Head and neck cancer

Head and neck cancers encompass a wide range of malignancies that affect the head and neck area.

Treatment for head and neck cancer is determined by the kind, location, and size of the tumour. Surgery, radiation therapy, and chemotherapy are frequently used to treat head and neck cancers. Treatments can be mixed and matched.

Following treatment for head and neck malignancies, patients may need to work with rehabilitation specialists and other professionals to deal with side effects include hearing loss, difficulties eating, dental problems, thyroid issues, difficulty breathing, or difficulty speaking.

Cancers of the head and neck include cancers that start in several places in the head and throat, not including brain cancers or cancers of the eye.

These cancers can start—

• In the sinuses (the spaces around the nose on the inside of the skull).
• Inside and behind the nose.
• In the mouth, including the tongue, the gums, and the roof of the mouth.
• In the back of the mouth and the throat (pharynx), which includes three sections called the nasopharynx, oropharynx, and hypopharynx.
• In the larynx (voice box).
• On the lips, although cancer on the lips is a type of skin cancer.
• In the glands that make saliva for the mouth, but those are relatively rare.

Types of head and neck cancer

There are 5 main types of head and neck cancer, each named according to the part of the body where they develop.

Laryngeal and Hypopharyngeal Cancer

Any portion of the larynx or hypopharynx might develop cancer. Cancer is caused by healthy cells that mutate and expand out of control, resulting in a tumour. Tumors can be malignant or noncancerous. A malignant tumour is one that has the potential to grow and spread to other regions of the body. The term “benign tumour” refers to a tumour that can develop but not spread.

Squamous cell carcinoma accounts for approximately 95% of all malignancies of the larynx and hypopharynx. This suggests they started in the linings of these organs’ flat, squamous cells.

Nasal cavity and paranasal sinus

Cancer develops when healthy cells in the body begin to alter and grow out of control, resulting in a tumour. Tumors can be malignant or noncancerous. A malignant tumour is one that has the potential to grow and spread to other regions of the body. The term “benign tumour” refers to a tumour that can develop but not spread. A benign tumour can typically be removed without recurrence.

Cancers of the nasal cavity and paranasal sinuses are cancerous tumours. They are two of the most common kinds of cancer in the head and neck region. They are part of the head and neck cancer group of malignancies. Although cancer of the paranasal sinuses can occur in any of the sinuses, it most commonly begins in the maxillary sinus.

Nasopharyngeal cancer

Head and neck cancers include nasopharyngeal carcinoma. Nasopharyngeal carcinoma, or NPC, is another name for it. The nasopharynx, or airway between the nose and the throat and lungs, is affected by NPC. It is placed above the soft palate of the mouth, behind the nasal cavity. The Eustachian tube, which can be found on either side of the nasopharynx, leads into the middle ear on both sides.

There are various types of tissue in the nasopharynx. Each tissue type has a variety of cells, each of which can grow into a different cancer. Many forms of NPC, for example, have white blood cells called lymphocytes. As a result, lymphoepithelioma is a malignancy named after these cells. The type of cell implicated, as well as other characteristics, are significant because they influence the severity of the disease and the treatment options available.

Oral and oropharyngeal cancer

Cancer is caused by healthy cells that mutate and expand out of control, resulting in a tumour. Tumors can be malignant or noncancerous. A malignant tumour is one that has the potential to grow and spread to other regions of the body. The term “benign tumour” refers to a tumour that can develop but not spread.

Oral cancer and oropharyngeal cancer are two of the most prevalent types of cancer in the head and neck region, which is referred to as head and neck cancer. We can chew, swallow, breathe, and converse thanks to the oral cavity and oropharynx, as well as other areas of the head and neck.

Salivary gland cancer

Salivary gland cancer is one of the five main forms of cancer seen in the head and neck region, which is referred to as head and neck cancer. When healthy cells alter and expand out of control, they create a tumour, which is a mass of tissue. Tumors can be malignant or noncancerous. A malignant tumour is one that has the potential to grow and spread to other regions of the body. The term “benign tumour” refers to a tumour that can develop but not spread.

Tumors can start in any of the main or small salivary glands, and they can be benign or malignant. The majority of tumours that grow in the parotid gland (80 percent) and around half of tumours in the submandibular gland are benign. Tumors of the sublingual gland are typically malignant. The majority of malignant tumours of this type start in the parotid or submandibular glands.

Symptoms of head and neck cancer

In the mouth, cancer can cause—

• A white or red sore that does not heal on the gums, tongue, or lining of the mouth.
• Swelling in the jaw.
• Unusual bleeding or pain in the mouth.
• A lump or thickening.
• Problems with dentures.

At the back of the mouth (pharynx), cancer can cause—

• Trouble breathing or speaking.
• A lump or thickening.
• Trouble chewing or swallowing food.
• A feeling that something is caught in the throat.
• Pain in the throat that won’t go away.
• Pain or ringing in the ears or trouble hearing.

In the voice box (larynx), cancer can cause—

• Pain when swallowing.
• Ear pain.

In the sinuses and nasal cavity, cancer can cause—

• Blocked sinuses that don’t clear.
• Sinus infections that do not respond to treatment with antibiotics.
• Bleeding through the nose.
• Headaches.
• Pain and swelling around the eyes.
• Pain in the upper teeth.
• Problems with dentures.

Causes of head and neck cancer

Tobacco and alcohol are key risk factors for head and neck cancers. Cigarettes, cigars, pipes, and smokeless tobacco (chewing tobacco, snuff, or a kind of chewing tobacco known as betel quid) are all associated to head and neck cancer (except for salivary gland cancers). Drinking any sort of alcohol, such as beer, wine, or liquor, increases the risk of oral, throat, and voice box malignancies.

