Head and Neck Cancer

Overview

What is head and neck cancer?

Head and neck cancer refers to several types of cancers that affect the head and neck areas of the body. These cancers account for approximately 3% to 5% of all cancers in the United States. Head and neck cancer is more common in men and in people over age 50. These cancers are very treatable if caught early and are easily preventable. The most common causes of head and neck cancer are tobacco and alcohol use. Human papillomavirus (HPV) is also an important risk factor for some head and neck cancers.

Head and neck cancer includes cancers of the:

  • Oral cavity: lips, tongue, gums, lining of the cheeks and lips, bottom and top of the mouth, and behind the wisdom teeth. The most common type of head and neck cancer.
  • Salivary glands: These produce the saliva that keeps your mouth and throat moist. The main glands are on the bottom of the mouth and near the jawbone.
  • Sinuses: the hollow spaces in the bones surrounding the nose.
  • Nasal cavity: the hollow area inside the nose.
  • Tonsils.
  • Throat (pharynx).
  • Voicebox (larynx).
  • Ears.
  • Lymph nodes in the upper part of the neck.

Despite their locations, brain, eye and thyroid cancers aren't usually referred to as head and neck cancers.

Symptoms and Causes

What are the symptoms of head and neck cancer?

Head and neck cancer can be hard to diagnose, because symptoms are often mild and can mimic less serious conditions such as a cold or sore throat. These symptoms include:

  • A mouth or tongue sore that does not heal.
  • A white or red patch on the gums, tongue, or lining of the mouth.
  • A persistent sore throat.
  • Hoarseness.
  • Swelling in the jaw, neck or side of the face. This may cause dentures to fit poorly.
  • Frequent sinus infections that don’t respond to antibiotics.
  • Neck pain that won't go away.
  • Frequent headaches.
  • Pain in the upper teeth.
  • Bleeding through the nose or in the mouth, or blood in the saliva.
  • Trouble swallowing.
  • Persistent earaches.
  • Trouble breathing or speaking.

If you notice any of these symptoms, it is important to check with your physician immediately. They may be signs of less serious conditions, but a thorough exam should be done.

Diagnosis and Tests

How is head and neck cancer diagnosed?

Early detection is key to successful treatment of head and neck cancer. Almost three-quarters of all head and neck cancers can be easily detected during an examination. Your healthcare provider will perform an examination and may order diagnostic tests.

These exams and tests might include:

  • A physical exam to check the oral and nasal cavities, neck, throat and tongue. Your provider may also feel your neck, lips, gum and cheeks for lumps.
  • Endoscopy: Your provider uses a thin, lighted tube called an endoscope to examine your voice box, throat, nasal cavity or other area where you are experiencing symptoms. This is done in the office and isn’t painful.
  • Laboratory tests on blood, urine or other body samples.
  • Head and neck X-rays, CAT scans, MRIs or PET scans to create pictures of the areas inside your head and neck. Your provider will determine which tests will best evaluate your symptoms.
  • Biopsy: Your provider removes tissue for a pathologist to study under a microscope. This is the only sure way to diagnose cancer. This may be done in the office with a local anesthetic, usually with a needle. Or it may have to be done in an operating room while you’re under a general anesthetic.

Management and Treatment

How is head and neck cancer treated?

The first step in treating head and neck cancer is to determine the stage of cancer.

Stage I and II cancers are small and haven’t spread from their original location. They are usually curable.

Stage III and IV cancers have usually spread to nearby lymph nodes, and/or are large tumors. They usually require more complicated treatment and have a smaller chance of cure, but most are potentially curable. Tumors that have spread to other parts of the body, called metastatic tumors, are generally thought to be incurable, but may be treated to reduce symptoms.

The stage, along with your age, general health and location of the tumor, will determine your treatment plan.

The three main courses of treatment for head and neck cancers are radiation therapy, surgery and chemotherapy. Some patients may receive all three treatments.

  • Surgery: Surgeons may remove the tumor and a margin of surrounding healthy tissue. Lymph nodes in the neck may also be removed if it’s suspected that the cancer has spread. Surgery on the head and neck areas may change the patient’s appearance and ability to chew, talk and swallow. For these reasons, patients may require reconstructive surgery and speech therapy after surgery.
  • Radiation therapy: This involves the use of high-energy X-rays to kill cancer cells. This is done via a machine near the body. Radiation therapy can have side effects, such as sores or irritation in the treated area, difficulty in swallowing or tasting, loss of saliva, decreased appetite and nausea. Tell your provider of any side effects for guidance on how to best deal with them.
  • Chemotherapy: Chemo is the use of anti-cancer drugs to kill cancer cells throughout the body. It’s more commonly used for advanced-stage head and neck cancers. Side effects include sores in the mouth, loss of appetite, nausea, vomiting, tiredness, rash, joint pain and hair loss. Talk to your provider about how to treat these side effects.

What are some new developments in treating head and neck cancer?

New treatments for head and neck cancers include the use of drugs that block the hormones that cause certain tumor cells to multiply. These treatments make the tumor more sensitive to radiation and increase the chance of a cure. Immunotherapy (a treatment that uses your own immune system to fight the disease) is rapidly evolving as an option. Immunotherapy drugs help your body produce cancer-fighting cells.

Many new therapies are focused on decreasing side effects of treatment while maintaining good cure rates. For example, newer chemotherapy drugs are being used that have less serious side effects, but still are effective in killing cancer cells.

Newer radiation techniques focus more energy on tumor cells and less on normal tissue, so that patients experience fewer side effects. And advanced surgical techniques can remove the cancer while allowing the patient to regain a more normal lifestyle after successful therapy.

There have also been breakthroughs in new ways of combining surgery, radiation and chemotherapy. Your provider can tell you about the latest treatments for head and neck cancers.

Prevention

How can I protect myself from head and neck cancer?

Head and neck cancers are very preventable. Here are three important steps:

  1. Quit tobacco. Tobacco use is the most common cause of head and neck cancers. Eighty-five percent of these cancers are linked to tobacco use. To reduce your risk of head and neck cancer, quit using all forms of tobacco (cigarettes, cigars, pipes, snuff, and chewing tobacco).
  2. Cut back on drinking. Alcohol use has also been determined to contribute to head and neck cancer. Reducing your alcohol intake can reduce your risk of these cancers.
  3. Consider getting the HPV vaccine. Human papillomavirus can cause some types of head and neck cancers, particularly oropharyngeal cancer. Talk to your provider to see if you would benefit from the vaccine. It’s most effective in preventing HPV if given at a young age (up to age 26).

If you have already had cancer, cutting out tobacco and alcohol can reduce the risk of your cancer recurring. Seeing your physician at the first sign of symptoms can also prevent cancers from progressing.

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