Head and Neck Cancer

Most head and neck cancers begin in the cells that line the mucosal surfaces in the head and neck area, e.g., mouth, nose and throat. Mucosal surfaces are moist tissues lining hollow organs and cavities of the body open to the environment. Normal mucosal cells look like scales (squamous) under the microscope, so head and neck cancers are often referred to as squamous cell carcinomas. Some head and neck cancers begin in other types of cells. For example, cancers that begin in glandular cells are called adenocarcinomas. Head and neck cancers account for approximately three to five percent of all cancers in the United States. These cancers are more common in men and in people over age 50.

Head and neck cancers are numerous and include nasopharyngeal carcinoma (a specific form of squamous cell carcinoma that arises from the back of the nose called nasopharynx); esthesioneuroblastoma (a rare and specific type of tumor that arises from the smell organ in nose); other types of sinus and nasal tumors; thyroid tumors; mouth cancer; salivary gland cancer that can either arise from major salivary glands sitting in front and below the ear (parotid) or under the jaw (submandibular), or from minor salivary glands that exists throughout the lining of the nose or mouth or throat; laryngeal carcinoma; and upper respiratory tract carcinoma. The prognosis, diagnosis, classification and treatment of these head and neck cancers vary widely.

Rick Factors

Tobacco use
Heavy alcohol consumption
Human papillomavirus (HPV) infection
Exposure to asbestos
Plummer-Vinson (Patterson-Kelly) syndrome
Poor oral hygiene

Symptoms

General symptoms of head and neck cancer may include:

A lump or sore on the head/neck area that does not heal
A sore throat that does not go away
Difficulty in or painful swallowing
A change or hoarseness in the voice
Spitting blood or coughing blood

Specific locations and symptoms may include:

Oral Cavity

A nonhealing ulcer or growth in the mouth
A white or red patch on the gums, tongue or lining of the mouth
A swelling of the jaw that causes dentures to fit poorly or become uncomfortable
Unusual bleeding or pain in the mouth

Nasal cavity and sinuses

Sinuses that are blocked and do not clear
Chronic sinus infections that do not respond to treatment with antibiotics
Bleeding through the nose
Frequent headaches
Swelling or other trouble with the eyes
Pain in the upper teeth
Problems with dentures

It should be noted that these symptoms are frequent in more common benign conditions such as infections, nasal dryness resulting in bleeding, etc.

Salivary glands

Swelling under the chin or around the jawbone
Numbness or paralysis of the muscles in the face
Pain that does not go away in the face, chin, or neck

Oropharynx and hypopharynx

Ear pain
Difficulty or pain in swallowing
Spitting blood
Weight loss

Nasopharynx

Trouble hearing
Neck lump
Trouble breathing or speaking
Frequent headaches
Pain or ringing in the ears

Larynx

Pain when swallowing
Change in voice
Difficulty breathing
Ear pain

Metastatic squamous neck cancer
Tumors in nose, mouth or throat can spread to lymph glands of neck, resulting in neck lumps. These lumps are usually painless and not tender to palpation. Pain in the neck or throat that does not go away.

Detection and Diagnosis

Endoscopy
The use of a thin, lighted fiberoptic tube called an endoscope to examine areas inside the body. Most commonly a flexible endoscope is used (when needed) through the nostril to visualize all the various areas of nose and throat. Occasionally a rigid form of endoscope is also used. A flexible endoscopy in the office setting can also be used to visualize the esophagus and take biopsies when needed.

CT (or CAT) Scan
A series of detailed pictures of areas inside the head and neck created by a computer linked to an x-ray machine.

Magnetic Resonance Imaging (or MRI)
Uses a powerful magnet linked to a computer to create detailed pictures of areas inside the head and neck.

Ultrasound
Used most commonly in head and neck area to evaluate thyroid nodules, and to guide needle biopsy in specific occasions for smaller non-palpable nodules.

PET Scan
Uses sugar that is modified to be absorbed by cancer cells, which appear as dark areas on the scan.

Biopsy
The removal of tissue to be examined for cancer cells. A pathologist studies the tissue under a microscope to make a diagnosis. A biopsy is the only sure way to tell whether a person has head and neck cancer. When a neck lump is the presenting symptom of head and neck tumor, or it is noted in the thyroid, a fine needle biopsy is an excellent way of sampling the tissue for cytopathologic studies. The visible tumors in the mouth and nose can most often be biopsied in the doctor's office. Some areas such as vocal cords or deeper parts of the throat may need to be biopsied in the operating room under general anesthesia.

Treatment Options

Surgery
The surgeon may remove the cancer and some of the healthy tissue around it. Lymph nodes in the neck may also be removed (lymph node dissection) if the Physician suspects that the cancer has spread. Surgery may be followed by radiation treatment. The type of surgery is quite variable depending on the exact location of the tumor and how advanced it is. Sometimes it is done through endoscopy using the natural orifices of the mouth or nose. Other times it may need to be performed as open surgery. Various surgical tools such as lasers are used in specific situations. The main objective of surgery is to remove the tumor completely and at the same time preserve all the functions such as swallowing and speech with good voice quality, and prevent aspiration when eating. A good cosmetic outcome also is important.

Radiation Therapy
Also known as radiotherapy, radiation therapy is another type of local therapy. It uses high-energy rays to kill cancer cells and affects cancer cells only in the treated area. A large machine directs radiation at the body. The patient has treatment at the hospital or clinic, five days a week for several weeks. A small number of patients have radiation therapy before surgery to shrink the tumor. Some have it after surgery to kill cancer cells that may remain in the area.

Chemotherapy
This is also a type of systemic therapy. Anticancer drugs enter the bloodstream and travel throughout the body. In general, anticancer drugs affect rapidly growing cells, including blood cells that fight infection,
cells that line the mouth and the digestive tract, and cells in hair follicles.

Prevention
People who have been treated for head and neck cancer have an increased chance of developing a new cancer, usually in the head and neck, esophagus, or lungs. The chance of a second primary cancer varies depending on the original diagnosis, but is higher for people who smoke. Patients who do not smoke should never start. Those who smoke should do their best to quit.

GW Cancer Center

GW Cancer Center Main Page

Cancer Glossary

Head and Neck Cancer Links

Risk Factors

Symptoms

Detection and Diagnosis

Treatment Options

Schedule an Appointment

To schedule a consultation with a head and neck specialist at GW, call 1-888-4GW-DOCS.

Insurance

Although insurance plans vary, medications and surgeries due to head and neck cancer are usually covered by insurance. Check with your insurance plan in advance to make sure.

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