Head and Neck Cancer

What is head and neck cancer?

“Head and neck cancer” is a broad category that includes several cancers that start in regions of your head and neck. Most start in squamous cells that make up the moist tissue lining your mouth, throat (pharynx), voice box or nasal cavity. Providers classify them as head and neck squamous cell carcinoma (HNSCC).

If you have head and neck cancer, your oncologist will work with you to determine the best treatment options. The goal is to fight the disease while preserving those parts of your body that help you speak, eat and make facial expressions. The earlier it’s caught and treated, the better your chances of getting rid of the cancer for good.

Types of head and neck cancers

Head and neck cancers include cancers in your mouth, parts of your throat (nasopharynx, oropharynx and hypopharynx) and other related structures:

• Oral cancer: Cancer that forms in your lips, gums, tongue, the lining of your cheeks and lips, the top and bottom of your mouth, or behind your wisdom teeth.
• Salivary gland cancer: Cancer of your salivary glands, which produce spit.
• Nasal cavity and paranasal sinus cancer: Cancer that forms in the hollow area inside of your nose (nasal cavity) or the hollow spaces in the bones surrounding your nose (paranasal sinuses).
• Nasopharyngeal cancer: Cancer of the upper part of your throat (nasopharynx).
• Oropharyngeal cancer: Cancer of the middle part of your throat (oropharynx), including your tonsils and the base of your tongue.
• Hypopharyngeal cancer: Cancer of the bottom part of your throat (hypopharynx).
• Laryngeal cancer: Cancer of your voice box (larynx), which contains your vocal cords.

How common are head and neck cancers?

About 4.5% of cancer diagnoses worldwide are head and neck cancers. Most head and neck cancers affect men and people assigned male at birth (AMAB) over 50. But this may be because this group is more likely to have risk factors associated with these cancers, like a history of tobacco use.

In the U.S., instances of tobacco-related head and neck cancers have fallen. Head and neck cancers related to HPV (a type of sexually transmitted infection) are on the rise. Alongside this shift, more people getting diagnosed are under 50.

What are the symptoms of head and neck cancer?

Head and neck cancer symptoms are often mild. They can mimic less serious conditions like a cold or sore throat. A sore throat that doesn’t get better is the most common sign of head and neck cancer.

Depending on the type of head and neck cancer, you may experience:

• A persistent sore throat.
• Persistent earaches or symptoms of ear infections (especially when your ear looks normal to your healthcare provider).
• Frequent headaches.
• Pain in your face or neck that won’t go away.
• Pain in your upper teeth.
• Pain when you chew or swallow.
• Hoarseness or voice changes.
• Trouble breathing or speaking.

You may notice:

• A lump in your throat, mouth or neck.
• A mouth or tongue sore that doesn’t heal.
• Frequent nosebleeds, bloody saliva or phlegm.
• A white or red patch on your gums, tongue or inside your mouth.
• Swelling in your jaw, neck or side of your face (that may cause your dentures to fit poorly).

Check with a healthcare provider immediately if you notice any of these symptoms. They may be signs of something less serious, but you’ll need a thorough exam to be sure.

What causes head and neck cancer?

Head and neck cancer starts when a normal cell turns malignant and starts to make copies of itself. The copies form a tumor that can invade tissue and spread throughout your body. Cancer that’s spread is called metastatic cancer.

Researchers have identified several factors that may cause a normal cell to transform into HNSCC.

Risk factors for head and neck cancer

The most common risk factors for head and neck cancer include:

• Tobacco use: Approximately 70% to 80% of head and neck cancers worldwide are linked to tobacco use. This includes smoking cigarettes or cigars and using snuff or any type of chewing tobacco. Exposure to secondhand smoke may also increase your risk.
• Alcohol consumption: Consuming too much alcohol can increase your risk. This is especially the case if you also use tobacco.
• Human papillomavirus (HPV): In developed nations, including the United States, HPV infection is overtaking tobacco use as the greatest risk factor associated with head and neck cancer.
• Betel nut chewing: Chewing betel nuts is a common practice in Southern and Southeast Asia and Polynesia. It accounts for more than half of head and neck cancers in these regions.

Other risk factors include:

• Epstein-Barr virus (EBV): An EBV infection can lead to nasopharyngeal cancer or salivary gland cancer.
• Weak immune system: A weakened immune system makes it harder for your body to fight cancer. HIV infection and recent major surgeries (like organ or bone marrow transplants) have both been associated with cancer resulting from weakened immune systems.
• Genetics: Your genes may increase your cancer risk. For example, people with Fanconi anemia inherit genes that increase their risk of head and neck cancers. The risk is greater if you have predisposing genes and you also use tobacco.
• Long-term exposure to cancer-causing substances: Several carcinogens may cause head and neck cancers. These include asbestos, pesticides, wood dust and paint fumes.
• Radiation exposure: Prior radiation therapy to the head and neck has been linked to salivary gland cancer and other head and neck cancers.
• Salt-cured foods: Regularly eating salt-cured meat and fish can increase your risk of nasopharyngeal cancer.
• Poor oral hygiene: Not taking care of your teeth and gums can increase your risk of oral cancer.

How are head and neck cancers diagnosed?

Diagnosis usually begins with a physical exam. During the exam, your provider will check your mouth, nasal cavities, throat and neck. They may feel your neck, lips, gums and cheeks for lumps.

