Head and Neck Cancer
What is head and neck cancer?
Head and neck cancer includes several types of cancer that usually start in the cells lining your mouth, throat (pharynx) or voice box (larynx). These cells are called squamous cells. Less commonly, head and neck cancers form in your sinuses or salivary glands.
Most head and neck cancers are classified as squamous cell carcinoma, after the cell that changes into a cancer cell.
What are the types of head and neck cancer?
Head and neck cancers include:
- Oral cancer: Cancer that forms in your lips, tongue, gums, the lining of your cheeks and lips, the top and bottom of your mouth, or behind your wisdom teeth.
- Oropharyngeal cancer: Cancer of the middle part of your throat (oropharynx). Tonsil cancer is the most common type of oropharyngeal cancer.
- Hypopharyngeal cancer: Cancer of the bottom part of your throat (hypopharynx).
- Laryngeal cancer: Cancer of your voice box (larynx), which contains your vocal cords.
- Nasopharyngeal cancer: Cancer of the upper part of your throat (nasopharynx).
- Salivary gland cancer: Cancer of your salivary glands, which produce saliva (spit).
- Nasal cavity and paranasal sinus cancer: Cancer that forms in the hollow area inside of your nose (nasal cavity) or the hollow spaces in the bones surrounding your nose (paranasal sinuses).
Head and neck cancers sometimes spread to the lymph nodes in the upper part of your neck.
Despite their locations, brain, eye, esophageal and thyroid cancers aren’t typically considered head and neck cancers. They require different treatments from those used in head and neck cancers.
Who is most likely to develop head and neck cancer?
Men and people assigned male at birth (AMAB) are up to three times more likely to get diagnosed than women and people assigned female at birth (AFAB). Age plays a role, too. Most people get diagnosed after age 50.
Certain factors raise your cancer risk, especially tobacco and alcohol use and HPV infection.
How common are head and neck cancers?
About 900,000 cases get diagnosed worldwide each year. In the U.S., head and neck cancers account for about 3% to 4% of all cancer diagnoses.
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 like a cold or sore throat. A sore throat that doesn’t get better is the most common symptom of a head and neck cancer.
- A persistent sore throat.
- Frequent headaches.
- Hoarseness or voice changes.
- Pain when you chew or swallow.
- Pain in your upper teeth.
- Facial numbness or pain.
- Neck pain that won’t go away.
- Trouble breathing or speaking.
- A lump in your throat, mouth or neck.
- Persistent earaches or infections.
- Nosebleeds, bloody saliva or phlegm.
- A mouth or tongue sore that doesn’t heal.
- Frequent sinus infections that don’t respond to antibiotics.
- A white or red patch on your gums, tongue or inside of your mouth.
- Swelling in your jaw, neck or side of your face (that may cause your dentures to fit poorly).
Check with a healthcare provider immediately if you notice any of these symptoms. They may be signs of something less serious, but you’ll need a thorough exam to be sure.
Risk factors for head and neck cancer
Head and neck cancers most often affect men and people AMAB over 50. Other than sex and age, the biggest risk factors are using tobacco, drinking too much alcohol and HPV infections. Some risk factors vary depending on the cancer type.
- Using tobacco: Tobacco use is the most common cause of head and neck cancers. Approximately 70% to 80% of these cancers are linked to tobacco use. Tobacco use includes smoking cigarettes, cigars or pipes or using chewing tobacco, snuff or dip. Exposure to secondhand smoke may also increase your risk.
- Drinking too much alcohol: Consuming too much alcohol can increase your risk. If you drink, the Centers for Disease Control and Prevention (CDC) recommends no more than two drinks daily for men and people AMAB and no more than one drink daily for women and people AFAB.
- Human papillomavirus (HPV): The occurrence of head and neck cancers associated with HPV infection is on the rise, especially among younger adults. Up to 75% of oropharyngeal cancers are associated with HPV infection.
- Epstein-Barr virus (EBV): EBV is most commonly associated with mono, but it’s related to cancer risk, too. Research suggests that an EBV infection can lead to nasopharyngeal cancer.
- Having a weak immune system: A weakened immune system makes it harder for your body to fight cancer. HIV infection and recent major surgeries (like organ or bone marrow transplants) have both been associated with cancer resulting from weakened immune systems.
