Head & Neck Cancer

Head and neck cancer is a broad category of cancers that occur in the head and neck region, including inside the mouth, the nose and the throat. These cancers account for about 4% of all cancers in the United States, or 65,000 new cases annually.

Cancers of the head and neck are categorized by the area in which they begin.

Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor or bottom of the mouth under the tongue, the hard palate or bony top of the mouth, and the small area of the gum behind the wisdom teeth.

Pharynx: The pharynx or throat is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts:

nasopharynx– the upper part of the pharynx, behind the nose

oropharynx– the middle part of the pharynx, including the soft palate or the back of the mouth, the base of the tongue and the tonsils

hypopharynx– the lower part of the pharynx

Larynx: Also called the voice box, 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, and produce saliva.

There are two main causes for most head and neck cancers: alcohol and tobacco. Alcohol and tobacco use, including smokeless or chewing tobacco, account for at least 75% of all cases, especially in cancers of the oral cavity, oropharynx, hypopharynx and larynx.

Infections such as the human papillomavirus (HPV), are also a common risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue. Other risk factors include poor oral health and hygiene, occupational exposure to such things as wood dust, asbestos or formaldehyde, radiation exposure and infection of the Epstein-Barr virus.

The symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing and a change or hoarseness in the voice.

Symptoms that may affect specific areas of the head and neck include the following:

Oral cavity– A white or red patch on the gums, the tongue, or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.

Pharynx– Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.

Larynx– Pain when swallowing or ear pain.

Paranasal sinuses and nasal cavity– Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.

Salivary glands– Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away.

The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage or progression of the cancer, plus the person’s age and general health. Depending on the type of cancer there are a variety of tests and procedures that may be performed to properly diagnose the disease. Most of these tests include physical exams, blood tests, imaging tests such as MRI, CT and PET scans, bone scans, barium swallows, biopsies and different variations of an endoscopy.

Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of treatments. Again, exact treatment plans will depend on the specific type of head and neck cancer. Surgery for head and neck cancers often changes the patient’s ability to chew, swallow, or talk. The patient may look different after surgery and the face and neck may be swollen for weeks or months after. If lymph nodes were removed, there could be additional swelling for quite a long time.

Specific types of head and neck cancers can include: esthesioneuroblastoma (also called olfactory neuroblastoma); floor of the mouth cancer; lip cancer; mouth cancer; nasal and paranasal tumors; nasopharyngeal carcinoma; pituitary tumors; salivary gland tumors; soft palate cancer; throat cancer; thyroid cancer; tongue cancer; tonsil cancer.