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The Risk And Treatment Of Head And Neck Cancers

Cancers of the head and neck (not including brain cancer) account for about 4 percent of cancer in the U.S. – affecting about 65,000 people. If you smoke or drink alcoholic beverages excessively, you greatly increase your risk of this type of cancer.

As a woman, however, your risk of head or neck cancer is half that of men — but it increases after age 50. 

What Causes Head And Neck Cancers?

"Smoking and drinking basically cause cellular changes in the mouth, throat and nose, and that's what causes many cancers,” otolaryngologist Stewart I. Adam III, MD, says. “Those who smoke half a pack or more a day for 20-plus years are at higher risk. Those who abuse alcohol or have a high alcohol intake have the second highest risk." 

Combining these risky behaviors compounds their ill effects. "When you smoke and drink at the same time," says Dr. Adam, "it's not just twice as bad, it's more like four times or more as bad." 

Some head and neck cancers are associated with the human papillomavirus (HPV), a common viral infection spread through sexual contact with an infected partner. HPV-caused head and neck cancers “can occur from the lips to the throat, but usually there's a higher incidence with the tonsils, and then the lingual tonsils, or base of the tongue," Dr. Adam says.

Other causes include:

• Poor oral health
• Consumption of certain preserved or salted foods during childhood
• Radiation exposure
• Sun exposure
• Race (African-Americans are more likely than whites to develop some types of head and neck cancers)
• Occupational exposure to wood dust, asbestos, and synthetic fibers

Types Of Head And Neck Cancers

Head and neck cancers are malignant (cancerous) tumors that develop in or around the throat, larynx (voice box), nose, sinuses, and mouth. Most of these cancers are known as squamous cell cancers because they form in the thin outer layer of cells known as squamous cells. Some head and neck cancers stay in these surface cells. Others grow into deeper tissues.

Head and neck cancers are categorized by the area of the head or neck where they begin:

• Oral cavity. The surfaces inside your mouth, including lips, gums, tongue and the insides of the cheeks 
• Pharynx. The throat, which runs from behind your nose down to your esophagus
• Larynx. The voice box, a short passage just below the pharynx
• Paranasal sinuses. Small hollow spaces in the bones of the head around the nose
• Nasal cavity. The inside of the nose 
• Salivary glands. Saliva-producing glands in the floor of the mouth and near the jawbone

Other types of cancer form in the head and neck, such as brain and eye cancers. But they aren’t classified as head and neck cancers because they’re diagnosed and treated differently.

"Smoking and drinking basically cause cellular changes in the mouth, throat and nose, and that's what causes many cancers."

Craniofacial plastic surgeon, head and neck surgical oncologist, and otolaryngologist Sameep Kadakia, MD, talks about the risk factors, symptoms, and diagnosis of head and neck cancers.

Click play to watch the video or read video transcript.

What Are the Symptoms Of Head And Neck Cancer?

Symptoms of head and neck cancers vary as they’re not all the same. If you notice any unusual symptoms, you should see your doctor or other health care provider for an examination. Symptoms of head and neck cancer can include:

• A non-healing sore in the mouth or on the tongue, a white or red patch anywhere in the mouth, unusual bleeding or pain in the mouth. (Dentists visually inspect their patients’ mouths and refer them to an ear, nose and throat specialist, or otolaryngologist, when trouble spots are found.) 
• Difficulty breathing or speaking
• Pain when chewing or swallowing
• Ear pain, which can result from cancer in the tonsil
• Ringing in the ears, trouble hearing
• "Lockjaw" – difficulty opening your mouth 
• Blocked sinuses that do not clear, chronic sinus infections, nose bleeds
• Frequent headaches
• A cyst-like lump in the neck that's painless
• A raspy, husky quality to the voice that didn’t exist before
• Swelling under the chin or near the jawbone
• Numbness, paralysis of the face muscles
• Persistent pain in the face, chin, or neck

Diagnosis And Treatment Of Head And Neck Cancers

Dr. Adam emphasizes the importance of being examined as soon as you notice symptoms. Early treatment improves prospects for recovery. “The earlier it’s discovered, the better,” he says. 

After you describe your symptoms, the doctor will evaluate your medical history, give you a physical exam, and order appropriate diagnostic tests. A cancer diagnosis must be confirmed by examination of a sample – or biopsy – of the tissue under a microscope.

If cancer is found, your doctor will conduct further tests to determine the stage of the disease – the size of the cancer and whether it has spread to surrounding tissues and other parts of the body.

Head and neck cancers can spread through the lymphatic system, first from their primary site into lymph nodes in the neck. Lymph nodes, located throughout the body, are an important part of the immune system, trapping bacteria, viruses, and other foreign substances that are then destroyed by special white blood cells called lymphocytes.

While it’s uncommon for head and neck cancers to spread beyond neighboring tissue, they can. For instance, in some cases, cancer in the back of the throat can spread, or metastasize, in the lungs. 

Treatment varies based on the tumor's location, the stage of cancer, and your age and general health. Typical treatments include surgery, radiation therapy, chemotherapy, and targeted therapy (drug therapy that pinpoints specific genes or proteins and works to help stop cancer from growing or spreading). Treatment approaches are commonly combined.

Dr. Adam emphasizes the importance of being examined as soon as you notice symptoms. Early treatment improves prospects for recovery. “The earlier it’s discovered, the better,” he says. 

Unlike many other types of cancer, head and neck cancers often impact important functional capabilities you take for granted. For instance, speech, swallowing, breathing, and expressing yourself with facial expressions.

For this reason, head and neck cancer treatment can go beyond surgery, chemotherapy, and radiation. For these types of cancers your treatment team may include speech and language pathologists, who help you regain speech and swallowing abilities. And, Dr. Adam adds, “If a patient has to have their voice box removed, speech and language pathologists can help the patient communicate again verbally with a voice prosthesis device.”

Dietitians can also play an important role. Loss of energy and weight are common side effects of neck cancer treatment, Dr. Adam explains. “Dietitians are key in helping to make sure patients are well-nourished. Because patients may have problems swallowing, they may need to have a tube inserted into the abdomen to deliver nutrition directly to the stomach while they're getting their chemo and radiation.”

Speech and language pathologists can also assist patients with feeding tubes and tubes inserted into their windpipe to assist with breathing. 

Nursing and care coordinators also are vital members of the health care team for head and neck cancer patients.

Source: National Cancer Institute; American Society of Clinical Oncology; Cancer.net; Stewart I. Adam III, MD, Premier ENT Associates

Stewart I. Adam, MD

Premier ENT Associates

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