Head and neck cancer is a combined term for carcinomas affecting the throat, mouth, and other parts of the head and neck, excluding brain and eye cancer. They usually initiate in the squamous cells lining the head and neck's mucosal surfaces.
However, depending on where the head-neck cancer has started, it gets its name. For example, the cancer that develops in the regions of the lips, gums, tongue, behind the wisdom tooth, and the lining of the lips and cheeks is called oral cancer. At the same time, cancer that develops in the voice box, or larynx, is termed laryngeal cancer.
Significantly, head and neck tumors are caused by persistent smoking, chewing tobacco, and alcohol consumption. The major symptoms of head and neck carcinoma include jaw swelling, a lump in the mouth, and bleeding through the nose or mouth. These symptoms usually depend on the location where the cancer is residing, such as the mouth, voice box, or nasal cavity.
One of the most common symptoms of the said carcinoma is continuous throat pain that does not go away and a change in voice.
Head and neck carcinomas are quite common, and they are ranked among the top ten cancers diagnosed in India. They are mostly diagnosed among people over the age of 50. Also, men are more affected by this cancer as compared to women.
Here are some of the common sites of head and neck carcinoma among patients:
Head and neck squamous cell carcinoma can develop in the oral cavity, which includes the gums, lips, two-thirds of the tongue, the top of the mouth, the part of the mouth under the tongue, and the area between the wisdom teeth and gums. Cancer developing in the oral cavity is termed oral cancer.
Neck cancer, which develops in the throat, starts in the pharynx, which is a 5-inch tube that initiates behind the nose and goes up to the esophagus. The pharynx is divided into three parts: the nasopharynx, the oropharynx, and the hypopharynx. The cancers of the head and neck developing in the oropharynx are called oropharyngeal cancers. The head-neck carcinomas developing in the hypopharynx are called hypopharyngeal cancers, and the cancers forming in the nasopharynx are called nasopharyngeal cancers.
The voice box, or larynx, is the passageway that is formed by the cartilage placed below the pharynx and possesses the vocal cords. The larynx also has an epiglottis, which is a piece of tissue covering the voice box in order to protect the food going inside the air passages. Neck cancer types developing in the voice box are called Laryngeal cancers.
Another common site for head-neck cancer is the paranasal sinuses and nasal cavity. The nasal cavity can be described as the hollow space found inside the nose. The paranasal sinuses are the hollow spaces that surround the nose.
As the name suggests, salivary glands are responsible for producing saliva, and most of these glands are found at the base of the mouth and nearby the jawline. The carcinoma that develops in this part is called salivary gland cancer.
Here are the different types of head and neck cancer found among patients.
Different head and neck tumors are classified according to the location where they occur. As the name suggests, laryngeal and hypopharyngeal cancers start in the larynx and lower throat. This is one of the most common types of head and neck cancer.
This is one of the head cancer types where malignant cells develop in the paranasal sinus and nasal cavity tissues. The common symptoms of this cancer type are nosebleeds and sinus issues.
Nasopharyngeal cancer is one of the head cancer types where cancerous cells form in the pharynx's upper part, placed behind the nose.
Oral and oropharyngeal cancer is a disease that occurs when malignant cancerous cells present in the mouth and oropharynx start growing uncontrollably and start spreading. This is also one of most common types of head and neck cancer.
Most salivary gland cancers develop in the submandibular glands in the mouth. Though these cancers are normally low-grade and rare, they can cause immense discomfort for the patient.
Like the symptoms of any other cancer, head and neck cancer symptoms also depend on the location where the cancerous cells have developed. As the name suggests, this type of cancer forms in the nose, throat, and ear regions.
Understanding the risk factors for cancer also helps in judging whether the patient is suffering from symptoms of head cancer or not. The reason is that the symptoms of neck cancer are similar to and can be confused with those of a common cold, such as sore throat, headaches, voice changes, etc. Some other symptoms include ringing or continuous pain in the ears.
Also, getting a clear picture of these symptoms, risk factors, and causes helps physicians design an effective course of treatment.
