Cancers of the Head and Neck

Head and neck cancers, making up 4% of U.S. cases, require early detection for better outcomes.

Head and neck cancers account for 4 percent of all cancers in the U.S., are twice as common in men as in women, and the incidence increases over the age of 50. As with all cancers, early detection leads to better outcomes, and early detection involves awareness of symptoms.

Symptoms of Cancers of the Head and Neck

Symptoms depend on the location of the cancer but may include a lump in the neck, painful sore in the mouth or throat, persistent sore throat, difficulty or pain in swallowing, chronic sinusitis, and hoarseness in the voice, among others.

These symptoms are usually associated with less serious conditions, but if they persist for an unusual length of time, your physician or dentist should evaluate you.

Types of Cancers

Most of these cancers usually begin in the squamous cells that line the mucosal surfaces of the head and neck (those inside the mouth, throat, and larynx or voice box). These cancers, referred to as squamous cell carcinomas, can less frequently begin in the salivary glands, nasal cavity, paranasal sinus, or muscles or nerves. When it spreads, squamous cell carcinoma of the head and neck almost always does so locally and/or to the lymph nodes in the neck. This is why an unusual neck lump can be a cancer symptom.

Risk Factors for Cancers of the Head and Neck

There are a number of risk factors for developing cancers of the head and neck. These include alcohol and tobacco use (including secondhand smoke, chewing tobacco, and snuff) most commonly. The consumption of both alcohol and smoking increases the risk of cancer by 40 percent.

Infection with cancer-causing types of human papillomavirus (HPV – especially Type 16) in the tonsils or base of the tongue is another cause. Other risk factors include occupational exposure in construction, metal, textile, and logging industries. Previous radiation exposure, Epstein-Barr virus infection, and underlying genetic disorders are other causes of these cancers.

HPV vaccination reduces the risk of developing these cancers.

Diagnosing Head and Neck Cancer

Head and neck cancers are sometimes without symptoms and detected by your physician or dentist at a routine examination. Alternatively, you may report symptoms above and your doctor will ask about your history and perform a physical examination with attention to your neck and the inside of your mouth and nose.

A suspicious lump can be biopsied with a small needle to withdraw cells from the lump for examination under the microscope. If those cells are malignant, you will undergo a positron emission tomography (PET) scan to find the location of the tumor.

A small endoscope, with or without local anesthetic, is used to examine the mouth, throat, and nose structures and remove tissue samples if surface lesions are present. Laryngoscopy is used to look directly or indirectly at the larynx (voice box) to see and biopsy any abnormalities of the vocal cords.

Treatment of Head and Neck Cancer

Head and neck cancer treatment utilizes surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, or a combination of treatments. Treatment depends on cell type, extent of spread, the cancer's location, and the patient's general physical condition.

Many of the cancers that occur in the mouth, nose, paranasal sinuses around the nose, and neck are very susceptible to radiation and chemotherapy. Those with HPV-positive oropharyngeal tumors have an even better prognosis and a higher chance of complete cure.

Chemotherapy is often added to the radiation if the cancer has spread to the lymph nodes in the neck. Surgery with extensive dissection is required in some advanced cases.
Survival of patients who have these cancers depends on the site, spread, and specific treatment, but the majority will survive five years; if detected early and in a localized spot, the cure rates can be as high as 98 percent.

Side Effects of Treatment of Head and Neck Cancer

As tumors of the head and neck are sensitive to radiation therapy, a significant number of patients thus treated will have to deal with the side effects of radiation. Side effects may persist for six to eight weeks after completion of the radiation treatments.

The side effects predominantly include the development of mucositis (sore or pain in the area of treatment) or painful ulcers of the mouth. Other common side effects include redness, irritation, and sores in the mouth; dry mouth and thickened saliva; difficulty and pain with swallowing; and changes in or loss of taste.

The most serious is the effect on swallowing. Some patients usually meet regularly with a dietician to discuss soft foods and high-calorie, high-protein liquid nourishment such as Ensure and Boost.

Many patients have found juice made from the aloe plant most effective in soothing the burning sensation in the oral cavity; the higher the concentration of actual juice, the better. The jaw may also feel stiff, and patients may not be able to open their mouths as widely as before treatment.

Surgery for head and neck cancers may affect the patient’s ability to chew, swallow, or talk. If lymph nodes are removed, patients may develop swelling in the area, known as lymphedema, from slowing the flow of lymph and collection in the tissues.

If treated promptly, lymphedema can be reversed, improved, or reduced in most cases. After a laryngectomy (surgery to remove the voice box) or other neck surgery, parts of the neck and throat may feel numb because nerves have been cut.

Although side effects of surgery and radiation therapy improve slowly in many patients, others will experience long-term effects, including difficulty swallowing, speech impairment, a dry, burning mouth, and skin changes.

The Bottom Line

Head and neck cancer increases as we age. Symptoms are similar to many benign conditions, but if a symptom does not go away, then you are your best advocate and should see your physician. Early diagnosis and treatment will produce the best outcome.

Learn more about head and neck cancer and how MUSC Hollings Cancer Center can help.

About the Author Jerry Reves, M.D.

Dr. Jerry Reves is an anesthesia and perioperative medicine professor at the MUSC College of Medicine.
Department of Anesthesia & Perioperative Medicine