What is head and neck cancer?

Head and neck cancer is a collective label for cancers that develop in various areas of the head and neck. Most often they start to develop in the thin layer of moist, mucosal tissues that line the nose, throat, and mouth. These thin layers of tissue are made up of flat squamous cells. Most of the cancers that develop in these moist tissues are known as squamous cell carcinomas of the head and neck. More uncommonly, cancer can develop in the salivary glands, but this article will focus on the squamous cell carcinomas of the head and neck.

What causes head and neck cancers?

The two most important risk factors for developing head and neck cancer are drinking alcohol and using tobacco (in any form), particularly cancers of the oral cavity, oropharynx, hypopharynx, and larynx. 75% or more of head and neck cancers stem from alcohol and tobacco consumption. Also, as people get older, their risk of developing head and neck cancers increases. The majority of head and neck cancers develop in people who are older than 45. Further, head and neck cancers are more common among men. The reasons for this are not fully understood.

Another important risk factor for head and neck cancers is the human papillomavirus (HPV). HPV is most commonly known for causing cervical cancer, among others. HPV is particularly implicated in cancers that involve the base of the tongue and the tonsils. HPV-related head and neck cancers generally have a better prognosis (chance of recovery) than those stemming from alcohol and tobacco use.

What are the symptoms of head and neck cancer?

As noted earlier, head and neck cancers can develop in a variety of locations. Because of this, there are also a large variety of symptoms that may indicate developing head and neck cancers. These include symptoms such as:

• Difficulty and/or pain when swallowing
• A lump or a sore that does not heal
• A lump in the neck
• A sore throat or pain in the neck that does not go away
• Changes in the voice or increased hoarseness of the voice
• A white or red patch on the lining of the mouth, the tongue, or the gums
• Trouble breathing or speaking
• Sinuses that are blocked and do not clear
• Chronic sinus infections that do not respond to antibiotics
• Bleeding through the nose
• Frequent headaches

It is important to note, however, that these symptoms can also be associated with other, less serious conditions. So, make sure that you first consult with your primary care physician or dentist to determine whether or not your symptoms are due to a less serious, non-cancerous condition or illness.

How are head and neck cancers diagnosed?

If less serious conditions are ruled out, and your doctor suspects that head and neck cancer is possible, the first steps in diagnosing it include an evaluation of your complete medical history, and possibly of your family’s history of cancer. Next will be a detailed physical examination of the entire head and neck area, including the mouth, throat and nasal passages, and possibly other diagnostic tests will be ordered. Ultimately, however, a conclusive diagnosis of head and neck cancer will require surgical removal and examination of a small sample of tissue (a biopsy) under the microscope.

Determining how advanced the cancer is (known as the Stage) will require further studies such as X-ray, other imaging studies such as computed tomography (CT scan) or a positron emission tomography (PET) scan, and laboratory tests. Determining the Stage (extent) of the cancer will aid your doctor or health care team in making an appropriate, effective treatment plan recommendation.

How are head and neck cancers treated?

Appropriate treatment depends on the exact nature of the cancerous tumor, and factors unique to the individual. These factors include the size of the tumor, its exact location, the stage (extent) of the cancer, and on the individual’s general health and age. Treatments for head and neck cancer include surgery, radiation therapy/treatments, chemotherapy, immunotherapy, and targeted therapy. It will often require a combination of more than one treatment. Effective treatment generally will involve an entire team of healthcare professionals, including doctors, nutritionists, and others.

What are the side effects of treatment?

The side effects of treatment for head and neck cancer depends on the type/location of the cancer, and on the type of treatment(s) followed. The most common side effects of radiation therapy can include fatigue, weight loss, difficulty and/or pain with swallowing, mouth sores, dry mouth, thickened saliva, redness and irritation. The common side effects of chemotherapy can include low blood counts, nausea, and changes or loss in taste (some foods may taste different, or be tasteless, after treatment). Loss of taste can have a negative effect on nutrition and needs to be watched carefully. Nausea generally improves soon after the chemotherapy treatments are over. Fatigue and problems with swallowing may take longer to get better.

Surgical removal of the tumor can change the patient’s ability to talk, swallow, or chew. The surgery may also cause swelling of the neck and/or face; however, the swelling generally dissipates after a few weeks. If lymph nodes were removed, this may cause additional swelling, which could last much longer. If the removed lymph nodes are in the neck, the neck and shoulder may become stiff and/or weak. If surgery includes removal of the larynx (laryngectomy) or involved other parts of the neck, the throat and neck may feel numb.

Long-term recovery requires the involvement of a competent team of medical professionals, not only in the treatment of cancer but also in managing recovery. Besides doctors, this team can include speech pathologists, dentists, dental hygienists, and dietitians/ nutritionists. They all play important roles in helping manage treatment side effects, both short and long-term. The patient may also choose to seek professional counseling and join a support group to aid in recovery.