Head and Neck Cancer
Head and neck cancer includes several different types of cancers that develop in areas such as the mouth, throat, voice box, nose, and sinuses. Most begin in the thin, flat cells that line these moist surfaces, and many are linked to tobacco use, alcohol consumption, and certain viral infections.
Table of contents
- What is Head and Neck Cancer?
- Types of Head and Neck Cancer
- Causes and Risk Factors
- Symptoms
- Diagnosis
- Treatment Options
- Prevention
- Living with Head and Neck Cancer
What is Head and Neck Cancer?
Head and neck cancer is a general term that includes multiple cancers that can develop in the head and neck region[1]. These cancers usually begin in the squamous cells—thin, flat cells that line the moist surfaces inside the mouth, throat, and nose[1]. When cancer starts in squamous cells, it is called squamous cell carcinoma[4].
Head and neck cancers account for about 4% of all cancers in the United States[14]. Globally, there were an estimated 890,000 cases in 2018 along with 450,000 deaths[13]. The five-year survival rate of patients with head and neck cancer is about 60 percent[13].
- Oral cavity (mouth, lips, tongue, gums)
- Pharynx (throat, including nasopharynx, oropharynx, and hypopharynx)
- Larynx (voice box)
- Nasal cavity and paranasal sinuses
- Salivary glands
Types of Head and Neck Cancer
Head and neck cancers are named based on the part of the head or neck where they begin[1]. Each type can affect different functions such as speaking, eating, and breathing.
Oral cavity cancer includes cancers of the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area of the gum behind the wisdom teeth[1].
Throat cancer (pharyngeal cancer) occurs in the pharynx, a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus[1]. The pharynx has three parts: the nasopharynx (upper part behind the nose), the oropharynx (middle part including the soft palate, base of the tongue, and tonsils), and the hypopharynx (lower part)[1].
Laryngeal cancer starts in the larynx (voice box), a short passageway formed by cartilage just below the pharynx in the neck[1]. The voice box contains the vocal cords and a small piece of tissue called the epiglottis, which moves to cover the voice box to prevent food from entering the air passages[1].
Nasal cavity and paranasal sinus cancer forms in the hollow space inside the nose (nasal cavity) or the hollow spaces in the bones surrounding the nose (paranasal sinuses)[1].
Salivary gland cancer occurs in the major salivary glands in the floor of the mouth and near the jawbone, or in the minor salivary glands located throughout the mucous membranes of the mouth and throat[1]. These glands produce saliva.
Causes and Risk Factors
Alcohol and tobacco use are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, hypopharynx, and voice box[1]. People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone[1]. All tobacco products, including cigarettes, cigars, pipes, and smokeless tobacco (chewing tobacco or snuff), are linked to head and neck cancer[2].
Drinking any type of alcohol, such as beer, wine, or liquor, also raises the risk of getting cancers of the mouth, throat, and voice box[2]. Most head and neck squamous cell carcinomas of the mouth and voice box are caused by tobacco and alcohol use[1].
Human papillomavirus (HPV) infection is a significant risk factor for oropharyngeal cancer (cancer of the middle of the throat, including the tonsils and base of tongue)[2]. About 70% of cancers in the oropharynx are linked to HPV, a common sexually transmitted virus[2]. While a strong connection has been established between HPV type 16 and the development of oropharyngeal cancer, other HPV types have been associated with oropharyngeal cancer as well[13]. HPV-related head and neck cancer has a unique risk factor profile and a more favorable prognosis than tobacco or alcohol induced cancer[13].
Other risk factors include:
- Overexposure to ultraviolet (UV) rays from the sun, tanning beds, or sunlamps, which is a cause of cancer on the lips[2]
- Occupational exposures to substances like wood dust, formaldehyde, asbestos, nickel, and other chemicals in construction, textile, ceramic, logging, and food processing industries[2]
- Infection with the Epstein-Barr virus, which can raise the risk of cancers in the nose, behind the nose, and cancers of the salivary glands[2]
- Radiation treatments to the head and neck[2]
About twice as many men as women get head and neck cancers[2]. They are more likely to be diagnosed in people who are over 50 years of age[2], although instances of HPV-related head and neck cancers are rising, and more people getting diagnosed are under 50[11].
