Head and neck cancer refers to a group of different types of cancer that start in this region of the body and may include: the larynx (voice box), hypopharnyx, throat, lips, mouth, nose, and salivary glands. They are typically categorized by where the cancer starts:
- Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor (bottom) 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.
- Pharynx: The pharynx (throat) is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts: the nasopharynx (the upper part of the pharynx, behind the nose); the oropharynx (the middle part of the pharynx, including the soft palate [the back of the mouth], the base of the tongue, and the tonsils); the hypopharynx (the lower part of the pharynx).
- Larynx: The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.
- Paranasal sinuses and nasal cavity: The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.
- Salivary glands: The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.
Cancers of the brain, the eye, the esophagus, and the thyroid gland, as well as those of the scalp, skin, muscles, and bones of the head and neck, are not usually classified as head and neck cancers.
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. When this happens, the cancer is called metastatic squamous neck cancer with unknown (occult) primary. More information about this cancer type can be found in Metastatic Squamous Neck Cancer with Occult Primary (PDQ®).
Signs and Symptoms of Head and Neck Cancers
The ears, nose, and throat are the most common areas affected by cancers in the head and neck. Symptoms typically depend on where the cancer develops and how it spreads. Some common signs and symptoms can include:
- A lump or sore in the nose, neck, or throat that does not heal or go away
- Difficulty and/or pain when swallowing
- Trouble breathing or speaking
- Change or hoarseness in the voice that isn’t related to a virus (ie: cold or flu) or bacterial infection (ie: strep throat)
- Swelling of the jaw
- Chronic blocked sinuses or sinus infections
- White or red patches on the gums, tongue, or lining of the mouth
- Frequent headaches
- Ear pain, trouble hearing and/or ringing in the ears not related to a common ear infection
Keep in mind that many of these symptoms can occur even if there is no cancer present. In many cases, they are due to some other condition. However, this cannot be confirmed without an examination. If you experience these symptoms–especially if they recur or persist more than two weeks–see your doctor or your dentist, if the concern is inside of your mouth.
Head and Neck Cancer Risk Factors
Tobacco use, heavy alcohol use, and the human papillomavirus (HPV) can increase the risk of many types of head and neck cancer. Treatment and prognosis is based on what type of head and neck cancer is present and what stage it is.
Optim Oncology offers an integrated team-oriented approach to provide you with the best possible care. We are also eager to explain the facts and answer your questions at every step along the way.
Diagnosis
How are head and neck cancers diagnosed?
Sometimes changes in the mouth, neck or nose are seen during a routine visit to the doctor or dentist. But in many cases, patients will go to their doctor to treat one of the symptoms that is causing problems without realizing it was cancer. If the general practitioner or dentist isn’t able to identify the cause of the issue they may refer the patient to visit to an ENT, which is a doctor who focuses on diseases of the ear, nose, and throat.
To find the cause of the signs or symptoms of a problem in the head and neck area, an oncologist doctor evaluates a person’s medical history, performs a physical examination, and orders diagnostic tests. Exams and tests may vary depending on the symptoms, the type of cancer suspected, your age and medical condition, and the results of earlier medical tests.
The doctor will ask questions about your health and conduct a physical exam. If signs are pointing to head or neck cancer, more tests will be done. Some of the tests you may need include:
- Complete head and neck exam: The doctor will check the head and neck area, looking and feeling for any abnormal areas. The lymph nodes in the neck will be felt for any signs of cancer. Because some parts of the mouth and throat are not easily seen, the doctor may use mirrors, lights, and/or special fiber-optic scopes to look at these areas.
- Panendoscopy: This is a complete exam done in the operating room after you are given drugs to make you sleep. The surgeon looks at the entire area through thin tubes called scopes and may take out pieces of tissue (biopsies) to be checked under a microscope.
- Biopsy: For this test, the doctor takes out a small piece of tissue where the cancer seems to be. The tissue is checked for cancer cells. This is the best way to know for sure if you have cancer.
