Head & Neck Cancer

What is head and neck cancer?

Head and neck cancer is a group of cancers that can start in the mouth, lips, nose, larynx, throat, salivary glands, or sinuses.

Overview

What are the common types of head and neck cancer?

There are many types of head and neck cancer. Here's an overview of the common types and the part of the body they affect:

• Cancer of the hypopharynx starts in the tissues at the bottom of the throat, behind and beside the voice box.
• Larynx cancer starts in the voice box at the top of the main breathing tube called the windpipe or trachea.
• Cancer of the nasopharynx is found in the tissues of the upper part of the throat, behind the nose.
• Oral cavity cancer starts in the mouth or tongue.
• Cancer of the oropharynx is in the back of the mouth or the middle part of the throat.
• Paranasal sinus and nasal cavity cancers start in the paranasal sinus and nasal cavity. The nasal cavity is just behind the nose.
• Cancer of the salivary gland is in the salivary glands. These glands are in the mouth, jaw and below the ears. There are also salivary glands in different parts of the upper digestive tract.
• Cancers of the thyroid gland located in the front of your neck.

Symptoms

What are the symptoms of head and neck cancers?

Some common head and neck cancer symptoms include:

• Growth or sore in the mouth that doesn't heal
• Sore throat that doesn't go away
• Hoarse voice or other voice changes that don't go away
• Trouble swallowing

Many symptoms depend on the cancer type, where it starts, and if the cancer has spread. Other symptoms of these cancers are:

• Lump in the neck that doesn't hurt
• Lump or sore inside the nose or on the lip that doesn’t heal
• Feeling like something is stuck in the throat or persistent sore throat
• Blocked sinuses or nasal congestion that won’t clear
• Chronic sinus infections
• Coughing up blood or bleeding in the mouth
• Trouble opening your mouth, speaking or breathing
• Pain when swallowing
• Pain in the ear, face, chin, neck, upper back, jaw or upper teeth
• Frequent headaches or pain around the nose, cheeks or forehead
• Frequent nosebleeds or ones that don’t stop
• Weakness in the muscles of the face, jaw and tongue
• Double vision or vision loss
• Numbness in the face
• Ringing in the ears or hearing problems
• Swelling of the eyes, under the chin or around the jaw
• Bad breath even with good oral hygiene
• Red or white patches in the mouth
• Tooth pain or sore gums
• Loose teeth or dentures
• Jaw pain
• Unexplained weight loss

When to see your health care provider

Many of these symptoms may be caused by other health problems. But seeing your health care provider if you have any of these symptoms is essential. You may need to see an ear, nose and throat (ENT) specialist (otolaryngologist) or a head and neck surgeon.

Risk Factors

The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer.

Things you should know about risk factors for cancer:

• Risk factors can increase a person's risk but don't always cause the disease.
• Some people with one or more risk factors never develop cancer. And some people with cancer have no known risk factors.
• Some risk factors are very well known. But there's ongoing research about risk factors for many types of cancer.

Some risk factors, such as family history or age, may not be in your control. But others may be things you can change. Knowing the risk factors helps you make choices that lower your risk.

What are some head and neck cancer risk factors?

• Using tobacco. Tobacco use is the single largest risk factor for head and neck cancer. People who smoke, chew tobacco, dip snuff, or smoke pipes have a much higher chance of getting head and neck cancer than people who do not. Smokeless tobacco greatly increases the risk. The risk is related to the amount used—how many cigarettes, cigars, or pipes you smoke or how often you chew or dip. The risk is also related to how many years you've used tobacco. Smoking marijuana or being exposed to secondhand smoke (other people's smoke) may also increase your risk of head and neck cancer.
• Alcohol use. Drinking a lot and drinking often increases your risk. If you drink heavily and smoke, your risk is many times higher.
• Unhealthy diet. A diet low in vitamins A and B and fruits and vegetables might increase your head and neck cancer risk. Eating a lot of processed or salt-cured meat can also increase risk.
• Poor mouth care. Not caring for your mouth and teeth may increase your head and neck cancer risk. A gum disease and tooth loss history may put you at higher risk.
• Certain virus infections. Infection with certain types of HPV (human papillomavirus) increases your risk for some kinds of head and neck cancer. Exposure to the Epstein-Barr virus, which causes mononucleosis, can increase the risk of nasopharyngeal and salivary gland cancers.
• Sun exposure. Lip cancer is more common in people who spend much time in the sun.
• Gender. Men are at two to three times greater risk than women. But women’s head and neck cancer rates have been increasing.
• Agee. People older than age 40 have an increased risk.
• Certain exposures at work. People exposed sulfuric acid mist, nickel, wood dust, paint fumes, formaldehyde or asbestos. Always follow safety and work regulations, such as adequate workplace ventilation and respirators, to avoid breathing in dangerous chemicals.
• Weakened immune system. You have a higher risk for some kinds of head and neck cancer if you have had an organ transplant or are living with AIDS.
• Inherited syndromes. Certain genetic diseases passed in families, like Fanconi anemia, put people at a higher risk.

