Head and Neck Cancer

What is head and neck cancer?

Cancer starts when cells change (mutate) and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. They can spread to other parts of the body, too. This is called metastasis.

Head and neck cancer is the term given to cancers that start in cells found in the head and neck region. Some of the most common types are:

• Cancer of the hypopharynx, or hypopharyngeal cancer. It starts in the bottom part of the throat (pharynx), behind and beside the voice box.

• Cancer of the larynx (voice box). It is located just below the pharynx in the neck.

• Cancer of the nasopharynx, or nasopharyngeal cancer. It starts in the upper part of the throat, behind the nose.

• Cancer of the oropharynx, or oropharyngeal cancer. It starts in the back of the mouth or the middle part of the throat. It also includes the soft palate, the base of the tongue and the tonsils.

• Cancer of the paranasal sinus. It starts in the small hollow spaces around the nose called sinuses.

• Cancer of the nasal cavity. It starts in the space just behind the nose.

• Cancer of the salivary gland. It starts in the salivary glands. There a 3 pairs of major salivary glands. They are found just below the tongue, on the sides of the face in front of the ears, and under the jawbone.

• Cancer of the oral cavity. The oral cavity includes the lips, the front two-thirds of the tongue, the gums, the inside lining of the cheeks and lips, the bottom of the mouth under the tongue, the hard palate, and the small section of gum behind the wisdom teeth.

Who is at risk for head and neck cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors are not in your control. But others may be things you can change.

The most important risk factors for head and neck cancer are:

• Using any form of tobacco, including smokeless tobacco

• Drinking alcohol

More than 3 out of 4 head and neck cancers are caused by these 2 risk factors. People who use both tobacco and alcohol are at even higher risk for 1 of these cancers.

Other risk factors for head and neck cancer include:

• Unhealthy diet

• Older age

• Radiation exposure to the head and neck

• Poor mouth care

• Betel quid or gutka chewing

• Human papillomavirus (HPV) infection

• Exposure to certain chemicals

• Weakened immune system

• Epstein-Barr virus infection

• Certain genetic syndromes

Talk with your healthcare provider about your risk factors for head and neck cancer and what you can do about them.

Can head and neck cancer be prevented?

There is no sure way to prevent head and neck cancers, but some things may help lower your risk for certain types of head and neck cancer, such as:

• Not using tobacco in any form

• Limiting or not drinking alcohol

• Reducing your risk for HPV infection. Get the HPV vaccine. Ask your healthcare provider if you are eligible for the vaccine.

• Limiting sexual partners and use condoms every time you have any type of sex. (Condoms do not fully protect against HPV.)

• Eating a healthy diet with lots of fruits and vegetables

• Getting regular dental care

• Having proper-fitting dentures

Talk with your healthcare provider about what you can do to lower your risk. Ask for resources to help. Making changes can be hard, but you don’t have to make them alone. 

What are the symptoms of head and neck cancer?

Symptoms of head and neck cancer depend on where the tumor is and how big it is. Common symptoms of head and neck cancer can include:

• Growth or sore in the mouth

• Lump in the neck

• Lump or sore inside the nose, on the lip, or in the mouth that won’t heal

• Sore throat that does not go away

• Feeling that something is stuck in the throat

• Blocked sinuses or nasal congestion that won’t clear

• Chronic sinus infections

• Cough that doesn't go away

• Voice changes or hoarseness

• Coughing up blood or bleeding in the mouth

• Trouble swallowing, speaking, or breathing

• Pain when swallowing

• Frequent headaches or pain around the nose, cheeks, or forehead

• Frequent nosebleeds or ones that don’t stop

• Weakness in the muscles of the face

• Double vision

• Numbness in the face

• Pain in the ear, face, chin, neck, upper back, jaw, or upper teeth

• Ringing in the ears or hearing problems

• Swelling of the eyes or under the chin or around the jaw

• Vomiting

• Bad breath even when correct oral hygiene is practiced

• Red or white patches in the mouth

• Loose or painful teeth

• Dentures not fitting like they should

• Unexplained weight loss

Many of these may be caused by other health problems. Still, it's important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is head and neck cancer diagnosed?

If your healthcare provider thinks you may have head and neck cancer, you'll need some tests to be sure. You'll be asked about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done. You may also have one or more tests, such as blood tests, X-rays, or a computed tomography (CT) scan.

A biopsy is the only way to know for sure that you have cancer. Small pieces of the tumor are taken out and checked for cancer cells. They may also be tested for signs of HPV infection. Your results will come back in about a week.

