About head and neck cancer
What is head and neck cancer?
What is cancer?
Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. All of the bodies tissues and organs are composed of cells of various types. Normally, cells grow and divide to form new cells in an orderly way. They perform their functions for a while, and then they die. Sometimes, however, cells do not die. Instead, they continue to divide and create new cells that the body does not need. The extra cells form a mass of tissue, called a growth or tumor. There are two types of tumors: benign and malignant. Benign tumors are not cancer. They do not invade nearby tissue or spread to other parts of the body. Malignant tumors are cancer. Their growth invades normal structures near the tumor and spreads to other parts of the body. Metastasis is the spread of cancer beyond one location in the body.
What kinds of cancers are considered cancers of the head and neck?
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 gland cells such as the spit or salivary glands are called adenocarcinomas.
Cancers of the head and neck are further identified by the area in which they begin:
- Oral cavity. The oral cavity includes the lips, the front two-thirds of the tongue, the gingiva (gums), the buccal mucosa (lining inside the cheeks and lips), the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area behind the wisdom teeth.
- Salivary glands. The salivary glands produce saliva, the fluid that keeps mucosal surfaces in the mouth and throat moist. There are many salivary glands; the major ones are in the floor of the mouth, and near the jawbone.
- Paranasal sinuses and nasal cavity. The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.
- Pharynx. The pharynx is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus (the tube that goes to the stomach) and the trachea (the tube that goes to the lungs). The pharynx has three parts:
- Nasopharynx. The nasopharynx, the upper part of the pharynx, is behind the nose.
- Oropharynx. The oropharynx is the middle part of the pharynx. The oropharynx includes the soft palate (the back of the mouth), the back third or base of the tongue, and the tonsils.
- Hypopharynx. The hypopharynx is the lower part of the pharynx.
- Larynx. The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.
- Lymph nodes in the upper part of the neck. Sometimes, squamous cancer cells are found in the lymph nodes of the upper neck when there is no evidence of cancer in other parts of the head and neck. When this happens, the cancer is called metastatic squamous neck cancer with unknown (hidden or occult) primary.
Cancers of the brain, eye, and thyroid gland as well as those of the scalp, skin, muscles, and bones of the head and neck are not usually grouped with cancers of the head and neck.
What are the symptoms for head and neck cancer?
Chewing symptom was found in the head and neck cancer condition
A lump in your neck or a sore in your mouth that doesn’t heal is cause for concern. Other warning signs include hoarseness or a scratchy throat that doesn’t get better and Pain in your neck, jaw, or ears. You also might have nosebleeds often or be congested. Many of these issues can be caused by other conditions, too.
What are the treatments for head and neck cancer?
How are head and neck cancers treated?
The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person's age and general health. The patient and the doctor should consider treatment options carefully. They should discuss each type of treatment and how it might change the way the patient looks, talks, eats, or breathes.
- 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 doctor suspects that the cancer has spread. Surgery may be followed by radiation treatment.
- Head and neck surgery often changes the patient's ability to chew, swallow, or talk. The patient may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks. However, lymph node dissection can slow the flow of lymph, which may collect in the tissues; this swelling may last for a long time. After a laryngectomy (surgery to remove the larynx), parts of the neck and throat may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck may be weak and stiff. Patients should report any side effects to their doctor or nurse, and discuss what approach to take.
- Radiation therapy, also called radiotherapy. This treatment involves the use of high-energy X-rays to kill cancer cells. Radiation may come from a machine outside the body (external radiation therapy). It can also come from radioactive materials placed directly into or near the area where the cancer cells are found (internal radiation therapy or radiation implant). In addition to its desired effect on cancer cells, radiation therapy cause unwanted side effects. Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Teeth may be damaged or need to be removed before radiation therapy can be done. Other problems that may occur during treatment are loss of taste, which may decrease appetite and affect nutrition, and earaches (caused by hardening of the ear wax). Patients may also notice some swelling or drooping of the skin under the chin and changes in the texture of the skin. The jaw may feel stiff and patients may not be able to open their mouth as wide as before treatment. Patients should report any side effects to their doctor or nurse and ask how to manage these effects.