Symptoms
Head and neck cancer symptoms are often mild and can mimic less serious conditions like a cold or sore throat[11]. A sore throat that doesn’t get better is the most common sign of head and neck cancer[11].
Depending on the type of head and neck cancer, symptoms may include:
In the mouth:
- A white or red sore that does not heal on the gums, tongue, or lining of the mouth[2]
- Swelling in the jaw[2]
- Unusual bleeding or pain in the mouth[2]
- A lump or thickening[2]
- Problems with dentures[2]
At the back of the mouth (pharynx):
- Trouble breathing or speaking[2]
- A lump or thickening[2]
- Trouble chewing or swallowing food[2]
- A feeling that something is caught in the throat[2]
- Pain in the throat that won’t go away[2]
- Pain or ringing in the ears or trouble hearing[2]
In the voice box (larynx):
In the sinuses and nasal cavity:
- Blocked sinuses that don’t clear[2]
- Sinus infections that do not respond to treatment with antibiotics[2]
- Bleeding through the nose[2]
- Headaches[2]
- Pain and swelling around the eyes[2]
- Pain in the upper teeth[2]
- Problems with dentures[2]
Other symptoms may include:
- Persistent earaches[11]
- Frequent headaches[11]
- Pain in your face or neck that won’t go away[11]
- A lump in your throat, mouth or neck[11]
- Swelling in your jaw, neck or side of your face[11]
- Trouble breathing[11]
Diagnosis
Head and neck cancer diagnosis often begins with an exam of the head and neck area[9]. A healthcare professional may look at your head and neck area for sores or other issues and might feel your neck for lumps or swelling[9].
To see inside your mouth, the health professional might use a light and a mirror[9]. To see inside the throat, sometimes a tiny camera is put down the throat that transmits images allowing the health professional to look for signs of cancer[9]. To see inside the nose, a tiny camera can go through the nostrils[9].
Imaging tests make pictures of the inside of the body and can show the size and location of the cancer[9]. Imaging tests used for head and neck cancer include CT, MRI and positron emission tomography scans, also called PET scans[9].
A biopsy is a procedure to remove a sample of tissue for testing in a lab[9]. How the cells are collected depends on the cancer’s location[9]. If the cancer is easy to access, a healthcare professional might cut out some of the tissue with a cutting tool[9]. Sometimes a needle can go through the skin and into the cancer to draw out some cells[9]. Special tools can collect cells from inside the throat or inside the nose[9].
Testing the tissue sample in the lab can show if the cells are cancerous[9]. Other special tests give more details about the cancer that help doctors determine the best course of treatment[9].
Treatment Options
The recommended treatment plan depends on many factors, including the location of the cancer, its size, the type of cells involved, and the patient’s overall health[4]. Treatment for head and neck cancer is designed to control or cure the cancer while preserving the function of the affected areas as much as possible[15].
Surgery aims to remove the tumor along with an edge of healthy tissue around it[15]. Nearby lymph nodes might also be removed if the cancer has spread to them[15]. The smaller the tumor, the better the chance of keeping normal functions, such as speaking and swallowing[15]. Plastic or reconstructive surgery may be needed after treatment to help restore appearance and function in the area that was treated[15].
Radiation therapy uses strong X-rays to kill cancer cells and shrink tumors[15]. This is sometimes the only type of treatment needed for head and neck cancer[15]. More often, radiation is given along with chemotherapy or targeted therapy[15]. Sometimes it’s used to shrink a tumor before surgery so it’s easier to remove without damaging nearby healthy tissues[15]. It might be used after surgery, too, to kill any cancer cells that may be left behind[15].
