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.

Adenocarcinoma Cancer that forms in the glandular tissue that lines certain internal organs and makes and releases substances in the body, such as mucus, digestive juices or other fluids.

Cancer that forms in the glandular tissue that lines certain internal organs and makes and releases substances in the body, such as mucus, digestive juices or other fluids. Most cancers of the breast, pancreas, lung, prostate, colon, esophagus and stomach are adenocarcinomas.

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. 

Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines.
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.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Prognosis A statement about the likely outcome of a disease in a patient. Tonsils Two small masses of lymphoid tissue on either side of the throat.
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. 

Digestive tract The organs that food and liquids travel through when they are swallowed, digested and absorbed before leaving the body as feces. The organs that food and liquids travel through when they are swallowed, digested and absorbed before leaving the body as feces. These organs include the mouth, pharynx (throat), esophagus, stomach, small intestine, large intestine, rectum and anus. The digestive tract is part of the digestive system. Also called alimentary tract and gastrointestinal tract. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream.

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.
Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

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.

Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
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.
Anesthesia Drugs or other substances that cause a loss of feeling or awareness. This keeps patients from feeling pain during surgery or other procedures. A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body, such as the mouth. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep.
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
Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones.
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.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose.

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
Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Tonsils Two small masses of lymphoid tissue on either side of the throat.