Head and neck cancer is a term that covers several different types of cancer that can develop in various parts of the head and neck region, including the mouth, throat, voice box, sinuses, and salivary glands. Understanding these conditions is important because they affect areas vital to breathing, speaking, eating, and expressing emotions.
Understanding Head and Neck Cancer
Head and neck cancers typically refer to cancers that start in the upper aerodigestive tract, which is the pathway that air and food take when entering the body. Most of these cancers begin in squamous cells, which are thin, flat cells that form the moist lining inside the mouth, nose, and throat. When cancer develops in these cells, it is called squamous cell carcinoma of the head and neck.[1][4]
The term “head and neck cancer” is not a single diagnosis but rather a category that includes multiple specific types based on where the cancer starts. These locations include the oral cavity (mouth and lips), the pharynx (throat), the larynx (voice box), the nasal cavity and sinuses, and the salivary glands. Each location presents unique challenges and requires different approaches to treatment.[2][4]
When doctors talk about head and neck cancers, they are usually not referring to cancers of the brain, eye, thyroid gland, or skin of the head and neck, even though these areas are anatomically in the same region. These cancers are typically classified separately because they behave differently and require different treatments.[1]
How Common Are Head and Neck Cancers?
Head and neck cancers account for approximately three to five percent of all cancers in the United States. Globally, these cancers represented about 890,000 new cases in 2018, along with approximately 450,000 deaths. The five-year survival rate for patients with head and neck cancer is around 60 percent, though this varies significantly depending on the stage at which the cancer is detected and treated.[13][8]
These cancers are diagnosed more frequently in men than in women, with about twice as many men receiving a diagnosis. They are also more likely to be found in people over 50 years of age. However, this pattern may reflect the fact that older men have historically been more likely to have risk factors such as tobacco and alcohol use.[2][11]
An important shift is occurring in the epidemiology of head and neck cancers. While cases related to tobacco and alcohol use have been declining in some countries, cancers associated with human papillomavirus (HPV) are increasing. This has led to more diagnoses in younger individuals, particularly those under 50, who may not have the traditional risk factors.[11][13]
What Causes Head and Neck Cancer?
The development of head and neck cancer is strongly linked to exposure to certain substances that damage cells over time. The two most important risk factors are tobacco and alcohol use. This includes smoking cigarettes, cigars, and pipes, as well as using smokeless tobacco products like chewing tobacco or snuff. People who use both tobacco and alcohol face an even greater risk than those who use either one alone.[1][2]
When tobacco smoke or alcohol comes into contact with the cells lining the mouth, throat, and voice box, it can cause changes in the DNA of these cells. Over time, these changes can lead to uncontrolled cell growth, which is the hallmark of cancer. Most head and neck squamous cell carcinomas of the mouth and voice box are caused by tobacco and alcohol exposure.[1]
Infection with certain viruses also plays a significant role. About 70 percent of cancers in the oropharynx (the middle part of the throat, including the tonsils and base of the tongue) are linked to HPV, particularly HPV type 16. HPV is a sexually transmitted virus that can infect the cells of the throat and cause changes that lead to cancer. HPV-related head and neck cancers tend to have a better prognosis and respond more favorably to treatment compared to cancers caused by tobacco and alcohol.[2][13]
Another virus, the Epstein-Barr virus (EBV), which causes infectious mononucleosis, can increase the risk of cancers in the nasopharynx (the upper part of the throat behind the nose) and cancers of the salivary glands.[2]
Overexposure to ultraviolet rays from the sun, tanning beds, or sunlamps can cause cancer on the lips, which is considered a type of skin cancer. Occupational exposures are also a concern. People who work in construction, textile, ceramic, logging, and food processing industries may be exposed to substances like wood dust, formaldehyde, asbestos, and nickel, all of which can increase the risk of head and neck cancer, particularly in the nasopharynx.[2]
Who Is at Risk?
