Understanding of Head and Neck Cancers
WHAT IS HEAD AND NECK CANCER?
Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These squamous cell cancers are often referred to as squamous cell carcinomas of the head and neck. Head and neck cancers can also begin in the salivary glands, but salivary gland cancers are relatively uncommon. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.
UNDERSTANDING HEAD AND NECK CANCER
Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These squamous cell cancers are often referred to as squamous cell carcinomas of the head and neck. Head and neck cancers can also begin in the salivary glands, but salivary gland cancers are relatively uncommon. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.
Cancers of the head and neck are further categorized by the area of the head or neck in which they begin. These areas are described below and labeled in the image of head and neck cancer regions.
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.
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).
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.
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.
The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.
Head and neck cancers include cancers of the mouth and the throat, as well as rare cancers of the nose, sinuses, salivary glands, and middle ear.
People use the word ‘throat’ to mean different parts of the neck. These include the:
AREAS OF THE HEAD AND NECK
WHERE CANCERS BEGIN
- Paranasal sinuses & nasal cavity
- Oral cavity
- Salivary glands
- Larynx (voice box)
- Pharynx (cavity behind nose & mouth, connecting both to esophagus)
Head and neck cancer is the umbrella term for a group of cancers that affect the mouth, lips, nose, sinuses, salivary glands, throat and voice box.
- The most common head and neck cancers start in the mouth, lips or throat.
- Head and neck cancers are often linked to alcohol and tobacco use. In recent years, infection with human papillomavirus (HPV) has become a leading risk factor.
- Screenings for head and neck cancers may be done by your regular doctor or dentist, with follow-up care by an ear, nose and throat provider. Then you may be referred to experts at the OHSU Knight Cancer Institute.
- Head and neck cancer symptoms may be similar to those of less serious conditions.
HEAD AND NECK CANCERS ARE COMMONLY DIAGNOSED IN PEOPLE AGE 50 YEARS AND MORE
THE INCIDENCE OF HEAD AND NECK CANCER IS 2 times higher in Male
Who gets head and neck cancer?
Head and neck cancers account for about 4 percent of all cancers in the United States. They affect about 65,000 people a year. About 75 percent of head and neck cancers are caused by tobacco use and heavy alcohol use. Research also shows a strong link between infection with some strains of HPV and certain throat cancers.
Risks factors that may play a role include
- Smoking and drinking: Doctors believe alcohol and tobacco act together to damage tissues in the head and neck. If you use tobacco and have two drinks a day, your risk of head and neck cancer is 20 times greater than if you do not. Tobacco use includes smokeless forms such as snuff, chewing tobacco, betel leaf and paan.
- HPV: Some types of human papillomavirus, a common virus spread by sexual contact, are linked to throat cancer.
- Age: Most people are older than 50 when diagnosed. Researchers have seen more cases in younger people, however, as HPV infections become more common.
- Gender: Head and neck cancers are three times more common in men, which researchers attribute to higher tobacco and alcohol use.
- Ancestry: People of Asian descent, especially with Chinese ancestry, may be at higher risk of cancer of the upper throat, behind the nose.
- Radiation exposure: Radiation to the head and neck from X-rays, CT scans or radiation therapy may increase risk.
- Workplace exposure: Being exposed to wood dust, asbestos, dry cleaning chemicals or other substances at work or routinely over a long time may raise your risk.
- Health history: A history of acid reflux (heartburn) or a related condition called Barrett’s esophagus may be a risk factor. Having diseases such as aplastic anemia or infection with the Epstein-Barr virus may raise risk.
- Family history: Most head and neck cancers are not hereditary. A family history of Fanconi anemia, Li-Fraumeni syndrome and other conditions, however, may increase your risk. OHSU is a center of excellence for Fanconi anemia and offers genetic counseling and testing for patients who have this or other inherited conditions.
Survival Rates
Survival rates vary by type and stage (whether and how much cancer has spread). Nearly 65 percent of patients with mouth and throat cancers survive at least five years after diagnosis, for example. Some with early throat cancers have rates up to 90 percent.
Other types are difficult to treat, however, and outcomes vary. Statistics are averages and can’t predict the results for individual patients.
Head and neck cancer types
Cancers of the head and neck are categorized by the part of the body where they start. These are the main types:
Mouth Cancer of the oral cavity is fairly common among head and neck cancers. It may affect:
- The lips
- The front two-thirds of the tongue
- The gums
- The lining inside the cheeks and lips
- The bottom of the mouth under the tongue
- The hard palate (the front portion of the roof of the mouth)
- The small area of the gum behind the wisdom teeth
These cancers may affect any of the three parts of the throat, also called the pharynx.
- Oropharyngeal cancer: Cancer of the middle part of the throat, or oropharynx, may include the soft palate (the back part of the roof of the mouth), the base of the tongue, and the tonsils. This is among the more common types.
- Hypopharyngeal cancer: Cancer of the lower part of the throat, or hypopharynx, starts beside and behind the voice box. This type is rare, with about 2,500 cases a year in the United States. It most often affects people ages 50 to 60.
- Nasopharyngeal cancer: Cancer of the upper part of the throat, or nasopharynx, originates behind the nose. This type has not been linked to tobacco and alcohol use.
Cancer of the voice box, or larynx, is called laryngeal cancer. It may affect the vocal cords or a small piece of tissue, called the epiglottis. The epiglottis moves to cover the larynx to block food from entering the air passages.
Nasal cancers are divided into two types because they may affect the space inside the nose or the spaces in the bones surrounding the nose.
- Nasal cavity cancer starts in the opening behind the nose and may run along the top of the roof of the mouth.
- Paranasal sinus cancer starts in the sinuses, hollow openings in the bones around or near the nose
Precancerous Growths
Your care team may identify precancerous growths or other abnormal cells.
- Tumors in the lymph nodes: Cancer does not begin in lymph nodes (tissues that serve as filters for the immune system) but may spread to them. When this occurs in the neck and it’s not clear where the tumor started, it is called metastatic squamous neck cancer with occult primary.
- Benign (noncancerous) growths: More than a dozen types of benign tumors may develop in the mouth, throat or neck. They can be in a variety of cells and from various causes. Most of the time, they are not life-threatening or likely to return. Surgery to remove them is the most common treatment.
- Leukoplakia or erythroplakia: Grey or white patches of abnormal cells are called leukoplakia. Raised red patches are called erythroplakia. These may be a precancerous condition called dysplasia or an early-stage cancer. A sample must be removed to check for cancer.
Head and neck cancer symptoms
Head and neck cancer can cause symptoms similar to those of less serious conditions. See your doctor if any of these lasts longer than usual:
- A mouth sore that does not heal and/or bleeds easily
- A hoarse or sore throat, or a change in your normal voice
- A lump or swelling in your neck
- Trouble swallowing, moving your jaw or chewing
- Frequent nosebleeds, a stuffy nose or sinus infections that do not improve with treatment
- Loose teeth or dentures that no longer fit
- Skin variations, such as a sore or mole that changes shape and color