Human papillomavirus (HPV), a common sexually transmitted virus, is connected to over 70% of malignancies in the oropharynx (which comprises the tonsils, soft palate, and base of the tongue).

UV light exposure, such as exposure to the sun or artificial UV rays such as tanning beds, is a leading cause of lip cancer.

Occupational exposures, or being exposed to specific substances while working, can raise the risk of nasopharyngeal cancer. Wood dust, formaldehyde, asbestos, nickel, and other pollutants can be found in the building, textile, pottery, logging, and food processing sectors, among other places.

The Epstein-Barr virus, which causes infectious mononucleosis and other disorders, can increase the risk of malignancies of the nose, behind the nose, and salivary glands.

Radiation to the head and neck can result in cancer of the head and neck.

Head and neck cancer affects roughly twice as many males as it does women. People over the age of 50 are more likely to be diagnosed with them.

Diagnosis of head and neck cancer

Head and neck cancer is diagnosed using a variety of assays. Not every person will be subjected to all of the tests outlined here. When choosing a diagnostic test, your doctor may take into account the following factors:

If a person has symptoms and signs of head and neck cancer, the doctor will take a complete medical history, noting all symptoms and risk factors. In addition, the following tests may be used to diagnose head and neck cancer:

Physical examination/blood and urine tests. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The doctor will also inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and a mirror for a clearer view. Blood tests and urine tests may be done to help diagnose cancer.

Endoscopy. An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is gently inserted through the nose into the throat and down the esophagus to examine inside the head and neck. Sedation is giving a person medication to become more relaxed, calm, or sleepy. The examination has different names depending on the area of the body that is examined, such as laryngoscopy to view the larynx, pharyngoscopy to view the pharynx, or nasopharyngoscopy to view the nasopharynx. When these procedures are combined, they are sometimes referred to as a panendoscopy.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s) removed during the biopsy. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A common type of biopsy is called a fine needle aspiration. During this procedure, cells are collected using a thin needle inserted directly into the tumor or lymph node. The cells are examined under a microscope for cancer cells, which is called a cytologic examination.

The biopsy may include testing to see whether the person has HPV. As described in Risk Factors and Prevention, HPV has been linked to a higher risk of some head and neck cancers. In some cases, whether a person has HPV can also be a factor in determining which treatments are likely to be most effective.

Biomarker testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests can help determine your treatment options.

X-ray/barium swallow. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A barium swallow may be required to identify abnormalities along the swallowing passage. During a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray. A special type of barium swallow called a modified barium swallow may be needed to evaluate specific swallowing difficulties. If there are signs of cancer, the doctor may recommend a computed tomography (CT) scan (see below).

Panoramic radiograph. A panoramic radiograph is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect cancer or evaluate the teeth before radiation therapy or chemotherapy. This is often called a panorex.

Ultrasound. An ultrasound uses sound waves to create a picture of internal organs.

Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The amount of radiation in the tracer is too low to be harmful. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image. This test may be done to see if cancer has spread to the bones.

Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

Treatment of head and neck cancer

The three main treatments for head and neck cancer are radiation therapy, surgery, and chemotherapy. The principal treatments are usually radiation therapy, surgery, or a combination of the two with the goal of destroying or eliminating the cancer. Chemotherapy is frequently used as a supplement to, or adjuvant to, other treatments. The best combination of the three treatment options for a patient with a certain type of head and neck cancer is determined by the cancer’s location and stage (amount of illness).

Patients with early-stage head and neck malignancies (especially those that are restricted to the site of origin) are often treated with one of two major therapies: radiation therapy or surgery. Chemotherapy and radiation therapy are frequently used in the treatment of patients with advanced malignancies. Patients may be treated with surgery, followed by radiation therapy and chemotherapy, depending on the clinical situation.

If the main malignancy is treated with radiation therapy alone, the neck is also treated with radiation therapy. In addition, if the quantity of illness in the neck nodes is particularly large or if the cancer in the neck nodes has not been entirely removed by the end of the radiation therapy course, surgery to remove affected lymph nodes in the neck (called a neck dissection) may be required.

A surgeon may remove the original tumour in some cases. If necessary, radiation can be given later. In some cases, the cancer has progressed to the point that surgery will not be able to entirely remove it. After that, radiotherapy may be used to try to shrink the tumour, with surgery following treatment.

According to recent studies, chemotherapy done concurrently with radiation therapy is more effective than chemotherapy given before a session of radiation therapy. As a result, if the cancer stage is advanced, radiation treatment plans may incorporate chemotherapy (advanced stage III or stage IV). Cisplatin (Platinol) and Cetuximab are the most often used drugs in conjunction with radiation therapy (Erbitux). Fluorouracil (5-FU, Adrucil), carboplatin (Paraplatin), and paclitaxel are some of the other medications that may be used (Taxol). This is simply a partial list of chemotherapy drugs; your doctor may prescribe something else. Chemotherapy can be administered in several ways, including a modest daily dose, a moderately low weekly dose, or a substantially greater dose every three to four weeks.

Surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, or a combination of treatments may be used to treat head and neck cancer. The treatment approach for an individual patient is determined by a variety of criteria, including the tumor’s location, cancer stage, and the patient’s age and general condition.

Is it OK to treat HPV-related oropharyngeal cancer with less treatment?
Researchers are looking into whether a less intensive treatment might still be successful while being safer.

Patients with HPV-positive oropharyngeal tumours have a substantially better prognosis and a higher chance of complete cure following the same treatment than those with HPV-negative tumours, according to research (32). As a result, ongoing clinical trials are looking into whether patients with HPV-positive malignancies can be treated with less aggressive treatments like radiation or immunotherapy.

The PDQ® cancer therapy summaries for certain forms of head and neck cancer contain more information regarding head and neck cancer treatment: