Head and neck cancer

Facts

Many head and neck cancers are curable, especially if they are diagnosed and treated early.

Seattle Cancer Care Alliance (SCCA) offers comprehensive treatment from a team of experts who specialize in head and neck cancers.

Usually, head and neck cancers begin in squamous cells. Squamous cells make up the lining of many areas of your body, including your mouth, throat, nose and sinuses.

  • If your cancer is only in the outermost layer of the lining (epithelium), it is referred to as squamous cell carcinoma.
  • If your cancer goes below the epithelium into the next layer (mucosa, or mucous membrane), it’s called invasive squamous cell carcinoma.

If cancer starts in your salivary glands, it’s a different type, called adenocarcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma or acinic cell carcinoma.

Types

Most head and neck cancers are classified into one of several main types based on where the cancer started.

Laryngeal cancer and hypopharyngeal cancer

Your voice box (larynx) is at the top of your windpipe (trachea) and is important for speaking, breathing and swallowing. 

There are three parts to your larynx:

  • Supraglottis — upper part, above your vocal cords
  • Glottis — middle part, including your vocal cords
  • Subglottis — lower part, below your vocal cords

Your hypopharynx is at the top of your esophagus, to the sides of and behind your larynx. It helps direct food and liquid into your esophagus instead of your larynx. 

Cancer can form in one or more of these areas, most often in the squamous cells. 

Nasal cancer and paranasal sinus cancer

Nasal cancer occurs either in your nose or in the area behind your nose and toward your throat (nasal cavity). Your paranasal sinuses are air-filled pockets in the bone surrounding your nose and nasal cavity. 

Squamous cell cancer is the most common form of cancer in this area. However, other types of cancer, including melanoma, sarcoma and midline granuloma, can form here. So can benign (noncancerous) tumors that may turn into cancer. 

Nasopharyngeal cancer

Your nasopharynx is the upper part of your throat, behind your nasal cavity. Your nostrils lead to your nasopharynx. Openings on each side of your nasopharynx lead to your ears. Nasopharyngeal cancer is also called throat cancer.

Cancer here typically starts in squamous cells. It is most common in people who have had the Epstein-Barr virus. 

Oral cancer and oropharyngeal cancer

These cancers may occur in:

  • Your mouth, including your lips, gums, front two-thirds of your tongue, bony roof of your mouth (hard palate) and lining of your cheeks (buccal mucosa) — considered cancers of the oral cavity
  • The base of your tongue, your soft palate, your tonsils or the middle part of your throat (oropharynx) — considered oropharyngeal cancer

These cancers arise most often in the squamous cells that line these areas.

Human papillomavirus (HPV) increases risk for oral and oropharyngeal cancers. HPV-positive oropharyngeal cancers and HPV-negative oropharyngeal cancers may not be treated the same. Recent studies show that HPV-positive oropharyngeal cancers usually occur in younger people, are less attributable to tobacco and alcohol, are more sensitive to treatment and often have a better prognosis. Doctors hope to better understand the differences through ongoing clinical studies.

Salivary gland cancer

Salivary gland cancer occurs in the glands around your mouth that produce saliva. There are three pairs of salivary glands: 

  • Parotid glands — along your jaw near your ears
  • Sublingual glands — below your tongue
  • Submandibular glands — below your jaw

Most salivary gland cancers begin in the parotid glands, the largest of the three pairs. 

Metastatic squamous neck cancer

This type refers to squamous cell cancer found in the lymph nodes of your neck but not in other parts of your head or neck, indicating cancer spread to your neck from somewhere else. 

  • Squamous cells exist all over your body, so this type of cancer may begin almost anywhere, including in the uterus, digestive tract, kidneys, lungs and blood vessels.
  • When doctors find squamous cell cancer in the lymph nodes of the neck, they cannot always tell where the cancer started. 
  • If doctors cannot identify the origin, or primary site, of the cancer, they may call this type metastatic squamous neck cancer with occult primary. 