Certain groups of people face a higher risk of developing head and neck cancer based on their behaviors, habits, and environmental exposures. Anyone who uses tobacco products of any kind is at increased risk. This includes not only cigarettes but also cigars, pipes, and smokeless tobacco. Secondhand smoke exposure also contributes to risk, meaning that even non-smokers who are regularly exposed to tobacco smoke may face elevated risk.[1][2]
Heavy alcohol consumption is another significant risk factor. When combined with tobacco use, the risk multiplies. People who drink any type of alcohol regularly—whether beer, wine, or liquor—and also use tobacco face the highest risk of developing cancers of the mouth, throat, and voice box.[2]
Individuals with a history of HPV infection, particularly high-risk strains like HPV-16, are at increased risk of developing oropharyngeal cancers. This risk is especially relevant for people who have had multiple sexual partners or who do not use barrier protection during oral sex. The HPV vaccine, which is now available and recommended for preteens and young adults, can help prevent HPV-related head and neck cancers.[2][13]
People who have received radiation therapy to the head and neck area for other conditions are at higher risk of developing head and neck cancers later in life. Those with certain occupational exposures, such as construction workers or those in industries that handle wood dust, formaldehyde, or asbestos, also face elevated risk.[2]
Poor nutrition may also play a role. While the relationship is complex, diets low in fruits and vegetables and high in processed foods may contribute to an increased risk of head and neck cancer. Maintaining a healthy, balanced diet rich in whole foods may offer some protective benefit.[2]
Recognizing the Symptoms
The symptoms of head and neck cancer can vary depending on where the cancer is located. Many of these symptoms can also be caused by less serious conditions, such as a cold, sore throat, or ear infection, which is why they are sometimes overlooked initially. However, if symptoms persist for more than a few weeks, it is important to see a healthcare provider for evaluation.[2][11]
In the mouth, signs of cancer may include a white or red sore that does not heal on the gums, tongue, or the lining of the cheeks. There may be swelling in the jaw, unusual bleeding or pain in the mouth, a lump or thickening in the tissues, or problems with dentures that suddenly don’t fit properly. These symptoms should not be ignored, especially if they last for more than two or three weeks.[2]
For cancers in the back of the mouth and throat (pharynx), symptoms can include trouble breathing or speaking, a lump or thickening in the tissues, difficulty chewing or swallowing food, a feeling that something is caught in the throat, or pain in the throat that won’t go away. Some people also experience pain or ringing in the ears, or trouble hearing.[2]
When cancer develops in the voice box (larynx), one of the most common symptoms is persistent hoarseness or other changes in the voice. There may also be pain when swallowing or ear pain that doesn’t seem to be related to an ear infection.[2]
Cancer in the sinuses and nasal cavity can cause blocked sinuses that don’t clear, sinus infections that do not respond to treatment with antibiotics, bleeding through the nose, frequent headaches, pain and swelling around the eyes, pain in the upper teeth, or problems with dentures fitting properly.[2]
A persistent sore throat that does not improve with standard treatments is the most common sign of head and neck cancer overall. Other general symptoms may include a lump in the neck that doesn’t go away, persistent earaches, and unexplained weight loss.[11]
How to Lower Your Risk
The good news is that many head and neck cancers are preventable. The single most effective way to reduce risk is to avoid using tobacco in any form. If you currently use tobacco, quitting is one of the most important steps you can take to protect your health. Quitting smoking or using smokeless tobacco lowers the risk of cancer significantly, and the benefits begin as soon as you stop.[2]
Limiting alcohol consumption is also important. If you drink alcohol, doing so in moderation can reduce your risk. When combined with tobacco use, alcohol greatly increases cancer risk, so avoiding both is the most protective strategy.[2]
The HPV vaccine is a powerful tool for preventing HPV-related head and neck cancers. The vaccine is most effective when given before exposure to the virus, which is why it is recommended for preteens around age 11 or 12. However, it can also be given to young adults who were not vaccinated earlier. Talking to your doctor about HPV vaccination is an important part of cancer prevention.[2][13]
Protecting yourself from excessive sun exposure can help prevent cancer of the lips. Wearing a wide-brimmed hat and using lip balm with sunscreen when outdoors can reduce your risk. Similarly, avoiding tanning beds and sunlamps lowers the risk of UV-related cancers.[2]
Eating a healthy diet rich in fruits, vegetables, and whole foods may offer some protective benefits, though more research is needed to fully understand the relationship between diet and head and neck cancer risk. Nonetheless, good nutrition supports overall health and may help the body’s natural defenses against disease.[6]
Regular dental examinations are another form of prevention. Dentists are often the first to notice abnormal changes in the mouth that could indicate early cancer. Catching these changes early, before symptoms develop, can lead to earlier treatment and better outcomes.[8]
What Happens in the Body
Head and neck cancer develops when normal cells in the head and neck region undergo changes that cause them to grow uncontrollably. These changes usually occur in the DNA of the cells, which contains the instructions for how cells should behave. When DNA is damaged by tobacco, alcohol, viruses, or other carcinogens, the cells may begin to divide without stopping and fail to die when they should.[6]
In a healthy body, cells grow, divide, and die in an orderly way. Old or damaged cells die and are replaced by new ones. Cancer disrupts this process. The damaged cells continue to grow and multiply, forming a mass of tissue called a tumor. Over time, these cancer cells can invade nearby tissues and structures, making it harder to speak, swallow, breathe, or perform other vital functions.[4]
Most head and neck cancers begin in the squamous cells that line the moist surfaces of the mouth, nose, and throat. These cells are constantly exposed to substances we inhale or swallow, which is why exposure to tobacco smoke, alcohol, and certain viruses can cause so much damage in this area. The repeated exposure to harmful substances causes the cells to undergo genetic changes that can eventually lead to cancer.[1][6]
If head and neck cancer is going to spread, it typically does so first to nearby lymph nodes in the neck. Lymph nodes are small, bean-shaped organs that are part of the immune system. They help filter out harmful substances and are often the first place cancer cells travel when they break away from the original tumor. This is why doctors often examine the neck carefully for lumps or swelling when evaluating someone for head and neck cancer.[1]
In some cases, cancer cells can be found in the lymph nodes of the neck, but doctors cannot find the original tumor in the head or neck. This is called metastatic squamous cell carcinoma with unknown (occult) primary. It indicates that cancer started somewhere in the head or neck but the primary tumor is too small to be detected.[1]
The anatomy of the head and neck is complex, with many vital structures packed closely together. The throat is used for both breathing and swallowing. The voice box contains the vocal cords, which vibrate to produce speech. The sinuses and nasal passages filter and warm the air we breathe. The mouth and salivary glands are essential for eating and digestion. When cancer develops in any of these areas, it can interfere with these basic functions and significantly affect quality of life.[1][4]