- Exposure to substances on the job: Your work may expose you to substances linked to head and neck cancers, including asbestos, pesticides, wood dust, paint fumes, etc.
- Radiation exposure: Radiation treatment for malignant or benign tumors has been linked to salivary gland cancer, but the risk is low.
- Diet: Eating too many salt-cured foods (like salt-cured meat and fish) can increase your risk of nasopharyngeal cancer.
- Genes: Your genes may increase your cancer risk. For example, people with Fanconi anemia inherit genes from their biological parents that increase their risk of certain cancers, including head and neck cancers. Your genes may make you more likely to develop cancer if you use tobacco.
- Poor dental hygiene: Not taking care of your teeth and gums can increase your risk of periodontal disease and oral cancer.
Diagnosis and Tests
How is head and neck cancer diagnosed?
Early detection is key to successful cancer treatment. Exams can easily detect most head and neck cancers. A healthcare provider will perform an exam and order diagnostic tests.
These exams and tests might include:
- A physical exam: Your provider checks your oral and nasal cavities, neck, throat and tongue. They may feel your neck, lips, gum and cheeks for lumps.
- An endoscopy: This procedure uses a thin, lighted tube called an endoscope that allows your provider to see your nasal cavity, throat, voice box or other areas where you’re experiencing symptoms. An endoscopy may have different names depending on the body part being examined. For example, a nasal endoscopy helps your provider view your nasal cavity. A laryngoscopy allows your provider to view your voice box (larynx).
- Imaging tests: Head and neck X-rays, CT scans, MRIs and PET scans create pictures of areas inside of your head and neck. Your provider will decide which tests will be most useful for making a diagnosis.
- Lab tests: Your provider may take a blood sample for testing. For example, they may test for viruses like HPV or EBV. They may perform biomarker testing (molecular testing) to check for proteins common in particular head and neck cancers. This information may help your provider determine treatment options.
- A biopsy: Your provider removes tissue that a pathologist examines under a microscope. They’ll check for cancer cells in the sample. A biopsy is the only way to diagnose cancer. Common biopsy methods used to diagnose head and neck cancers include fine needle aspiration and core needle biopsy.
How are head and neck cancers staged?
Cancer staging helps healthcare providers determine how advanced cancer is and plan treatment. Healthcare providers use the TNM (tumor, node, metastasis) system to stage head and neck cancers.
They consider factors like a tumor’s size and location (T), whether cancer has spread to lymph nodes (N) and whether cancer has spread to other parts of your body, or metastasized (M). Using this information, they assign a number ranging from I to IV, with higher numbers meaning more advanced disease.
There’s different staging depending on the location of the cancer and the cancer stage.
The cancer’s stage, along with your age and general health, will determine your treatment plan.
Management and Treatment
How is head and neck cancer treated?
The three main treatments are surgery, radiation therapy and chemotherapy. Your healthcare provider may also recommend newer treatments like targeted therapy and immunotherapy or suggest you participate in a clinical trial.
- Surgery: Surgeons may remove the tumor and a margin of surrounding healthy tissue. The surgeon may also remove the lymph nodes in your neck if they suspect the cancer’s spread there.
- Radiation therapy: The most common form of radiation for head and neck cancers uses a machine that directs high-energy X-rays toward your tumor (EBRT). You may receive radiation as a standalone treatment or alongside other treatments like surgery and chemotherapy. Radiation therapy can help relieve symptoms, too.
- Chemotherapy: Chemotherapy uses a single drug or a combination of drugs to kill cancer cells. It’s more commonly used for advanced-stage head and neck cancers.
- Targeted therapy: These drugs target specific types of cancer. They’re most often used in combination with other treatments to treat advanced head and neck cancers. Cetuximab (Erbitux®) is a drug that targets a tumor protein called epidermal growth factor (EGFR) and is U.S. Food and Drug Administration (FDA)-approved to treat particular head and neck cancers. There are treatments approved by the FDA specific to genetic changes, such as larotrectinib (Vitrakvi®), which is used to treat people with mutations in their NTRK gene.