Head and neck carcinoma usually starts in the squamous cells lining the mucosal surfaces of the head and neck regions. In addition, cancerous cells can also develop in the sinuses, nerves of the head and neck, and salivary glands.
The symptoms of head cancer can be differentiated as per the place where the carcinoma cells are located. However, there is no difference between men's and women's head and neck cancer symptoms.
Oral cancer develops on the back side of the throat and mouth.
The common symptoms of oral cancer include persistent mouth ulcers. Other symptoms of oral cancer include the presence of a lump inside the mouth or the lip, a lump in the neck or the throat, difficulty speaking, weight loss without any effort, and pain in the mouth that has no evident cause.
Throat cancer is a general term referring to cancer of the voice box and throat or pharyngeal carcinoma. Its symptoms include:
One of the major symptoms of throat cancer is the development of a lump on the back of the neck, which again does not go away even after taking medicines. One of the early signs of throat cancer is a lump on the back of the neck. Cancer of the throat can be caught in its early stages if the symptoms are brought to a doctor’s attention immediately.
Another common symptom of throat cancer is a persistent sore throat or the feeling that something is blocking your throat.
Difficulty in swallowing things without any proper reason should not be ignored, as it could also be a symptom of throat or larynx cancer.
Getting a hoarse voice or having inappropriate voice changes could be a symptom of larynx cancer, which should be checked immediately. Some other common head and neck cancer symptoms include problems breathing, continuous bouts of coughing, and unexplained weight loss.
Oropharyngeal cancer refers to the growth of cancerous cells in the area ranging from the backside of the oral cavity to the upper side of the throat. Its symptoms include:
Sharp pain in the ear or hearing loss may also be seen in patients with oropharyngeal cancer. Other symptoms include unintentional weight loss, the appearance of a white patch on your tongue or inner cheeks, phlegm with blood, and trouble opening the mouth.
This particular type of cancer is usually asymptomatic and goes undetected for quite some time after developing in the lower part of the throat. Its symptoms include:
A lump or swelling at the back of the neck can be a symptom of hypopharyngeal cancer. This is one of the most common symptoms of neck cancer.
Another common symptom of hypopharyngeal carcinoma is chronic ear pain, which does not go away easily. This is one of the symptoms of neck cancer that should never be ignored.
Nasal cavity and sinus cancer are not easy to find, and their symptoms are often vague and can be easily mistaken for the symptoms of other less serious and more common health conditions. Their symptoms include:
Continuous or persistent nasal congestion or a blockage of the nose on one side could be significant symptoms of nasal cavity cancer. Other symptoms of head cancer associated with the nasal cavity and sinus glands include pain in the eyes and ears, pressure in one of the ears, hearing difficulties, etc.
Weight loss without any extra effort can also be a sign of nasal and sinus cancer. Weight loss is also a symptom of other head and neck cancers.
Head and neck cancer causes are no different from those of most other carcinomas. These include age groups, tobacco and alcohol use, and HPV infections. In addition, some more factors have been identified in studies conducted on what causes head and neck cancer.
Tobacco and alcohol consumption in excess is one of the most common causes of neck cancer. A majority of head and neck cancers are usually caused by chewing tobacco and excessive alcohol consumption. Also, tobacco use may affect the prognosis, i.e., the chances of recovery after the treatment.
HPV, or Human Papillomavirus infection, is also one of the possible head and neck cancer causes. Initiating unprotected sexual activities and unnatural sexual practices with individuals having HPV infections can also increase the chances of getting this infection.
Some occupations or jobs cause individuals to be exposed to certain toxic substances, and this can serve as one of the potential head and neck cancer causes. These substances may be wood dust, pesticides, paints, asbestos, etc.
As per some studies, having radiation treatment for benign or malignant tumors is, in some cases, associated with the development of salivary gland cancer. However, the associated risk is quite low.
Certain genetic factors have also been identified as possible head and neck cancer causes. For example, people who have inherited Fanconi anemia from their parents can have an increased risk for head and neck cancers.