- More information about radiation therapy is available in the NCI booklet Radiation Therapy and You: A Guide to Self-Help During Treatment. NCI publications and materials are available by calling the Cancer Information Service (CIS) at 1-800-4-CANCER (1-800-422-6237).
- Chemotherapy is the treatment of cancer with various anticancer drugs. This treatment is used to kill cancer cells throughout the body. The side effects of chemotherapy depend on the drugs that are given. 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. As a result, patients may have side effects such as lower resistance to infection, sores in the mouth and on the lips, loss of appetite, nausea, vomiting, diarrhea, and hair loss. They may also feel unusually tired and experience skin rash and itching, joint pain, loss of balance, and swelling of the feet or lower legs. Patients should talk with their doctor or nurse about the side effects they are experiencing, and how to handle them. The NCI booklet Chemotherapy and You: A Guide to Self-Help During Treatment has more information about this type of treatment.
Additional information on treatment for head and neck cancers can be found in the following PDQ® cancer treatment summaries, available in patient and health professional versions, at http://www.cancer.gov/cancertopics/pdq/adulttreatment on the Internet:
- Hypopharyngeal Cancer
- Laryngeal Cancer
- Lip and Oral Cavity Cancer
- Nasopharyngeal Cancer
- Oropharyngeal Cancer
- Paranasal Sinus and Nasal Cavity Cancer
- Salivary Gland Cancer
Are clinical trials (research studies) available for patients with head and neck cancers?
Clinical trials are research studies conducted with people who volunteer to take part. Participation in clinical trials is an option for many patients with head and neck cancers.
Treatment trials are designed to find more effective cancer treatments and better ways to use current treatments. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and standard therapy to another group. Doctors are studying new types and schedules for delivering radiation therapy, new anticancer drugs, new drug combinations, and new ways of combining treatments. They are also studying ways to treat head and neck cancers using biological therapy (a type of treatment that stimulates the immune system to fight cancer) by itself or in combination with anticancer drugs or radiation therapy.
Scientists are also conducting clinical trials to find better ways to reduce the side effects of chemotherapy and radiation therapy for head and neck cancers. These clinical trials, called supportive care trials, explore ways to improve the comfort and quality of life of cancer patients and cancer survivors.
People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the CIS (see below) and the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. This booklet describes how research studies are carried out and explains their possible benefits and risks. In addition, the NCI's Web site, http://www.cancer.gov on the Internet, provides information about clinical trials. It also offers detailed information about specific ongoing studies by linking to PDQ, a cancer information database developed by NCI. The CIS also provides information from PDQ.
What are the risk factors for head and neck cancer?
Laryngeal and hypopharyngeal cancers that start in the lowest point of the throat are often grouped together with other cancers of the mouth and throat into a group known as head and neck cancers. The risk factors include:
- Smoking/tobacco: Smokers are more at risk of developing cancer in these areas than nonsmokers. Most people with head and neck cancers have a history of smoking or tobacco exposure. Chewing tobacco also increases the risk of mouth (oral cavity) cancer.
- Poor Nutrition: Lack of nutrition may increase the risk of getting head and neck cancer. Heavy drinkers often have vitamin deficiencies, making them susceptible to developing cancer.
- Genetic syndromes: People with certain syndromes such as Fanconi Anemia and Dyskeratosis Congenita caused by inherited defects in certain genes are at a very high risk of throat cancer, including cancer of the hypopharynx.
- Gender: Head and neck cancer are about four times more common in men than women. This is because smoking and alcohol use- the main risk factors, are more common in men. However, these habits have become more common among women, and their risks for these cancers have increased as well.
- Other factors: Other risk factors include being over 50 years old, being exposed to asbestos or other toxic chemicals, having a history of radiation treatment, being infected with Human papillomavirus (HPV) infection (which is caused by sexual contact), long-term use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen and using illegal drugs like cocaine or marijuana.