Overview of Head & Neck Cancer

Symptoms, Risk Factors & Diagnosis of Head & Neck Cancers

Overview of Head & Neck Cancers

Medically reviewed by Dr. C.H. Weaver M.D. Medical Editor 8/2018

Head and neck cancers originate in the throat, larynx (voice box), pharynx, salivary glands, or oral cavity (lip, mouth, tongue) in the squamous cells that line these moist surfaces. These cancers are often preceded by non-cancerous sores or leukoplakia-an unusual patch of white tissue that cannot be rubbed off. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.

Squamous cell cancers of the head and neck are further defined by the area of the head or neck where they originate.

Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the 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 of the gum behind the wisdom teeth.

Pharynx: The pharynx (throat) is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts: the nasopharynx (the upper part of the pharynx, behind the nose); the oropharynx (the middle part of the pharynx, including the soft palate [the back of the mouth], the base of the tongue, and the tonsils); the hypopharynx (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.

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.

Salivary glands: The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.

Cancers of the brain, the eye, the esophagus, and the thyroid gland, as well as those of the scalp, skin, muscles, and bones of the head and neck, are not usually classified as head and neck cancers.

Signs & Symptoms of Head & Neck Cancers

The symptoms of head and neck cancers may typically include a lump or a sore that does not heal, difficulty swallowing, a persistent sore throat or hoarseness in the voice. These symptoms may also be caused by other conditions but should always be brought to the attention of a physician.

Diagnosis & Tests Used to Diagnose Head & Neck Cancer

Diagnosis of head and neck cancers usually involves several tests to help determine the size and extent of spread from its site of origin or stage. In addition to blood tests other tests may include;

  • Endoscopy. An endoscope is a lighted tube, which is used to examine the throat, larynx, and upper esophagus. Endoscopy is performed to obtain a biopsy, determine the local extent of the cancer, and look for additional cancers
  • Biopsy involves the removal of a small sample of the suspected cancer. The samples are then examined under a microscope to determine if cancer is present.
  • Imaging Tests: Chext x-ray, computed tomographic (CT) scans, magnetic resonance imaging (MRI) scans, ultrasound, and positron emission tomography (PET) scans are often valuable for detecting the extent to which the cancer has spread to the lymph nodes and to further identify the extent of cancer at the primary location.

Patients with head and neck cancers should consider being evaluated in a medical center that treats many patients with these cancers because cancers of the head and neck often require a multidisciplinary team approach comprised of a head and neck surgeon, a radiation oncologist, a medical oncologist, a pathologist, a dentist, and social services personnel. Evaluation and treatment by an experienced team is essential for determining optimal treatment and support.

Head and Neck Cancers

What Causes Head and Neck Cancer?

There are approximately 53,000 head and neck cancers diagnosed annually in the United States. They are twice as common among men as they are among occur more often among people over age 50.

  • Alcohol and tobacco use (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) are the single most important risk factors for developing a head and neck cancer, especially cancers of the oral cavity. People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone.(1,2)
  • Human papillomavirus (HPV). especially HPV-16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue. This is at least partly due to the rise of the human-papillomavirus (HPV), a cancer-causing virus that can be transmitted through oral sex.(3)
  • Paan (betel quid). Immigrants from Southeast Asia who use paan (betel quid) in the mouth should be aware that this habit has been strongly associated with an increased risk of oral cancer.(4)
  • Maté.Consumption of maté, a tea-like beverage habitually consumed by South Americans, has been associated with an increased risk of cancers of the mouth, throat, esophagus, and larynx.(5)
  • Preserved or salted foods.Consumption of certain preserved or salted foods during childhood is a risk factor for nasopharyngeal cancer.(6)
  • Radiation exposure.Radiation to the head and neck, for noncancerous conditions or cancer, is a risk factor for cancer of the salivary glands.(7)
  • Epstein-Barr virus infection.Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.(8)
  • Asian ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer.(9)

References:

  1. Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Research 1988; 48(11):3282–3287.
  2. Hashibe M, Brennan P, Chuang SC, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiology, Biomarkers and Prevention 2009; 18(2):541–550.
  3. Danaei G. Global burden of infection-related cancer revisited. The Lancet Oncology. Published early online May 9, 2012. doi:10.1016/S1470-2045(12)70176-6.
  4. Goldenberg D, Lee J, Koch WM, et al. Habitual risk factors for head and neck cancer. Otolaryngology and Head and Neck Surgery 2004; 131(6):986–993.
  5. Yu MC, Yuan JM. Nasopharyngeal Cancer. In: Schottenfeld D, Fraumeni JF Jr., editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.
  6. Mayne ST, Morse DE, Winn DM. Cancers of the Oral Cavity and Pharynx. In: Schottenfeld D, Fraumeni JF Jr., editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.
  7. Chien YC, Chen JY, Liu MY, et al. Serologic markers of Epstein-Barr virus infection and nasopharyngeal carcinoma in Taiwanese men. New England Journal of Medicine 2001; 345(26):1877–1882.
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