Symptoms

Depending in part on the location of head and neck cancers, symptoms may include:

  • A lump in your neck, face or nose that lasts more than two weeks, gets progressively larger or is painful
  • A sore on your lip or in your mouth that doesn’t heal, or a persistent red or white patch in your mouth
  • Swollen lymph nodes in your neck that don’t go away
  • Frequent nosebleeds or coughed-up blood
  • Frequent nasal congestion that does not improve, or blocked sinuses
  • Loss of the sense of smell
  • A change in your voice, such as hoarseness, that occurs for no clear reason (such as from coughing during a cold or flu) or that persists, or loss of voice
  • Trouble swallowing, chewing, breathing, speaking or moving your jaw or tongue
  • Numbness or weakness in your face or a numb tongue
  • Unexplained tooth pain, sore throat, facial pain or headache
  • An ongoing earache, ear drainage, fluid build-up in your ear, trouble hearing or hearing loss
  • Vision changes, such as double vision
  • A mole or blemish that gets bigger, bleeds or is painful

The symptoms of head and neck cancers may also be caused by other conditions, including some common conditions, that are not related to cancer. See your doctor if:

  • You have symptoms that concern you.
  • You have symptoms that last more than two to three weeks.
  • Your symptoms get worse.

Diagnosing head and neck cancers

To diagnose head and neck cancers, your doctor will start by asking about your medical history and any symptoms you have.

Physical exam

Your doctor will examine you, looking at and feeling for lumps around your head and neck and looking in your nose, mouth and throat. They may use mirrors and a lighted tube, called an endoscope, to examine hard-to-see areas. 

  • The tube may be inserted through your nose or mouth and into your throat. 
  • An anesthetic spray or general anesthesia can make the exam more comfortable for you. 
  • This type of exam is called a nasopharyngoscopy, pharyngoscopy or laryngoscopy, depending on the area the doctor examines.
Imaging tests

You may have imaging tests to help determine where a tumor is, how large it is and whether it has spread (metastasized). Imaging tests might include:

  • Magnetic resonance imaging (MRI) scan
  • Computed tomography (CT) scan
  • Ultrasound
  • Positron emission tomography (PET) scan
  • X-rays (including dental or chest X-rays) 
  • Radionuclide bone scan
Biopsy

If your exam or tests reveal signs that you might have cancer, your doctor may do a biopsy. This means removing a sample of tissue with a needle or scalpel for a pathologist to examine under a microscope.

Who is at risk for head and neck cancer?

Most head and neck cancers are found in people over age 50.

At least 75 percent of head and neck cancers are related to use of tobacco (including cigarettes, pipes, cigars and smokeless tobacco, like chewing tobacco and snuff) and alcohol (especially beer or hard liquor), according to the National Institutes of Health.

  • People who use both tobacco and alcohol are at greatest risk.
  • If you use tobacco or drink alcohol, your doctor should do a simple 10-minute exam at least once a year to check for signs of head and neck cancers — looking in your nose, mouth and throat; examining the skin around your head and neck; and feeling for lumps in your neck. 
  • While men are two to three times more likely than women to have head or neck cancer, the rates in women have been rising, along with their growing use of tobacco and alcohol.

The number of cases related to HPV, the same virus that causes cervical cancer in women, seems to be on the rise. 

  • Cancers at the base of the tongue and tonsils may be related to HPV infection, especially infection with HPV-16. 
  • Cancers from HPV are increasing in the United States, while oral cancers related to other risk factors are decreasing.

HPV vaccination is an effective measure to prevent HPV infection, which may reduce your risk for some cancers.

Other risk factors include:

  • Being exposed to asbestos or wood dust
  • Eating preserved or salted foods
  • Having poor oral hygiene and health
  • Having had radiation therapy to your head and neck 
  • Having Epstein-Barr virus infection