Head and neck cancer begins with the abnormal growth of cells. These cancerous cells multiply out of control, eventually forming a tumor. As the tumor grows, it can form a lump, a sore, or an abnormal superficial patch of white or discolored tissue. Without treatment, the tumor can invade and destroy nearby bones and soft tissues. Eventually, it can spread (metastasize) to lymph nodes in the neck and to organs in other parts of the body. In many cases, head and neck cancers are triggered by carcinogens, substances that cause cancer. Common carcinogens include chemicals found in tobacco smoke, smokeless (chewing) tobacco and snuff. Chronic or heavy alcohol use also contributes to head and neck cancer. The disease is especially prevalent in those who both smoke and drink alcohol. In addition to the classifications listed below, head and neck cancers include those of the larynx (the voice box); the tongue; both the soft and hard palates; and tumors of the salivary glands, including the parotid gland.

Head and neck cancers are divided into according to where they are found:

• Upper aerodigestive tract � This includes the lips, mouth, throat and voice box (larynx). Of all head and neck cancers, those involving the upper aerodigestive tract are the most common. Almost all cancers in this part of the head are squamous cell carcinomas, which arise from a type of epithelial cell that makes up the structures of the head and neck area. Squamous carcinomas can also occur on the skin in the head and neck area, but a head and neck cancer that is of the squamous variety is not considered a skin cancer. These cancers are more common in people older than 45. Men are affected two to four times more often than women. More than 90% of cases are related to tobacco use. Alcohol increases the risk of cancers in this area of the body, especially when use is heavy and constant.



• Salivary glands � Salivary gland cancer is rare. There are several types of salivary gland cancer that vary in aggressiveness. Exposure to radiation increases the risk of this type of cancer, and smoking may play some role in certain types of salivary gland cancer. It has also been thought that people who have had chronic salivary gland stones and inflammation of the glands may be more prone to this disease.



• Nasopharynx � The nasopharynx is the upper portion of the back of the throat, where the throat meets the back of the nasal cavity. Unlike other head and neck cancers, this one is not associated with tobacco or alcohol use. This area is generally more sensitive to chemotherapy and radiation than other head and neck cancers. In the United States, nasopharyngeal cancer has not been associated with any particular cause. But in parts of northern Africa, Asia and the Arctic region, where this cancer is more common, it has been related to the following: infection with the Epstein-Barr virus (EBV), the cause of infectious mononucleosis; eating Cantonese salted fish; high exposure to dusts and smoke; and eating a lot of fermented foods.



• Sinuses and nasal cavity � Seventy-four percent to 79% of cancers found in the sinuses (behind the bones of the forehead and cheeks and inside the nose) are squamous cell carcinomas. Rarely, adenocarcinomas, melanomas and lymphomas also occur in this area. In many cases, these cancers grow fairly large before they are diagnosed. This is because the sinuses and nasal cavity have enough room for tumors to grow before they block the sinuses or nasal passages or cause other symptoms.

Symptoms of head and neck cancer depend on where the cancer is located.

• Lips and mouth � You may see or feel a lump, open sore or area of bleeding, or an abnormally colored white or red patch inside the mouth or on the lip. You may have a persistent sore throat, earache, discomfort while chewing or swallowing or a swollen jaw.



• Throat and larynx � Symptoms include hoarseness, discomfort or difficulty swallowing, pain in the neck, jaw or ear, a lump or swelling in the neck, or a feeling that something is stuck in the throat



• Salivary glands � The most common symptom is a slow-growing lump in the cheek, under the chin, on the tongue or on the roof of the mouth. Sometimes this lump is painful.



• Nasopharynx � Symptoms include painless, enlarged lymph nodes (swollen glands) in the neck, a persistent blocked or stuffy nose, frequent nosebleeds, hearing loss, frequent ear infections, sore throat or headache.



• Sinuses and nasal cavity � Symptoms include nose blockage; nosebleeds; numbness in the face; pain in the forehead, between the eyes or behind the cheeks; bulging of one eye.

Your doctor will ask about your symptoms and whether you smoke, chew tobacco, dip snuff or drink alcoholic beverages. Your doctor may ask about your diet, ethnicity, occupation and history of radiation exposure. Next, your doctor will examine you, paying special attention to your mouth, throat, nose, ears and the lymph nodes in your neck. If a lump or suspicious lymph node is found, your doctor will refer you to a specialist for a biopsy. In a biopsy, a small piece of tissue is removed and examined in a laboratory. Depending on your symptoms and the location of the lump or lymph node, the specialist might be an ear, nose and throat surgeon, an oral maxillofacial surgeon or a general surgeon.

Once cancer has been diagnosed, additional tests will be done to determine how far the cancer has spread.

The main way to evaluate head and neck tumors is a by a procedure called fiberoptic endoscopy. The doctor inserts a flexible fiberoptic tube into the throat to look at areas that might be cancerous. This procedure can be used to examine the upper airways, larynx, lungs and esophagus, as well as the nasal passages with examination of the sinuses.

Based upon the part of the head and neck to be evaluated, the tests used may vary:

• Lips and mouth � X-rays, computed tomography (CT), magnetic resonance imaging (MRI) of the head and chest



• Throat � Fiberoptic endoscopy to examine the throat and larynx, and possibly the esophagus and lungs; X-rays; CT or MRI scans of the head, neck and chest; angiography of the neck to look at the flow of blood vessels. These tests are important to evaluate whether the cancer has spread or if it has more than one origin.



