associated with HPV^[4][19].

The complexity, timing, and nature of treatment affect outcomes. In advanced head and neck cancer, multimodal treatment (using surgery, radiation therapy, chemotherapy, and immunotherapy together) and reconstructive or salvage surgeries (surgery following failure of initial treatment) are more likely to result in short-term and long-term side effects^[19].

About 4.5 percent of cancer diagnoses worldwide are head and neck cancers. Most head and neck cancers affect males over 50, but this may be because this group is more likely to have risk factors associated with these cancers, like a history of tobacco use^[3][11][18].