Having exposure to the Epstein-Barr virus infection can increase the patient's chances of getting nasopharyngeal cancer.
According to the experts, the best time to see an oncologist is when and if you start experiencing any of the above-mentioned head and neck cancer symptoms. The reason is that early detection, in most cases, means an increase in survival rates. The oncologist, after examining the symptoms, would perform a physical exam and recommend some diagnostic tests. The results from the diagnostic tests help the oncologist easily determine what causes neck cancer and design a proper treatment course.
Since early detection is the most effective key to getting proper head and neck cancer treatments, experts often advise visiting your doctor as soon as any of the symptoms appear.
First and foremost, the doctor would conduct a physical exam on the basis of your symptoms and risk factors to evaluate the condition. If the doctor finds anything amiss, they may go for further tests, such as an endoscopy, CT of the sinuses, dental core beam CT, chest imaging, etc.
There are multiple tests recommended for head and neck cancer diagnosis, but not all the tests are applicable to every patient. The doctor considers different factors when selecting a particular diagnostic test. These factors include the patient's age and complete health overview, signs and symptoms, the type of head and neck cancer suspected, and the result of any medical tests conducted earlier.
Here are 11 head cancer diagnosis tests recommended for a conclusive diagnosis of head and neck cancer and treatment planning:
Depending on the patient's symptoms, the doctor may examine the patient's throat, mouth, neck, ears, and eyes for any abnormalities. Doctors use a tongue depressor to get a clear view of the mouth's inside. They may also feel the insides of the mouth with a gloved finger.
Also, the doctor may try to feel for any lumps on the patient's gums, cheeks, neck, and lips. In areas where it may be difficult for the doctor to check physically, they may suggest an endoscopy or may also remove a tissue sample for biopsy.
During an endoscopy, the doctor uses a thin, flexible tube with a light and camera at the end. This tool is called an endoscope and is used for examining the insides of the nose and throat area. During this examination, the doctor is able to look for any abnormal changes, growths, blockages, or any other kind of issue for a detailed head and neck cancer diagnosis.
During the procedure, the patient is sedated, and the doctor gently inserts the tube into the patient's body. Also, the endoscopy examination gets different names as per the body part that is examined. For example, endoscopy treatment done to view the larynx is known as laryngoscopy; nasopharyngoscopy is done to view the nasopharynx; and pharyngoscopy is done to examine the pharynx.
Imaging tests are considered one of the best diagnostic methods for detecting the spread and presence of cancerous cells. These head and neck cancer imaging tests help the doctors by generating detailed pictures of the affected area.
The different imaging tests conducted for head and neck cancer detection include X-rays of the head and neck, PET scans, CT scans, and MRIs, or a Panorex. The Panorex is an advanced X-ray that helps doctors obtain detailed images of the upper and lower parts of the jaw, including the sinuses.
Biomarker testing is the process of seeking proteins, genes, and other tumor markers that provide detailed information about factors that are unique to head and neck cancer. Every carcinoma has a unique pattern of biomarkers, and biomarker testing of the tumor helps the doctor design a relevant treatment for every patient.
A panoramic radiograph is a two-dimensional dental X-ray of the upper and lower parts of the jawbone. The said X-ray is designed to capture the different parts of the mouth, such as teeth, the lower and upper parts of the jaw, and the surrounding tissues. The particular X-Ray is used mainly for detecting oral cancers.
An ultrasound makes use of sound waves to create a detailed image or picture of the human body's internal organs. The doctor may use the ultrasound to examine the salivary glands, lymph glands present in the neck, and thyroid.
Computed tomography, or CT or CAT scan, is an imaging test that makes use of X-Rays to get images, pictures, or scans of the insides of the body from different angles. The CT scans are used to detect any kind of abnormality or tumor in the head and neck area. These scans also help the doctor determine the tumor's size.
Another diagnostic test conducted for head and neck carcinoma is a bone scan. This bone scan uses a radioactive tracer to look inside the bones. However, the amount of radiation used is too low to be harmful. In the image, the healthy bone appears to be light in color, while the cancerous parts stand out. This bone test is conducted to check whether the head and neck carcinoma has spread to the bones.