Prevention

How to prevent head and neck cancers?

Researchers aren’t sure what causes all head and neck cancers. There is no sure way to prevent cancer, but some things may help lower your risk for certain types, such as:

• Not using tobacco in any form
• Limiting or not drinking alcohol
• Protect your lips with sunscreen or lip balm with appropriate SPF protection
• Reduce your risk for HPV infection. Get the HPV vaccine before you start having sex, and limit sexual partners.
• Eating a healthy diet with lots of fruits and vegetables
• Get regular dental care
• Having proper-fitting dentures

Talk with your health care provider about lowering your risk. Ask for resources to help. Making changes can be challenging, but you don’t have to make them alone.

Diagnosis

How is head and neck cancer diagnosed?

Diagnosing head and neck cancer starts with discussing your health history, symptoms, risk factors and your family history of disease. A physical exam will be done. You may need to see an ear, nose, and throat specialist, called an ENT or otolaryngologist, or surgeon.

What tests might I need?

You may have one or more of these tests:

• Endoscopy
• Panorex dental films
• Barium swallow
• CT scan
• MRI
• Biopsy
• Blood tests
• PET scan

Treatment

What are the treatments for head and neck cancers?

There are many treatment choices for head and neck cancer. The one that's best for you depends on things like:

• The type of cancer
• The size of the tumor and where it is in your body
• Results of lab tests
• Extent of the disease, called the stage
• Your overall health
• Your age
• Your concerns and preferences

Cancer treatment is either local or systemic. You may have both.

• Local treatments remove, destroy or control cancer cells in a certain place in the body. Surgery and radiation are local treatments.
• Systemic treatments destroy or control cancer cells throughout the body. Chemotherapy and targeted therapy are examples.

Goals of head and neck cancer treatment

Treatment may control or cure cancer. It can also improve your quality of life by helping to control the symptoms. The goal of head and neck cancer treatment is to do one or more of these things:

• Remove the primary cancer tumor or other tumors
• Kill cancer cells or keep them from growing or spreading
• Keep cancer from coming back or delaying its return
• Ease symptoms of cancer, such as pain or pressure in nearby tissues

Each type of treatment has a different goal. Talk to your health care provider about treatment goals, so you know what to expect.

Commonly used treatments for head and neck cancer

Here's a list of common head and neck cancer treatments:

• Radiation therapy. Radiation uses strong X-rays to kill cancer cells and shrink tumors. This is sometimes the only type of treatment needed for head and neck cancer. More often, radiation is given along with chemotherapy or targeted therapy. Sometimes it's used to shrink a tumor before surgery so it's easier to remove without damaging nearby healthy tissues. It might be used after surgery, too, to kill any cancer cells that may be left behind. Radiation can also be used if the cancer comes back after treatment.
• Surgery. The goal of surgery is to take out the tumor along with an edge of healthy tissue around it. Nearby lymph nodes might also be taken out if the cancer has spread to them. The smaller the tumor, the better the chance of keeping normal functions, such as speaking and swallowing. Surgery may also be done to put in infusion ports for chemotherapy or to place a feeding tube. Plastic or reconstructive surgery may be needed after treatment to help restore appearance and function in the area that was treated.
• Chemotherapy. This is the use of strong medicines to treat cancer. One goal of chemotherapy (or chemo) is to reduce the size of a tumor before using other types of treatment. It can also help decrease the chance that the cancer will spread to other parts of your body. Chemo is most often given at the same time as radiation. This is called chemoradiation. The chemo helps the radiation work better. Chemo may also be used for more advanced cancers, when radiation or surgery can’t be used. Or it may be used when the cancer has spread to other parts of the body.
• Targeted therapy. This treatment uses medicines that target certain parts of cancer cells. For instance, many head and neck cancer cells are controlled by a protein called EGFR, which helps them grow. A medicine called cetuximab targets these cells. It blocks EGFR so that cancer cell growth slows or stops. Medicines that target EGFR are sometimes used to treat head and neck cancers.
• Immunotherapy. These medicines help your immune system find and kill cancer cells. Some head and neck cancer cells use a protein called PD-L1 to keep your immune system from attacking them. Medicines that block PD-L1 can boost the immune system against these cancer cells.

Is head and neck cancer curable?

Yes. Survivability largely depends on the stage of head and neck cancer. The American Cancer Society reports a five-year survival rate for head and neck cancer that hasn’t spread and remained localized at 94%. If the cancer has spread outside the starting location, the survival rate is 63%.