• Salivary glands � CT and MRI scans of the head and neck



• Nasopharynx � Fiberoptic examination to examine the tumor in the nasopharynx; a neurological examination to check for cranial nerve damage in the head and neck; hearing tests; a thorough dental exam; X-rays, CT and MRI scans of the head and neck; blood tests



• Sinuses and nasal cavity � Fiberoptic endoscopy to examine the tumor within the nasal cavity or sinus, CT or MRI scans of the head



• Larynx � Fiberoptic endoscopy of the larynx to examine the tumor area and to determine whether the vocal cords are moving normally; X-rays, CT or MRI scans of the head and neck

Once it develops, cancer will continue to grow and spread until it is treated.

To reduce your risk of head and neck cancer, you can:

• Avoid smoking cigarettes, cigars or pipes. If you smoke, ask your doctor about proven ways to help you quit.
• Avoid chewing tobacco or dipping snuff.
• Avoid excessive alcohol use. Besides being a risk factor by itself, chronic or excessive alcohol use seems to multiply the risk of head and neck cancer in people who also use tobacco.
• Practice good oral hygiene.
• Visit your dentist regularly. A thorough dental checkup includes a routine examination of the inside of your mouth.

The type of treatment usually depends on how far advanced the tumor is (called the "stage" of the tumor). For most head and neck cancers, the stage is determined by the tumor's size and whether it has invaded nearby tissues, nearby lymph nodes or other areas of the body.

• Upper aerodigestive tumors � Tumors usually are treated with radiation alone or radiation and surgery. Chemotherapy may be added to improve the results of surgery and radiation. In general, the more advanced the cancer, the more treatments will be required.



• Salivary glands � Smaller, early stage tumors can be treated with surgery alone. Larger tumors that have spread usually require radiation after surgery. Tumors that cannot be removed surgically are treated with radiation or chemotherapy.



• Nasopharynx � High-dose radiation is the primary treatment, although chemotherapy and surgery can be used in people whose cancer does not respond well to radiation.



• Sinuses and nasal cavity � In most people, this cancer is advanced when it is discovered. The major threat is that the tumor will invade areas of the skull near the eye and brain. Surgery can remove as much of the tumor as possible. This is followed by radiation to the affected area. Sometimes, radiation treatment is started before surgery.



• Larynx � Smaller and more superficial cancers can be treated with radiation or with surgery that preserves the ability to speak. Adding chemotherapy to radiation may decrease the chances of having to remove the entire larynx. If the entire larynx is removed, treatments that can restore the voice include an external microphone device (electrolarynx), esophageal speech (in which air is expelled from the esophagus to make speech) or a procedure called a tracheoesophageal puncture (in which a valve is inserted to allow air to leave the trachea and travel to the esophagus to provide esophageal speech).

Make an appointment to see your doctor as soon as possible if you have any of the following problems, especially if you use or have ever used alcohol or tobacco:

• A persistent sore, lump, area of bleeding, white patch or discolored area on your lips or anywhere inside your mouth
• A persistent lump or swelling on your neck, jaw, cheek or tongue, or roof of your mouth
• A persistent sore throat
• Hoarseness or difficulty swallowing that lasts for more than two weeks
• Persistent nosebleeds or blocked nose
• Frequent ear infections

The outlook depends on the stage of the cancer in each region.

• Aerodigestive cancers � In general, the closer to the lips the cancer is, the better the prognosis. This may be because it is easier to detect early tumors in the lip and mouth region. Small tumors have a cure rate of 75% to 95%. Even many tumors that have spread to the lymph nodes are potentially curable, but the rate of cure decreases in larger tumors or in tumors that have spread.



• Lips and mouth � Early stages have a cure rate of 90% to 100%. More advanced stages have a cure rate of 65% to 90% if the cancer has not spread to lymph nodes in the neck. Cancers that have spread to the lymph nodes or other areas of the body tend to have a poorer prognosis.



• Salivary glands � Early stage cancer of the salivary gland often can be cured with surgery alone. The outlook is poorest for cancers under the tongue or in the minor salivary glands, cancers that have invaded the facial nerve and bulky cancers that have spread.



• Nasopharynx � Radiation cures 80% to 90% of people with small nasopharyngeal cancers that have not spread. Survival drops to 10% to 40% in later stages.



• Sinuses and nasal cavity � Because most tumors in this region are diagnosed at an advanced stage, the prognosis is often poor. Overall, the cure rate is 50% or less.



• Throat and larynx � If the cancer is small and has not spread to the lymph nodes, the cure rate is 75% to 95%.

National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322
Bethesda, MD 20892-2580
Phone: 301-435-3848
Toll-Free: 1-800-422-6237
TTY: 1-800-332-8615
Email: cancergovstaff@mail.nih.gov
http://www.nci.nih.gov/

American Cancer Society (ACS)
1599 Clifton Road, NE
Atlanta, GA 30329-4251
Toll-Free: 1-800-227-2345
http://www.cancer.org/

American Dental Association
211 East Chicago Ave.
Chicago, IL 60611-2678
Phone: 312-440-2500
http://www.ada.org/

American Academy of Otolaryngology � Head and Neck Surgery
One Prince St.
Alexandria, VA 22314-3357
Phone: 703-836-4444
Email: info@entnet.org
http://www.entnet.org/

American Academy of Oral and Maxillofacial Radiology
P.O. Box 1010
Evans GA 30809-1010
Phone: 706-721-2607
http://www.aaomr.org/