PET, or positron emission tomography, is another imaging test that is often combined with CT scans to get a clear picture of the tissues and internal organs. The PET scan is conducted by injecting a small amount of radioactive sugar molecules into the patient's body.
These radioactive sugar molecules get absorbed in the cells that use maximum energy, and cancerous cells use energy actively.
Blood tests are conducted by doctors to get an idea of the patient's complete health. A complete blood count helps doctors assess the patient's immunity and other health aspects before designing the treatment for head and neck cancer.
A biopsy is conducted by the doctor to make the cancer diagnosis on the basis of a needle aspiration of a particular tumor. A biopsy is a test that involves the removal of tissues from the suspected area and their examination under the microscope. Biopsies are also performed in multiple ways:
Incisional biopsy involves making a minor cut in the area with abnormal tissues and removing a small piece from the area. The sample is then sent for analysis at the laboratory.
A fine needle aspiration is a biopsy test that involves inserting a needle into the lump or mass in the head or neck area and collecting the sample for analysis.
Head cancer treatment involves options such as radiation therapy for destroying the cancerous cells, targeted therapy, chemotherapy using drugs, and surgery for removing the cancer cells. The treatment modality is selected depending on the size, location, and type of head and neck cancer.
The main aim of surgery is to remove the tumor completely while making efforts to preserve the functions of the affected area. During the surgery, the doctor removes the tumor and a small portion of the healthy tissues that surround it. These healthy tissues are then checked by the pathologist to ensure that the entire cancerous cell population is removed.
The different surgeries conducted for head and neck cancer treatments include robotic head and neck surgery, laser surgery, cordectomy, vocal cord stripping, Laryngectomy, myocutaneous flap procedure, pharyngectomy, lymphadenectomy, tracheotomy, and reconstructive microsurgery.
As the name suggests, robotic surgery is a minimally invasive procedure that helps doctors reach difficult areas inside the mouth and throat with a scope. Robotic surgery for head and neck cancer has multiple benefits, namely reduced blood loss and pain, fewer treatment-related complications, shorter hospital stays, and faster recovery.
A laser surgery involves conducting an endoscopy with an endoscope with a high-grade laser attached at the end. Laser surgery is often performed to remove the tumor in the throat.
A cordectomy is a surgical procedure used to partly or entirely remove the vocal cords. This surgical method is used for treating glottic cancer, which is located on the surface tissues.
The vocal cord stripping surgery involves the removal of the outer layer of tissues of the vocal cords. This method is either used for conducting a biopsy or treating some early cancers of the vocal cords.
Laryngectomy is a surgical method used to partly or entirely remove the larynx, which is also known as the voice box.
During the surgical myocutanoeus flap procedure, the surgeon reconstructs the affected throat parts using skin and muscle from the nearby area.
Pharyngectomy is a surgical procedure that involves the removal of either a part or the whole of the throat with cancerous cells.
When the cancerous cells of the pharynx spread to the lymph nodes present in the neck, a surgical treatment is performed for the removal of the lymph nodes, and this is known as a lymphadenectomy.
A surgeon performs a tracheotomy to create an alternative path for breathing. This path is created through a hole or stoma in the windpipe or trachea.
Reconstructive microsurgery is a surgical procedure for reconstructing affected areas of the head and neck. Through this surgical procedure, the doctors are able to reconstruct the tongue, throat, or nose while using tissues from nearby healthy body parts.
A treatment method known as radiation therapy or radiotherapy involves directing high-grade energy beams of particles at the neck cancer. On reaching the tumor, the beams damage the DNA of the cancer cells, thereby damaging the cancerous cells in whole. There are different approaches to radiotherapy for head and neck cancer.
Head and neck cancer radiation therapy may be used as the main treatment course for pharyngeal and laryngeal cancers. In some cases, it may be used as an effective way to prevent the recurrence of head and neck cancer.