Based on your provider’s findings, you’ll likely need tests, which may include:

• An endoscopy: This procedure uses a thin, lighted tube that allows your provider to see inside your nasal cavity, throat or voice box. It’s usually an in-office procedure. 
• Imaging tests: X-rays of your head and neck, CT scans, MRIs and PET scans can show tumors inside your body.
• Lab tests: Your provider may do an HPV test to check for the HPV virus as a cause of cancer if they see something concerning.
• A biopsy: A biopsy is the only way to confirm that a tumor is cancerous. Your provider will remove tissue from the tumor, and a pathologist will test it for cancer cells.

Stages of head and neck cancer

Cancer staging for head and neck cancers helps healthcare providers determine how advanced cancer is. Providers use the TNM (tumor, node, metastasis) system to stage head and neck cancers.

This system considers:

• A tumor’s size and location (T)
• Whether cancer has spread to lymph nodes (N).
• Whether cancer has spread to other parts of your body, or metastasized (M).

Using this information, your provider will assign a number ranging from I to IV.

The staging specifics differ depending on the type of head and neck cancer. But generally, lower numbers (I and II) mean that the cancer is in the early stages. Early-stage head and neck cancers have the highest treatment success rates.

How is head and neck cancer treated?

The main head and neck cancer treatments are:

• Surgery: Whenever possible, surgeons attempt to remove the tumor and a margin of surrounding healthy tissue. Your surgeon may also remove lymph nodes in your neck if they suspect the cancer has spread there or has a reasonably high risk of spreading there.
• Radiation therapy: The most common form of radiation for head and neck tumors uses a machine that directs high-energy X-rays toward cancer cells (EBRT). You may receive radiation alone or alongside other treatments like surgery and chemotherapy.
• Chemotherapy: This uses drugs to kill cancer cells, especially in advanced-stage head and neck cancer. You may receive chemo alongside radiation treatment.

Your healthcare provider may recommend other treatments, especially if your cancer is advanced or if it went away after treatment but then came back:

• Targeted therapy: These drugs are most often used with other treatments for advanced head and neck cancers. The U.S. Food and Drug Administration (FDA)-approved targeted therapy drugs for head and neck cancer include Cetuximab (Erbitux^®) and Larotrectinib (Vitrakvi^®).
• Immunotherapy: These drugs help your immune system identify and destroy cancer cells. Pembrolizumab (Keytruda^®) and nivolumab (Opdivo^®) are two immunotherapy drugs that treat certain head and neck cancers that have spread or returned following treatment.
• Clinical trials: A clinical trial is a study that tests the safety and effectiveness of new treatments. Ask your healthcare provider if they recommend you take part in one.

Your healthcare provider may also recommend palliative care. Palliative care providers can complement your cancer care by helping you manage symptoms. They can make living with a cancer diagnosis easier, no matter your cancer stage or prognosis.

Treatment side effects

Head and neck cancer treatments can cause side effects. For instance, surgery to remove a large tumor may change your appearance. Some people treated for head and neck cancers have trouble breathing, eating, swallowing or talking afterward.

Ask your healthcare provider about potential side effects, including ways to manage them. For example, reconstructive surgery or prosthetics may help you achieve your desired appearance following treatment. Regular visits with a speech-language pathologist can help with speaking and swallowing difficulties.

How can I prevent head and neck cancer?

You can take steps to help prevent most head and neck cancers. To protect yourself:

• Quit tobacco. Stop using all forms of tobacco (cigarettes, cigars, pipes, snuff, dip and chewing tobacco).
• Cut back on drinking. Reducing your alcohol intake or cutting it out can reduce your cancer risk.
• Get the HPV vaccine. Gardasil 9^® is the HPV vaccine approved in the U.S. It protects against several strains of HPV, including those that cause throat cancer.
• Use sun protection. Wearing sunscreen and protective clothing when you’re outside can reduce your risk of skin cancer. Although it’s not technically a head and neck cancer, skin cancer is the most common cancer that affects your head, neck and face.

If you’ve already had cancer, quitting tobacco and alcohol can reduce your risk of cancer returning.

Is head and neck cancer curable?

Some head and neck cancers are potentially curable. The chance of a cure is best if your healthcare provider finds the cancer early and treats it immediately. Small tumors that haven’t spread are also sometimes curable.

Your outlook depends on many factors, including your cancer type, general health and response to treatment. Ask your healthcare provider about your prognosis based on your unique cancer diagnosis.

What is the survival rate for head and neck cancer?

The survival rate for people with Stage I (1) or Stage II (2) oral and throat cancer ranges from approximately 70% to 90%. This means that 70% to 90% of people diagnosed with a head and neck cancer at these stages are alive after five years.

But remember, these numbers are general. They don’t account for your cancer type, health or treatment response. They don’t consider the effects of newer treatments on improving the survival rate. Discuss these factors with your healthcare provider to better understand your prognosis.

When should I see my healthcare provider?

Even if your provider removes your tumor, you’ll still need follow-up care to ensure you receive immediate treatment if the cancer returns. Depending on your treatment, you may need physical therapy or speech therapy afterward.

Follow your provider’s guidance on caring for yourself during recovery, scheduling follow-up visits and recognizing signs that the cancer has returned.

What questions should I ask my healthcare provider?

Questions may include:

• What’s my cancer type and stage?
• Who’ll be part of my care team?
• What treatments do you recommend?
• What treatment side effects should I expect?
• How can I manage treatment side effects?
• What resources are available to support me?