The head and neck can be the tumor site for a variety of different cancers. According to the American Society of Clinical Oncology (ASCO) estimates, cases of aerodigestive tract head and neck cancers comprise 3% of all cancer cases in the U.S. Around 63,000 new cases of head and neck cancers will be diagnosed this year, and ASCO projects about 13,000 deaths will occur this year from this group of diseases.

The 5-year survival rate for head and neck cancers varies, depending upon site, stage, tissue type and underlying health of the patient. Patient awareness can lead to early diagnosis, treatment and better outcomes.

Henry N. Ho, M.D., F.A.C.S., specializes in treating head and neck cancers at The Ear, Nose, Throat and Plastic Surgery Associates.

Head and Neck Cancer Sites

Head and neck cancers occurring in the aerodigestive tract usually arise from the mucosal surface and are called squamous cell cancers. Other cancers can occur in the salivary glands, sinuses, thyroid gland or skin. Common locations include:

• Oral cavity. Cancer of the oral cavity includes the lips, front two-thirds of the tongue, gums, hard palate (bony roof of the mouth), floor of the mouth and cheeks.
• Pharynx. The pharynx is the throat that starts behind the nose and extends to the level just below the larynx before communicating with the esophagus. It has three parts – the nasopharynx, oropharynx and hypopharynx.
• Larynx. Cancer of the larynx involves any part of the complex voice box. The vocal cords are commonly involved with cancers of the larynx.
• Paranasal sinuses and nasal cavity. Paranasal sinuses are the hollow spaces in the skull that communicate with the nasal cavity. These areas can harbor cancers.
• Salivary glands. Cancer of the salivary glands can occur in the large glands in the cheeks or under the jaw or almost anywhere there is mucous membrane.

What Causes Head and Neck Cancer?

Tobacco use is the top risk factor for aerodigestive tract head and neck cancers. Alcohol use adds to the risk associated with tobacco use. According to the National Cancer Institute, at least 75% of all aerodigestive tract head and neck cancer cases are caused by use of tobacco and alcohol, with the exception of cancer of the salivary glands, which is not associated with the use of either substance.

Other risk factors for the different types of head and neck cancer include:

• HPV. The human papillomavirus 16 is a rapidly increasing cause of oropharyngeal cancers. These cancers typically involve the tonsils.
• Use of paan (betel quid) in the mouth. This primarily applies to immigrants from Southeast Asia who use paan in the mouth, which is associated with an increased risk for oral cancer.
• Poor oral hygiene. Although it is not a strong association, bad oral health and missing teeth may increase the risk for oral cancer.
• Occupational exposure. Certain jobs in the metal, construction, ceramic, textile, logging or food industries may increase the risk for larynx cancer, while exposure to wood dust, in particular, has been associated with an increased risk for nasopharyngeal cancer.
• Ancestry. South Asian ancestry in particular is associated with an increased risk for nasopharyngeal cancer, possibly diet related.
• Radiation. Exposure poses a risk to develop certain types of head and neck cancer, especially thyroid cancer.

Signs and Symptoms of Head and Neck Cancer

Many people with head and neck cancers experience certain signs and symptoms, although not every patient experiences noticeable changes. The most common symptom is a swelling or sore in the mouth that doesn’t heal.

Other signs and symptoms of head and neck cancer may include:

• Red or white patches in the mouth
• An unexplained lump in the head or neck area (usually not painful)
• An unrelenting sore throat, hoarseness or a change in the voice
• Difficulty breathing, nasal obstruction or persistent congestion
• Frequent nosebleeds or unusual nasal discharge
• Pain or trouble swallowing
• Ear or jaw pain
• Saliva or phlegm with blood
• Fatigue

Patients experiencing any of these symptoms should be evaluated by an otolaryngologist, or ear, nose and throat specialist, to rule out the possibility of head and neck cancer.

How Head and Neck Cancer is Diagnosed

If a patient is presenting with signs or symptoms of head and neck cancer, an otolaryngologist will perform diagnostic tests to determine the type of cancer, the extent or stage of the cancer, and then coordinate the treatment plan which may involve other cancer specialists. A biopsy of the cancer establishes the diagnosis. Other tests help in clarifying the extent of disease.

• A thorough history and physical exam.
• HPV testing is done on the biopsy specimen or surgical specimen of cancers of the oropharynx or neck.
• Endoscopy. Flexible fiberoptic instrument can view much of the internal anatomy of the head and neck in the outpatient, office setting.
• Ultrasound. An ultrasound image is produced without radiation primarily to evaluate thyroid nodules or neck lymph nodes.

PET/CT scans, CT scans, and MRI scans are also commonly recommended during diagnosis and treatment.

Stages of Head and Neck Cancer

The American Joint Committee on Cancer developed the “TNM” cancer staging system to define the three primary factors to consider when describing the extent of the cancer:

• Tumor. “T” refers usually to the size and relationship to neighboring structures.
• Node. “N” describes the lymph node involvement related to the primary tumor.
• Metastasis. “M” refers to whether or not the cancer has spread beyond the head and neck to involve distant parts of the body.

The combination of these 3 characteristics goes into determining the Stage for each cancer.

Treatment of Head and Neck Cancer

If found early, head and neck cancers are usually treatable. Treatment for head and neck cancer will vary depending on:

• Cancer staging
• Age and overall health
• Location of the tumor
• Type of cancer
• Possible side effects (toxicity and morbidity) of treatment

Treating the cancer while preserving function and cosmesis is the primary goal of treatment.

The goal of surgical intervention is to remove all the cancerous cells. The following are some common terms relating to surgery for head and neck cancer:

• Laser surgery employs the use of a surgical laser as a precision cutting tool. It is associated with less swelling and bleeding compared with scalpel or cautery.
• Excision means to excise or remove.
• Lymph node dissection or neck dissection is the operation to remove lymph nodes which may be involved when the cancer spreads beyond the primary tumor site.
• Reconstructive (plastic) surgery is performed to recreate or repair the removed part to enhance function and/or cosmesis.

Patients will give informed consent, prior to any procedure, after reviewing all the risks and benefits in detail with their head and neck surgeon.

Radiation, chemotherapy and immunotherapies are also commonly part of the treatment plan ideally formulated by a multidisciplinary team of physicians in a regularly held meeting called the tumor board.