Different types of radiation therapy include Proton therapy, adaptive radiotherapy in head and neck cancer, intensity-modulated radiation therapy, image-guided intensity-modulated radiation therapy, chemoradiation, and brachytherapy.
The head and neck radiation recovery time is usually 4 weeks, when the patient starts feeling better. However, for some patients, the recovery time may be a little longer.
Chemotherapy is a treatment procedure that makes use of highly powerful drugs to attack cancerous cells in the head and neck area. These chemotherapy drugs are often given as head and neck cancer medications, along with radiation therapy or surgery, to improve the overall effectiveness of the treatment. This combination of radiation therapy and chemotherapy is termed as chemoradiation. In addition, oncologists also recommend neoadjuvant chemotherapy for head and neck cancer, adjuvant chemotherapy, and palliative chemotherapy.
Head and neck cancer targeted therapy is a treatment that remains focused on the genetic changes responsible for turning healthy cells into cancerous ones. During this treatment, the doctors first test for these particular genetic changes and then use specific ways to kill the cancerous cells or prevent them from growing.
EGFR inhibitors block the protein epidermal growth factor receptor, which is found on the surface of cells and is responsible for cell growth. The EGFR protein is one of the main reasons for cancerous cells growth and spreading.
Tumor-agnostic therapy uses drugs or substances that are used for treating head and neck cancer based on the carcinoma's molecular and genetic features. This therapy does not consider the cancer type or the location of its initiation.
Immunotherapy is a course of treatment that makes use of a person's own immune system to kill off cancerous cells. The different immunotherapy medications available for head and neck cancer treatment are Cetuximab (Erbitux®), Dostarlimab (Jemperli), Pembrolizumab (Keytruda®), and Nivolumab (Opdivo®).
Clinical trials involve studies conducted to test and judge the effectiveness of new cancer treatments and drugs. Multiple studies are being conducted at present to explore different head and neck cancer treatments. Those head and neck cancer patients who have exhausted all the conventional treatment options can consider clinical trials. During clinical trials, patients are given access to new drugs, new treatment combinations, and new treatment approaches that are not yet available to the general public. Before considering opting for clinical trials, it is important to have a detailed discussion with the expert team.
The staging of head and neck cancer gives information about the extent of the cancer's spread and at what stage it is. This information is highly useful to doctors regarding how to treat neck cancer when it reaches a particular stage.
Stage 1, as the name suggests, is the very early stage of neck cancer. At this stage, the tumor is not bigger than two centimeters, and the carcinoma has not reached the lymph nodes.
During stage 2, the cancerous tumor is bigger than two centimeters but less than four centimeters. At this stage, the cancer has not reached the lymph nodes.
Stage 3 head and neck cancer refers to a cancer tumor that is larger than four centimeters and has spread to lymph nodes.
Stage 4 is the advanced stage of head and neck carcinoma. At this stage, the tumor may be of any size. However, the cancer has already spread to lymph nodes, nearby tissues of the head and neck, and distant organs such as the lungs.
Though radiotherapy for head and neck cancer is an effective line of treatment, it has its share of side effects too. Some of the common head and neck radiotherapy side effects include:
HCG has a perfect team of doctors and professionals who are well versed in diagnosing and treating head and neck cancer. The team includes surgeons, medical oncologists, radiation oncologists, palstic and reconstructive surgeons, radiologists, pathologists, and expert nurses. This ensures that your line of treatment is well designed and that the success rates are quite high.
Head and neck carcinoma is one of the most common cancers in different parts of the world, with different risk factors contributing to its spread. These risk factors can significantly increase a person's chances of getting head and neck cancer.
Also, possessing relevant knowledge about these factors can assist a person in lowering their chances of getting cancer, thereby playing a major role in head and neck cancer prevention.
The common head and neck cancer risk factors include tobacco consumption, excess alcohol consumption, chronic HPV infection, and genetic factors, among others. However, not every person with these risk factors is diagnosed with head and neck cancer, but there are increased chances.