Chemotherapy uses strong medicines to treat cancer[15]. One goal of chemotherapy is to reduce the size of a tumor before using other types of treatment[15]. It can also help decrease the chance that the cancer will spread to other parts of your body[15]. Chemotherapy is most often given at the same time as radiation, called chemoradiation[15]. The chemotherapy helps the radiation work better[15].
Targeted therapy uses drugs that target specific features of cancer cells to stop them from growing[13]. One example is cetuximab, a monoclonal antibody that targets a pathway involved in cancer cell growth[13].
Immunotherapy helps your immune system fight cancer[13]. Several immunotherapy drugs that work by blocking certain proteins that prevent the immune system from attacking cancer cells are approved for treating head and neck cancer[13].
Major improvements have been made in surgical techniques and radiation therapy delivery[6]. Systemic therapy including chemotherapy and molecularly targeted agents has been successfully integrated into potentially curative treatment of locally advanced squamous-cell carcinoma of the head and neck[6].
Prevention
You can lower your risk of getting head and neck cancer in several ways[2]:
Don’t use tobacco. If you smoke, quit. Quitting smoking lowers the risk for cancer[2]. Don’t use smokeless tobacco products[2].
Limit alcohol. Limit the amount of alcohol you drink[2]. Alcohol consumption is a major risk factor for head and neck cancers.
Get the HPV vaccine. Talk to your doctor about human papillomavirus (HPV) vaccination[2]. One HPV vaccine is approved for the prevention of HPV-related head and neck cancers[13]. The HPV vaccine helps to prevent HPV-related oropharyngeal cancer[8].
Protect yourself from UV rays. Avoid tanning beds and sunlamps, and use sun protection to reduce the risk of lip cancer[2].
Eat a healthy diet. Eating a good whole-food diet and trying to minimize eating processed foods and refined sugars may help[23].
Get regular dental exams. Regular dental examinations may help identify signs before the cancer develops[4].
Living with Head and Neck Cancer
Treatment for head and neck cancers often involves numerous physical and emotional challenges[18]. The goals of rehabilitation depend on the extent of the disease and the treatment that a patient has received[21].
Depending on the location of the cancer and the type of treatment, rehabilitation may include physical therapy, dietary counseling, speech therapy, and learning how to care for a stoma (an opening into the windpipe through which a patient breathes after surgery to remove the larynx)[21].
Sometimes, especially with cancer of the oral cavity, a patient may need reconstructive and plastic surgery to rebuild bones or tissues[21]. If reconstructive surgery is not possible, a prosthodontist may be able to make a prosthesis (an artificial dental and/or facial part) to restore satisfactory swallowing, speech, and appearance[21].
Patients who have trouble speaking after treatment may need speech therapy[21]. Often, a speech-language pathologist will visit the patient in the hospital to plan therapy and teach speech exercises or alternative methods of speaking[21].
During treatment, it’s important to pay close attention to your oral health, drink plenty of fluids and eat a healthy diet[19]. Liquid meal replacements can provide extra calories and protein[19]. Some people do better with small, frequent meals rather than one or two large ones[19]. Your doctor may suggest a feeding tube if your mouth and throat are too sore to chew and swallow[19].
Listen to your body and rest when you’re tired[19]. Be kind to the skin near your treatment area by washing with mild soap and water, and do not put hot or cold packs on the skin[19].
Regular follow-up care is very important after treatment for head and neck cancer to make sure that the cancer has not returned, or that a second primary (new) cancer has not developed[21]. Depending on the type of cancer, medical checkups could include exams of the stoma (if one has been created), and of the mouth, neck, and throat[21]. Regular dental exams may also be necessary[21].
It’s important to report any new symptoms to your doctor right away, so the cause can be found and treated[19]. Finding a support group or seeking out help to manage the stress that comes with cancer treatment and a cancer diagnosis can be beneficial[19].
