An Overview of Head and Neck Cancer
What is head and neck cancer? Head and neck cancers are cancers affecting the throat, lips, mouth, larynx and salivary glands. Risk factors may include heavy tobacco or alcohol use and infections, such as human papillomavirus (HPV).
According to a report in the Cancer Journal for Clinicians, head and neck cancers account for up to 4% of all cancers in the United States. They affect men twice as often as they do women, and they are more often diagnosed in people over the age of 50.
Head and neck cancers usually begin in the squamous cells of moist, mucosal parts of the nose, mouth and throat. Squamous cells are thin, flat cells, making up the outermost layer of skin (the epidermis). These cancerous cells are called squamous cell carcinomas of the head and neck.
Types of cancer on the neck and head are categorized by the area of the neck or head they start in.
- Oral cavity cancer may affect the lips, front of the tongue, gums, lining of the cheeks, bottom of the mouth (under the tongue), hard palate (bony top of the mouth) and the gum areas behind the wisdom teeth.
- Throat (pharynx) cancer can affect the area behind the nose, the middle part of the throat, back of the mouth, base of the tongue and tonsils, and lower part of the throat.
- The larynx, or voice box, is the short passageway of cartilage located just below the throat. The larynx is covered by a small piece of tissue — the epiglottis — which prevents food from entering the air passageways. The vocal cords are also part of the larynx. Any of these areas may be affected by cancer of the larynx.
- Cancer of the paranasal sinuses and nasal cavity affects the paranasal sinuses, the small hallow spaces of the bones surrounding the nose and nasal cavity, and the hallow space inside the nose.
- Cancer of the salivary glands affects the major glands at the bottom of the mouth and near the jawbone.
Symptoms of head and neck cancer are specific to the part of the body the cancer is located in and may include:
- Swelling or a sore throat that does not heal
- Red or white patches in the mouth
- Lumps or masses in the neck area that may or may not cause pain
- Foul mouth odor, unrelated to hygiene
- Voice hoarseness or voice changes
- Ongoing nasal obstruction or congestion
- Frequent nose bleeds or nasal discharge
- Breathing problems
- Double vision
- Numbness and/or weakness of the neck or head
- Jaw or tongue pain, with or without movement
- Problems with chewing or shallowing
- Loose teeth or dentures no longer fitting well
- Blood in saliva or phlegm from mucus discharge to the mouth from respiratory passages
- Unexplained weight loss
- Chronic fatigue
- Frequent ear infections and/or ear pain
It is a good idea to talk to your doctor if you experience any of the above symptoms. Your doctor will want to know how long you have had the symptoms for and ask other questions to determine a cause and diagnosis.
Causes and Risk Factors
Alcohol and tobacco — including chewing tobacco — are the two strongest risk factors for head and neck cancers, especially those of the oral cavity, throat and larynx. However, tobacco and alcohol are not risk factors for salivary cancers.
Human papillomavirus, a cancer-causing infection, is a risk factor for some kinds of cancers, especially those affecting the tonsils or tongue (oropharyngeal cancers). Research from the Journal of Clinical Oncology shows oropharyngeal cancers caused by HPV are increasing, while other causes for these cancers are decreasing.
Other risk factors for head and neck cancers include:
- Paan (betel quid): this is a type of smokeless tobacco used by some people in parts of Southeast Asia. Research reported in Epidemiology and Health shows this habit is associated with an increased risk for oral cancer.
- Preserved or salted foods: overconsumption of preserved and salted foods is a risk factor for nasopharyngeal cancer.
- Poor oral hygiene: while a weak risk factor, poor oral hygiene may contribute to oral cancer.
- Occupational exposure: certain occupations can increase a person’s risk for nasopharyngeal cancer, larynx cancer, and cancers of the paranasal sinuses and nasal cavity.
- Radiation exposure: previous radiation to the neck and head for non-cancerous conditions or cancer is a risk factor for salivary gland cancer.
- Epstein-Barr virus infection: the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of salivary glands.
- Ethnicity: people with Asian ethnicity, especially Chinese ethnicity, have an increased risk for nasopharyngeal cancer.
Diagnosis and Treatment
To find the cause of symptoms related to the head and neck area, a doctor will look at medical history, perform a physical examination and order diagnostic testing. The type of exams and tests requested will depend on the symptoms. Tissue samples may be taken from affected areas and examined under a microscope to confirm a diagnosis.
If a diagnosis of cancer is made, your doctor will want to determine the extent of the disease, a process called staging. Staging attempts to determine whether the cancer has spread, and if it has, to what parts of the body. Staging may involve x-rays and other imaging, bloodwork, and examination in an operating room under anesthesia. Knowing the stage helps in formulating a treatment plan.
A treatment plan for head and neck cancer depends on several factors, including the tumor location, cancer stage, and a person’s age and overall health. Treatment may include surgery, radiation, FDA approved head and neck cancer drugs, chemotherapy, targeted therapy or a combination of therapies.
You can reduce your risk for head and neck cancer by not smoking, not using smokeless tobacco and limiting alcohol intake. People under the age of 26 should talk to their doctors about HPV vaccines. It is also a good idea to always use condoms or dental dams correctly during oral sex to reduce the risk of HPV.
Use lip balm that contains sunscreen, avoid indoor tanning and wear clothing or head gear (hat) that covers your neck and head when outdoors. You should also visit your dentist regularly. Dental checkups can pinpoint head and neck cancer early on when the cancer is easier to treat.