Cancers of the head and neck region account for approximately 3% of all cancers in adults in the United States. This region comprises several areas, including the lip, oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx, lymph nodes, skin, and thyroid.

According to Jeremy D. Richmon, MD, assistant professor, department of otolaryngology with Johns Hopkins University in Baltimore, Maryland, the most common type of cancer to occur in the head and neck is squamous cell

carcinoma. “This arises from the top layer of tissue (skin or mucosa) and usually presents as a lump or ulceration on the surface,” says Dr. Richmon. “Squamous cell carcinoma is by far the most common type of cancer to occur in the oral cavity, pharynx (including nasopharynx, oropharynx, and hypopharynx), and larynx.”

Furthermore, other types in the head and neck include tumors of the salivary gland origin, lymphomas, and rare soft tissue cancers. Head and neck cancers also include thyroid cancers, which include papillary, follicular, medullary, and anaplastic cancers, as well as skin cancers, Dr. Richmon says.

Cancer Types and Their Symptoms

Dr. Richmon says cancers manifest with various symptoms, depending on where they arise. He has provided a breakdown of common symptoms based on type:

• Oral cavity - pain, lump in the mouth, non-healing wound, difficulty speaking/swallowing/chewing, loose teeth, bleeding tissue. 
• Oropharynx - lump on back of throat (base of tongue/tonsil), difficulty swallowing, pain 
• Nasopharynx, paranasal sinuses - difficulty breathing through nose, nosebleeds, pain in mid-face 
• Hypopharynx - throat pain, difficulty swallowing 
• Larynx - hoarseness, difficulty swallowing or breathing 
• Salivary glands - lump on side of face or under jaw bone, pain in glands, weakness or paralysis of face 
• Thyroid - neck mass, hoarseness, difficulty swallowing 
• Skin - growing lesion on skin surface 
• Lymph nodes - enlarging mass in neck, often painless

Recognize Change

Generally speaking, Bruce Haughey, MD, chief of head and neck cancer at the Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri says persistent symptoms of the head and neck should be addressed if they last more than 3 weeks. “Persistent symptoms such as a lump in the neck, hoarseness, trouble swallowing, mouth sores or masses that won’t heal, stuffy noses that don’t go away, sore throat, (especially on one side) should be evaluated by a doctor, often backed up by an ENT specialist’s opinion,” he says.

Risk Factors

Lifestyle choices, heredity, family history, and more are several of the risk factors that may cause cancers of the head and neck. “Tobacco exposure (all types) is the number one cause of head and neck cancer,” says David M. Brizel, MD, associate professor of head and neck surgery at Duke Comprehensive Cancer Center in Durham, North Carolina.

Furthermore, Dr. Brizel says human papilloma virus (HPV) is now recognized as an independent risk factor for the development of squamous head and neck cancer, predominantly in the oropharynx (tonsils, base of tongue). “This is the exact same virus that causes cervix carcinoma in women,” he says. “It is in all likelihood a sexually transmitted disease. The incidence of this cancer is rapidly increasing and may account for 5000 to 10,000 new cases per year in this country. It occurs in people with no prior history of tobacco exposure.”


Dr. Richmon reports that head and neck cancer is the sixth most common cancer in the United States. If a head and neck cancer is suspected, patients are usually referred to a head and neck cancer specialist. This is often an otolaryngologist (ear, nose, and throat doctor, or ENT) or oral surgeon with special training in head and neck cancer. After a complete head and neck examination is performed, says Dr. Richmon, an accurate diagnosis requires a tissue biopsy. This involves taking a small sample of tissue with a knife or needle and submitting it for analysis. Once a diagnosis is rendered as to the type of cancer, workup will often include imaging (CT, MRI, and/or PET scan). Furthermore, blood tests and evaluation of cardiovascular status is often performed to see what kinds of treatment may or may not be best for the patient.

Treatment Options

Cancers of the head and neck are generally treated with surgery, radiation, chemotherapy, or some combination of the three. According to Dr. Richmon, early-stage cancers (small tumors that have not spread to the lymph nodes) can usually be treated with either surgery or radiation alone. Late-stage cancers (larger tumors, lymph node involvement) are usually treated with combinations of treatment, such as surgery and radiation or radiation and chemotherapy. “As the type and location of these cancers is very heterogenous in the head and neck, arriving at the optimal treatment plan is often complex and involves the collaboration of a team of physicians specializing in head and neck cancer,” Dr. Richmon adds.

For cancers of the throat, voice box (larynx), mouth, and other areas of the head and neck, there may be changes to speech, eating, and diet, either from treatments used or the tumors themselves. “A speech and swallowing team is integral in patient success,” says Tapan A. Padhya, MD, Associate Member, Head and Neck Oncology Program at Moffitt Cancer Center in Tampa, Florida. Other professionals, including dieticians, rehabilitation experts, and speech professionals, can assist with speech and swallow function before, during, and after treatments.

Wendell Gray Yarbrough, MD, an otolaryngologist at Vanderbilt University Medical Center in Nashville, Tennessee, says tumors and treatment can leave the neck and shoulders with decreased motion, and therefore physical therapy early in the healing phase is very helpful for most patients. “Lymphedema, [which is] swelling in the neck and throat, is common, particularly after combined therapy with chemotherapy and concurrent radiation,” he says. “Specially trained physical therapists can also help prevent disability related to lymphedema.” For more information on lymphedema, see What You Should Know About Lymphedema.

Dr. Yarbrough also says speech therapy is critical for patients whose tumor or treatment affected their voice or swallowing. Services can restore voice after total laryngectomy or improve voice after laryngeal-sparing treatment. 

Looking Ahead

Experts agree that patients recovering from or being treated for head and neck cancer should be highly encouraged to stop smoking. Regular exercise, eliminating alcohol, eating a healthy diet, and regular follow-up exams are crucial to fighting these diseases.

Resources

• Support for People with Oral, Head and Neck Cancer (http://www.spohnc.org)
• Head and Neck Cancer Support (www.hncsupport.org)
• Head and Neck Cancer Alliance (www.headandneck.org/site/c.8hKNI0MEImI4E/b.6281225/k.BDD9/Home.htm)