After a diagnosis of head and neck cancer, you’ll need more tests. These help learn more about your overall health and the cancer. They're used to find the stage of the cancer. The stage is how much cancer there is and how far it has spread (metastasized) in your body. It's one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the details of your cancer to you in a way you can understand.

How is head and neck cancer treated?

Your treatment choices depend on the type of head and neck cancer you have, the location of the tumor, test results, the stage of the cancer, and your overall health. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and any risks and side effects. Be sure you understand how treatment can change the way you look and the way your body works.

Cancer treatments are either local or systemic. Local treatments remove, destroy, or control cancer in one area. Surgery and radiation therapy are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. Targeted therapy and immunotherapy are also systemic therapies. You may have just one treatment or a combination of treatments.

Common treatments for head and neck cancer include:

• Radiation therapy

• Surgery

• Chemotherapy

• Targeted therapy

• Immunotherapy

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects?

Side effects will vary depending on your overall health and the type of treatment. You may experience many or few side effects. Cancer treatment like chemotherapy and radiation therapy can damage normal cells. This can cause side effects, such as hair loss, mouth sores, or vomiting. Radiation may cause skin changes, jaw stiffness, and fatigue. Surgery may change the way your body works and looks. It may impact your ability to chew, swallow, or talk. Your face or neck may look different after surgery. Targeted therapy may cause nausea, low blood counts, and skin changes. Immunotherapy may cause fatigue, nausea, or a rash. Talk with your healthcare provider about side effects linked to your treatment. Know what to watch for. There may be things you can do to help prevent side effects, and there are often ways to manage them.

Coping with head and neck cancer

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you may have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister, rabbi or Imam.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group online or in person.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with as many protein foods as possible.

• Drink plenty of water, low sugar fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse

• Signs of an infection, such as a fever

• Side effects of treatment that affect your daily function or don't get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays. 

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions.

How is head and neck cancer diagnosed?

If your healthcare provider thinks you might have head and neck cancer, certain exams and tests will be needed to be sure. Diagnosing head and neck cancer starts with your healthcare provider talking with you about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done. You may need to see an ear, nose, and throat specialist, called an ENT or otolaryngologist, or a head and neck surgeon.

What tests might I need?

You may have one or more of these tests:

• Endoscopy

• Panorex dental films

• Barium swallow

• CT scan

• MRI

• Biopsy

• Blood tests

Imaging tests

• Endoscopy. These tests use a long, thin, flexible tube with a light and a camera at the end. This tube is called a scope. It's put in through your mouth or nose. (Numbing medicine is sometimes used first.) It helps the healthcare provider get a close look at the inside of your nasal cavity, mouth, throat (pharynx), and voice box (larynx). The name of these tests depends on which part of the head and neck is being checked. For instance, a pharyngoscopy looks at the pharynx, and a laryngoscopy looks at the larynx. When all of these areas are checked during the same test, it's called a panendoscopy.

• Panorex films. This is an X-ray that moves around your head to look at your upper and lower jaw. It can show if the cancer has spread into the bone.

• Barium swallow. This is a series of X-rays taken while you swallow a thick, chalky substance called barium. The barium coats the inside of your throat so that any swallowing changes can be seen on the X-rays.

• CT scan. In this test, an X-ray beam takes pictures of the inside of your body from many angles. These images are then combined by a computer, giving a detailed 3-D picture of your insides.

• MRI. This test uses magnets and radio waves to take detailed pictures of the inside of your body, much like a CT scan. But MRIs don't use X-rays. MRI is very good for finding changes in soft tissues, like the tongue and tonsils.

Biopsy

A biopsy is the only sure way to know if you have cancer. During a biopsy, a tiny piece (called a sample) of tissue is removed from the changed area or tumor. Then a pathologist, a specialist who tests tissue samples in a lab, looks at the tissue under a microscope to check for cancer cells. The sample may also be tested for human papillomavirus (HPV) infection. HPV status is important to know when making treatment decisions. It usually takes a few days for the results of your biopsy to come back.

A biopsy can sometimes be done in your healthcare provider’s office. Or it may need to be done in the hospital with surgery. In that case, you’d get general anesthesia so that you're asleep and don’t feel pain during the biopsy.

