Head and Neck Cancer
Head and neck cancer can develop in or around the throat, larynx, nose, sinuses, and mouth. Squamous cell carcinoma accounts for almost all head and neck cancers. These cancers usually begin as dysplasia, a pre-cancerous condition. Dysplasia can develop into carcinoma in situ (CIS), the earliest form of cancer. Most CIS can be cured if treated at this stage. If left untreated, it can develop into an invasive squamous cell cancer that will destroy nearby tissues and spread to other parts of the body. A head and neck cancer that starts in the salivary glands will usually be classified as an adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma.
Forms of head and neck cancer
Laryngeal and hypopharyngeal cancers begin in the lower part of the throat. Laryngeal cancer starts in the voice box (larynx) and is treated depending on where it is located: in the glottis (which contains the vocal cords) or in the supraglottis or subglottis, which are above and below the vocal cords. Hypopharyngeal cancer starts in the part of the throat beside and behind the larynx.
Nasal cavity and paranasal sinus cancer. The nasal cavity is the space just behind the nose where air passes on its way to the throat. The paranasal sinuses are the air-filled areas around the nasal cavity.
Nasopharyngeal cancer begins in the air passageway at the upper part of the throat behind the nose (nasopharynx).
Oral and oropharyngeal cancer. The oral cavity includes the mouth and tongue. The oropharynx includes the middle of the throat, from the tonsils to the tip of the voice box.
Salivary gland cancer can begin in the major or minor salivary glands. About 7 out of 10 salivary gland tumors start in the parotid glands, located just in front of the ears. Cancers start much less frequently in the submandibular glands below the jaw, and rarely in the sublingual glands located under the floor of the mouth and below either side of the tongue. Several hundred microscopic minor salivary glands are located under the lining of the lips and tongue; in the roof of the mouth; and inside the cheeks, nose, sinuses, and larynx.
Chondrosarcomas or synovial sarcomas can develop from connective tissues of the larynx or hypophyarynx. These cancers are extremely rare.
Melanomas usually start in the skin, but in rare cases they can start in the larynx or hypophyarynx.
Risk factors for head and neck cancer
Tobacco use — Eighty-five percent of head and neck cancers are linked to tobacco use, and secondhand smoke can also increase risk. This is the most important risk factor.
More than one alcoholic drink per day increases risk, but not as much as smoking does. However, people who use both tobacco and alcohol have the highest risk of all and are many times more likely to get head and neck cancer than people with neither habit.
Poor nutrition — A diet low in vitamins A and B can increase a person’s risk of head and neck cancer.
Poor oral and dental hygiene may increase the risk of head and neck cancer.
Human papilloma virus (HPV) infection of the throat may contribute to some cancers of the tonsils and hypopharynx. HPV infection is very rarely a factor in laryngeal cancer.
Epstein-Barr virus (EBV) plays a role in the nasopharyngeal cancer development.
Genetics — Two genetic syndromes — Fanconi anemia and dyskeratosis congenita — are associated with a very high risk of throat cancer, including cancer of the hypopharynx.
Long and intense exposure to wood dust, paint fumes, and some chemicals used in the metalworking, petroleum, plastics, and textile industries can increase the risk of laryngeal and hypopharyngeal cancers. Some studies have also suggested a link between asbestos exposure and laryngeal cancer, but not all studies agree.
Gender — Men are two to three times more likely than women to get cancers of the larynx and hypopharynx, likely due to differences in smoking and heavy alcohol use. However, women’s risks for these cancers have increased as they engage more commonly in those habits.
Age — More than half of patients with cancers of the larynx and hypopharynx are first diagnosed at age 65 or older. Risk increases for people above age 40.
Race — Cancers of the larynx and hypopharynx are more common among African Americans and whites than among Asians and Latinos.
Gastroesophageal reflux disease (GERD) is a suspected risk factor for laryngeal and hypopharyngeal cancers and is currently being studied.
Research suggests that other potential risk factors include marijuana use and lowered immunity.
Symptoms of head and neck cancer
Hoarseness or voice changes. Consult a health care provider if these changes do not improve within two weeks.
Cancers that start in the area of the larynx above or below the vocal cords or in the hypopharynx do not usually cause voice changes. Symptoms may include:
Swelling or a sore that does not heal; this is the most common symptom
A sore throat that does not go away
Pain or difficulty chewing, swallowing, or moving the jaw or tongue
Ear pain or infection
A lump, bump, or mass in the head or neck area, with or without pain
A red or white patch in the mouth
Foul mouth odor not explained by hygiene
Nasal obstruction or persistent nasal congestion
Frequent nose bleeds and/or unusual nasal discharge
Numbness or weakness of a body part in the head and neck region
Blood in the saliva or phlegm
Loosening of teeth
Dentures that no longer fit
Unexplained weight loss
How is head and neck cancer treated with radiation?
Radiation therapy can be used to treat laryngeal and hypopharyngeal cancers in several ways:
As the main treatment for some early stage cancers. If the tumor is small, radiation can often destroy it without the need for surgery.
To treat patients who are too sick to have surgery
To destroy small areas of cancer that might remain after surgery
To treat returning cancer (recurrence)
To ease symptoms of advanced laryngeal and hypopharyngeal cancer, such as pain, bleeding, trouble swallowing, and problems caused when cancer spreads to the bones, as part of palliative care.
Before beginning radiation therapy for any type of head and neck cancer, patients should be examined by an oncologic dentist or oral oncologist. Damaged teeth may need to be removed.
More extensive information about head, neck, and other cancers may be found at these sites:
American Cancer Society: Cancer.org
American Society of Clinical Oncology: Cancer.net
National Cancer Institute: Cancer.gov