- CT scan: This is also called a “CAT scan.” It’s a special kind of x-ray that takes detailed pictures to see if the cancer has spread to the lymph nodes, lungs, or other organs.
- MRI scan: MRIs use radio waves and strong magnets instead of x-rays to take detailed pictures. MRIs can be used to learn more about the size of the cancer and look for other tumors.
- Barium swallow: For this test, x-rays are taken while you swallow a liquid with barium in it. Barium coats the inside surface of the throat and helps get a good picture. This test helps to see how your throat looks as you swallow.
- Chest x-rays: X-rays may be done to see if the cancer has spread to the lungs.
- PET scan: In this test, you are given a special type of sugar that can be seen inside your body with a special camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found. This test is useful when your doctor thinks the cancer might have spread, but doesn’t know where.
- Blood tests: Certain blood tests can provide important information for the doctor.
Head and neck cancers are classified according to the part of the body in which they occur. Some types of head and neck cancers you could be diagnosed with can include:
- Throat cancers such as laryngeal cancer (voice box), hypopharyngeal cancer (lower part of the throat), and oropharyngeal cancer (area of throat just behind the mouth)
- Nasal cavity and paranasal sinus cancer (nose and surrounding nose area)
- Salivary gland cancer
- Oral cancer (cancers of the mouth)
If the diagnosis is cancer, your doctor will then go on to learn the extent (stage) of the disease.
Questions to ask the doctor:
- What tests will I need to have?
- Who will do these tests?
- Where will they be done?
- Who can explain them to me?
- How and when will I get the results?
- Who will explain the results to me?
- What do I need to do next?
Staging
If you have either head cancer or neck cancer, your cancer specialist will want to learn the stage (or extent) of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging typically involves an examination under anesthesia, laboratory tests, and x-rays or other imagining procedures.
The American Joint Committee on Cancer developed the TNM (tumor, node, metastasis) classification system, which is the most commonly used staging system by medical professionals around the world. It evaluates three key factors of head and neck cancers:
- Tumor (T): the size and primary location of the tumor
- Node (N): if the cancer has spread to the lymph nodes
- Metastasis (M): whether the cancer has metastasized (spread) to other areas of the body
Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread from where it started to other parts of the body.
Knowing the stage of your cancer also allows your oncologist to make a treatment recommendation that is specific to your situation. Your cancer care team at Optim Oncology will thoroughly review your medical history, family history, and other factors to develop an individualized cancer treatment plan for you.
Questions to ask the oncology team:
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- What will happen next?
- How quickly do I need to start treatment?
Treatment Options
How are head and neck cancers treated?
There are several ways to treat head and neck cancers, but the primary ways are local or systemic.
Local treatment is when only the cancer is treated. This is done with surgery and radiation. Systemic treatment, on the other hand, reaches cancer cells throughout the entire body. This is accomplished with chemotherapy and targeted drug therapy. In some cases, patients may need a combination of both local and systemic treatments.
The treatment plan for an individual patient depends on a number of factors, including the type of head or neck cancer one is diagnosed with, the exact location of the tumor, the stage of the cancer, and the person’s age and general health.
People who are diagnosed with HPV-positive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are HPV-negative. Recent research has shown that patients with HPV-positive oropharyngeal tumors have a better prognosis and may do just as well on less intense treatment. An ongoing clinical trial is investigating this question.
Treatment options should be considered carefully. Talking with your oncologist can help determine what type of cancer treatment is best for you.
Questions to ask the oncologist:
- What treatment do you think is best for me?
- What is the goal of treatment? Could it cure the cancer?
- If I need surgery, what will it be like and who will do it?
- Will I need additional treatments?
- What side effects might I have?
- How soon do I need to start treatment?
- Can I do anything to help the treatment work better?
Ask your cancer care team or visit the National Cancer Institute where this information and more can be found about head and neck cancer including side effects of treatments, support information and more.