Head and Neck Cancers

Head and neck cancers at a glance

• Head and neck cancers are a group of several cancers, or diseases in which cells grow uncontrollably, that begin in various areas of the head or neck.
• These cancers are named according to the area where they start, such as mouth cancer, nasal cancer, cancers of the throat and other specific areas.
• They often are not detected until they begin to develop symptoms such as swelling, discoloration, pain, numbness and weight loss.
• Our oncologists diagnose head and neck cancers through multiple tests including a complete head and neck exam, oral exam, CT scan, MRI scan, barium swallow and PET scan, among others.
• Risk factors for these diseases include alcohol and tobacco use, human papillomavirus, poor oral hygiene, age and gender.
• Treatments for head and neck cancers may include surgery, radiation, chemotherapy and targeted therapy.

What are head and neck cancers?

Head and neck cancers are groups of cells in those areas that do not stop growing, which disrupts the body’s normal functioning. In the United States, these cancers make up about 4% of all cancers, with men being more than twice as likely as women to get them, according to the National Cancer Institute.

They begin in the head or neck and can spread to other parts of the body. For example, a cancer that began in the neck but spread to another area such as the lungs would still be considered neck cancer.

The most common types of head and neck cancers are called squamous cell carcinomas. This type of cancer starts in the squamous cells that line the moist surfaces inside the mouth, nose and throat.

Head and neck cancers are also named according to the regions of the head and neck or more specific areas where they begin. These are sometimes named differently than listed below, but include the following.

Oral cancer (mouth cancer)

These begin in the oral cavity in areas that include the lips, the gums, parts of the tongue, the bottom of the mouth and the lining of the lips and cheeks.

Oropharyngeal cancer (a cancer of the throat)

These begin in the back of the throat (the pharynx) or mouth.

Nasopharyngeal cancer

Begins behind the nose in the upper part of the throat.

Laryngeal cancer

Begins in the voice box, also called the larynx.

Hypopharyngeal cancer

Begins behind the voice box and in the lower part of the throat.

Nasal cavity cancer

Begins in the cavity the nose opens into, which has two nasal passages air moves through during breathing, and lies above the bone that forms the roof of the mouth and curves downward to join the throat.

Paranasal sinus cancer

Begins in the sinuses, which are the hollow air-filled areas around or near the nose.

Additional cancers found in the oral, head and neck region

These include lymphomas, which occur in the tonsils and base of the tongue. Salivary gland cancer is also a type of head and neck cancer that is not very common.

Other cancers that occur in the head and neck areas are not generally classified as head and neck cancers. These include cancer of the eye, brain cancer and cancers of the thyroid gland, the esophagus and the scalp, as well as some others.

Causes and risk factors of head and neck cancer

Alcohol and tobacco use, including smokeless tobacco, are the main risk factors for head and neck cancers, especially cancers of the oropharynx, oral cavity, larynx and hypopharynx (bottom part of the throat). At least 75% of these cancers are caused by tobacco and alcohol use. People who use both tobacco and alcohol are at an even greater risk of developing these cancers than are those who use tobacco or alcohol alone.

Infection with cancer-causing types of the human papillomavirus (HPV) is another large risk factor for some types of head and neck cancers, in particular oropharyngeal cancers involving the tonsils or the base of the tongue. This is especially true of HPV-16. The occurrence of oropharyngeal cancers caused by HPV infection is currently increasing in the U.S.

Additional causes and risk factors include:

• Prolonged sun exposure, which can lead to cancer in the lip area.
• Poor oral hygiene.
• Poor diet and nutrition.
• Occupational exposure to wood dust, asbestos and synthetic fibers.
• Radiation exposure.
• Having Asian ancestry, particularly Chinese.
• Being male.
• Being over the age of 45.

Signs and symptoms of head and neck cancers

These cancers are often not found until they begin to cause problems that lead a patient to visit the doctor. Some signs and symptoms of these cancers include:

• A sore in the mouth that doesn’t heal.
• Pain in the mouth that doesn’t subside.
• A lump in or thickening of the cheek.
• A white or red patch on the tonsil, gums, tongue or lining of the mouth.
• A persistent sore throat.
• The feeling that something is caught in the throat and won’t go away.
• Trouble swallowing or chewing.
• Trouble moving the tongue or jaw.
• Numbness of the tongue or other areas of the mouth.
• Swelling of the jaw.
• Loosening of the teeth.
• Pain around the jaw or teeth.
• Changes in voice.
• A mass or lump in the neck.
• Weight loss.
• Consistent bad breath.