There are multiple risk factors for head and neck cancer, and having these risk factors can increase one’s chances of developing head and neck cancer. The 12 common head and neck cancer risk factors include:
Tobacco consumption includes smoking cigars, cigarettes, pipes, and intoxicating substances. Tobacco use is known to be one of the most significant head and neck cancer risk factors. Multiple studies have reported that people who consume tobacco have a higher risk of getting cancer of the head and neck, especially mouth cancer, as compared to others who do not.
Alcohol consumption in excess also increases an individual’s head and neck cancer risk. Alcohol possesses different harmful substances that are derived from fermentation. These substances are carcinogenic for humans as they enable the cells present in the mouth and throat to absorb cancer-causing chemicals easily. Due to this reason, different harmful particles, such as those found in cigarettes, can easily find their way to the mouth and throat cells, causing cancer.
Human papillomavirus infection is another important factor that can increase head and neck cancer risk. HPV infections cause the body's cells to undergo significant changes. However, if these cells are not treated at a suitable time, they can convert into cancerous cells. In fact, as per experts, HPV plays a substantial role in causing head and neck carcinomas, especially oropharyngeal cancer.
EBV, or Epstein-Barr infection, can also increase one’s head and neck cancer risk. Though the EBV virus usually remains in a latent state without leading to any major symptoms, once active, it can easily convert normal cells into malignant ones.
Different studies have shown that cancers of the head and neck are more common among men than women. This is regardless of whether women are drinking alcohol or smoking tobacco.
Poor diet is also one of the head and neck cancer risk factors. A diet that is extremely low in vitamins A and B can substantially increase a person's risk, in addition to having an excess of salt-cured meat. A diet devoid of nutrition can lead to metabolic abnormalities, which again increase the chances of getting cancer.
Poor oral health also plays an important role in increasing one’s head and neck cancer risk. Studies have revealed that people with poor oral hygiene are more likely to suffer from oral infections, increasing their chances of getting head cancer.
When the oral tissues are regularly exposed to acid reflux, it can lead to cell damage. This damage, if left untreated, can lead to pharyngeal and laryngeal cancer over time.
Working in close proximity to cancer-causing substances in the environment, such as paint fumes, wood dust, harmful chemicals, and asbestos, can also be one of the major risk factors for head and neck cancer.
Radiation therapy, or ionizing radiation, can cause substantial damage to the cell's DNA. Thus, a history of radiation therapy in the head and neck region increases the chances of getting this cancer.
Experts suggest that people who consume illicit drugs are at a higher risk of getting cancer of the neck in addition to alcohol usage.
A person with a weakened immune system is also a major risk factor for causing head and neck carcinoma.
There are no known ways to completely prevent head and neck cancer. However, there are some head and neck cancer prevention measures that can help reduce one’s risk of developing head and neck cancer. The following are some of the important head and neck cancer prevention tips that one can follow to reduce their risk of developing this disease:
Quitting tobacco is one of the most important head and neck cancer prevention measures. The risk of developing head and neck cancer is significantly lower among those who do not consume tobacco and those who have quit as compared to those who do.
Another significant head cancer prevention tip would be to limit the use of alcohol.
Take extra effort to protect yourself against HPV, as it is one of the main reasons for causing oral cancer. It is advisable to talk to your doctor about taking the HPV vaccination.
Exposure to the sun and its harmful rays for long periods of time can also lead to the growth of cancerous squamous cells.
As poor oral hygiene is one of the risk factors for head and neck cancer, it is recommended to get regular dental checkups.
As exposure to harmful substances in the environment can also cause head cancer, it is advisable to wear protective gear while working with them.
Poor oral hygiene contributes to increased throat cancer risk. Many studies have found that poor oral hygiene aids the carcinogenic potential of tobacco and alcohol and thereby increases the risk of throat cancer.
Carcinoma of the head and neck comprises multiple cancers in the upper region of the body. The diagnosis needs proper head and neck cancer imaging, and the treatment depends on where the cancer has started. Also, the survival rate depends on the type of head-neck cancer, head and neck cancer stages, the treatment administered, and the patient’s overall health status.