- Immunotherapy: Immunotherapy drugs activate (or boost) your immune system to identify and destroy cancer cells more effectively. Pembrolizumab (Keytruda®) and nivolumab (Opdivo®) are two FDA-approved immunotherapy drugs used to treat certain head and neck cancers that’ve spread or returned following treatment.
- Clinical trials: A clinical trial is a study that tests the safety and effectiveness of new treatments. Current research on head and neck cancer treatments is testing new immunotherapy drugs and radiation therapy techniques. Research is ongoing to discover the best treatment combinations for various cancer types. Ask your healthcare provider if a clinical trial is right for you.
Your healthcare provider may also recommend palliative care. Palliative care providers include doctors, nurses, social workers and others who are experts at helping people navigate long-term illnesses. They can complement your cancer care by helping you make treatment decisions and manage everyday affairs. Palliative care can improve your quality of life, no matter your cancer stage.
What are the side effects of treatment?
Cancer treatments can cause various side effects, depending on the type of treatment and where your tumor’s located. For instance, surgery to remove a large tumor may change your appearance. Some people treated for head and neck cancers have trouble breathing, eating, swallowing or talking afterward.
Ask your healthcare provider about potential side effects, including ways to manage them. For instance, reconstructive surgery or prosthetics may help improve your appearance following treatment. Regular visits with a speech-language pathologist can help with speaking and swallowing difficulties.
How can I prevent head and neck cancer?
You can take steps to prevent most head and neck cancers. To protect yourself:
- Quit tobacco. To reduce your risk of head and neck cancer, quit using all forms of tobacco (cigarettes, cigars, pipes, snuff, dip and chewing tobacco).
- Cut back on drinking. Reducing your alcohol intake or cutting it out can reduce your risk of these cancers.
- Get the HPV vaccine. Gardasil 9® is the HPV vaccine approved in the U.S. It protects against several strains of HPV, including the ones that cause oropharyngeal cancer. It’s most effective in preventing HPV if you get it before you’re sexually active. Still, it may be beneficial up to age 45. Ask your healthcare provider if you would benefit from the vaccine.
If you’ve already had cancer, quitting tobacco and alcohol can reduce your risk of cancer recurring (returning). Seeing a healthcare provider at the first sign of symptoms can also prevent cancers from progressing.
Outlook / Prognosis
Is neck and head cancer curable?
It can be. The chance of a cure is best if your healthcare provider finds your cancer early and treats it immediately. Small tumors that haven’t spread are also potentially curable.
Your outlook depends on many factors, including cancer type, age, general health and response to treatment. Ask your healthcare provider about your prognosis based on your unique cancer diagnosis.
What is the survival rate for head and neck cancer?
The survival rate for people with Stage I or Stage II cancer ranges from 70% to 90%. These numbers mean that 70% to 90% of people diagnosed with a head and neck cancer at these stages are alive after five years.
Keep in mind, though, that these numbers are general. They don’t account for your cancer type, health or treatment response. They don’t consider the effects of newer treatments on improving the survival rate. Discuss these factors with your healthcare provider to better understand your prognosis.
When should I see my healthcare provider?
Even if your provider removes your tumor, you’ll still need follow-up care, physical exams and tests to ensure you receive immediate treatment if the cancer returns. Depending on your treatment, you may need physical or speech therapy to cope with side effects.
Follow your provider’s guidance about caring for yourself during recovery, scheduling follow-up visits and recognizing signs that the cancer’s returned.
What questions should I ask my doctor?
Don’t hesitate to ask your healthcare provider questions about your diagnosis. It’s a good idea to bring a friend or family member with you during appointments to ensure you get all of your questions answered. Questions may include:
- What type of cancer do I have?
- What stage of cancer do I have?
- Who’ll be part of my care team?
- What treatments do you recommend?
- What treatment side effects should I expect?
- How can I manage treatment side effects?
- Would you recommend palliative care? Clinical trials?
- What resources are available to support me?
A note from Cleveland Clinic
Many head and neck cancers are treatable with surgery and radiation if they’re found early. See a healthcare provider immediately if you experience any symptoms of head and neck cancer, especially if you engage in high-risk activities like smoking or using tobacco. Early detection and treatment are the best ways to fight cancer once you’ve been diagnosed. Ask your healthcare provider about the best treatment options, depending on your health and cancer stage.
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