If you have a lump in your neck, it may be a swollen lymph node. This swelling might be caused by cancer. Your healthcare provider can use a very thin needle to do a fine needle aspiration (FNA) biopsy. This is done to see if there are cancer cells in the lymph node. This is usually done in your healthcare provider’s office or a clinic. You don’t generally need to stay in the hospital.

Blood tests

Your healthcare provider will do tests to check your blood counts and see how well your liver and kidneys are working. Tests are also done to look at levels of substances like calcium, sodium, potassium, and magnesium. These blood tests help give an idea of your overall health.

Getting your test results

Your healthcare provider will contact you about the results of your tests and what they mean. You'll be told about other tests you may need if head and neck cancer is found. Make sure you understand the results and what your next steps should be.

There are many treatment choices for head and neck cancer. The one that's best for you depends on things like:

• The type of cancer
• The size of the tumor and where it is in your body
• Results of lab tests
• Extent of the disease, called the stage
• Your overall health
• Your age
• Your personal concerns and preferences

Learning about your treatment choices

You may have questions and concerns about your treatment choices. You may want to know how you’ll feel, how you'll look, how your body will work after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. They can explain what the treatment choices are, how well treatment is expected to work, what the risks and side effects may be, and how much it's likely to cost.

Your healthcare provider may advise a specific treatment. Or they may offer more than one and ask you to decide which one you’d like to use. It can be hard to make this decision. It's important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your choices. You may want to get a second opinion before deciding on your treatment plan. You may also want to involve your family and friends in this process.

Types of treatment for head and neck cancer

Treatment for cancer is either local or systemic. You may have both.

• Local treatments remove, destroy, or control cancer cells in a certain place in the body. Surgery and radiation are local treatments.
• Systemic treatments destroy or control cancer cells throughout the body. Chemotherapy and targeted therapy are examples.

Goals of treatment for head and neck cancer

Treatment may control or cure the cancer. It can also improve your quality of life by helping to control the symptoms of the disease. The goal of head and neck cancer treatment is to do one or more of these things:

• Remove the primary (main) cancer tumor or other tumors
• Kill cancer cells or keep them from growing or spreading
• Keep the cancer from coming back or delay its return
• Ease symptoms of the cancer, such as pain or pressure in nearby tissues

Each type of treatment has a different goal. Talk to your healthcare provider about treatment goals so you know what to expect.

Commonly used treatments for head and neck cancer

Here's a list of common head and neck cancer treatments:

Radiation therapy

Radiation uses strong X-rays to kill cancer cells and shrink tumors. This is sometimes the only type of treatment needed for head and neck cancer. More often, radiation is given along with chemotherapy or targeted therapy. Sometimes it's used to shrink a tumor before surgery so it's easier to remove without damaging nearby healthy tissues. It might be used after surgery, too, to kill any cancer cells that may be left behind. Radiation can also be used if the cancer comes back after treatment.

Surgery

The goal of surgery is to take out the tumor along with an edge of healthy tissue around it. Nearby lymph nodes might also be taken out if the cancer has spread to them. The smaller the tumor, the better the chance of keeping normal functions, such as speaking and swallowing. Surgery may also be done to put in infusion ports for chemotherapy or to place a feeding tube. Plastic or reconstructive surgery may be needed after treatment to help restore appearance and function in the area that was treated.

Chemotherapy

This is the use of strong medicines to treat cancer. One goal of chemotherapy (or chemo) is to reduce the size of a tumor before using other types of treatment. It can also help decrease the chance that the cancer will spread to other parts of your body. Chemo is most often given at the same time as radiation. This is called chemoradiation. The chemo helps the radiation work better. Chemo may also be used for more advanced cancers, when radiation or surgery can’t be used. Or it may be used when the cancer has spread to other parts of the body.

Targeted therapy

This treatment uses medicines that target certain parts of cancer cells. For instance, many head and neck cancer cells are controlled by a protein called EGFR, which helps them grow. A medicine called cetuximab targets these cells. It blocks EGFR so that cancer cell growth slows or stops. Medicines that target EGFR are sometimes used to treat head and neck cancers.

Immunotherapy

These medicines help your immune system find and kill cancer cells. Some head and neck cancer cells use a protein called PD-L1 to keep your immune system from attacking them. Medicines that block PD-L1 can boost the immune system against these cancer cells.

Clinical trials for new treatments

Researchers are always finding new ways to treat cancer. These new methods are tested in clinical trials. Taking part in a clinical trial means you get the best treatment available today, and you might also get new treatments that are thought to be even better. Talk with your healthcare provider to find out if there are any clinical trials you should think about.