Many of these symptoms can be caused by things other than cancer or even by other types of cancer. It is always better to get symptoms checked and identify cancer early, which leads to better outcomes.

Testing and diagnosis

One of our doctors will first ask questions about the patient’s medical history, risk factors, symptoms and additional medical problems. If head and neck cancer is suspected, additional testing will occur. We use several types of tests if we suspect cancer.

Complete head and neck exam

The doctor will check the head and neck region, feeling and looking for abnormal areas. The lymph nodes in the neck will also be felt for signs of cancer. Mirrors, special fiber-optic scopes and/or lights may be used for areas of the throat and mouth that are not easily seen.

Panendoscopy

This exam is done in the operating room with the patient under sedation. The surgeon checks inside the nose, throat and mouth using thin tubes called scopes. The surgeon may also remove pieces of tissue to check under a microscope. This is called a biopsy. Biopsies are believed to be the best way to determine if cancer is present.

CT scan

A computed tomography (CT) scan, also known as a CAT scan, uses a special type of X-ray that takes detailed pictures to see if cancer has spread to the lungs, lymph nodes or other organs.

MRI scan

MRI (magnetic resonance imaging) scans use strong magnets and radio waves instead of X-rays to take detailed pictures. These pictures can help determine the size of the cancer and look for other tumors.

Barium swallow

X-rays are taken while the patient swallows a liquid containing barium. Barium coats the inside of the throat and helps generate an image. This test allows doctors to see what a patient’s throat looks like when swallowing.

Chest X-rays

X-rays may be done to see if cancer has spread to the lungs.

PET scan

During a PET (positron emission tomography) scan the patient is given a special type of sugar that can be seen inside the body with a particular type of camera. If cancer is present, the sugar shows up as “hot spots” where the cancer is located. This test is often used when we suspect the cancer has spread but are unsure of where.

Blood tests

Specific blood tests can tell the doctor more about a patient’s overall health, including the patient’s white blood cell count, which can help signal the presence of cancer.

Treatment for head and neck cancers

Like many cancers, head and neck cancers can be treated locally, systematically or using a combination of both techniques. Local treatment uses surgery and/or radiation to only treat the cancer without affecting the rest of the body. Systematic treatment uses chemotherapy and/or targeted therapy drugs throughout the whole body to reach cancer cells anywhere in the body.

We can use surgery to remove the cancer and an edge of healthy tissue surrounding it. In some types of these cancers, all or portions of the tongue, voice box, throat, windpipe, jawbone and other affected areas may need to be removed. Some head and neck cancers are located in places that are hard to operate on, ruling out surgery as an option.

We may also use radiation along with surgery or by itself when surgery is not possible. This treatment can be highly targeted to spare healthy tissues. Radiation uses high-energy rays to kill cancer cells.

This can be used as the main treatment to shrink cancer cells in order to make surgery easier or to kill cancer cells left behind after surgery. Radiation can be administered by a machine outside the body aimed at the cancer, or administered inside the body using radioactive seeds placed near the cancer.

Chemotherapy, or chemo for short, uses drugs to fight the cancer. These drugs can be given intravenously (through the vein) or taken as pills. The drugs then travel through the bloodstream and spread throughout the body. This type of therapy is given in rounds or cycles with breaks in between. Often two or more chemotherapy drugs are given, and treatment often lasts for many months.

Targeted therapy is different than chemotherapy as the drugs used mainly affect cancer cells and not normal, healthy cells. These drugs may work even if chemotherapy doesn’t or may help chemotherapy work better.

Risks of treatment

Our doctors will discuss the risks and side effects of each treatment with the individual patient and his or her family. All surgeries carry risks such as infection, pain, blood loss, scarring, deep venous thrombosis and more.

Chemotherapy side effects include fatigue, nausea, hair loss, infection and poor appetite. Radiation therapy side effects can be comprised of fatigue, stomach upset, skin reactions and memory issues. Targeted therapy can incur similar but more mild side effects as chemotherapy and radiation. The side effects of these three treatments generally fade away after treatment ends.