What are cancers of the head and neck?
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.
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.
Oral cavity: 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.
Pharynx: 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).
Larynx: 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.
Paranasal sinuses and nasal cavity: 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.
Salivary glands: The major salivary glands are on the floor of the mouth and near the jawbone. The salivary glands produce saliva.
Symptoms of Head and Neck Cancers
- A lump or a sore that does not heal
- A sore throat that does not go away
- Difficulty in swallowing
- Change or hoarseness in the voice
***These symptoms may also be caused by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms.
Symptoms that may affect specific areas of the head and neck include the following:
- A white or red patch on the gums, the tongue, or the lining of the mouth
- A swelling of the jaw that causes dentures to fit poorly or become uncomfortable
- Unusual bleeding or pain in the mouth.
- Trouble breathing or speaking
- Pain when swallowing
- Pain in the neck or the throat that does not go away
- Frequent headaches, pain, or ringing in the ears; or trouble hearing.
- Pain when swallowing
- Ear pain
Paranasal sinuses and nasal cavity:
- Sinuses that are blocked and do not clear
- Chronic sinus infections that do not respond to treatment with antibiotics
- Bleeding through the nose
- Frequent headaches
- Swelling or other trouble with the eyes
- Pain in the upper teeth
- Problems with dentures
- Swelling under the chin or around the jawbone
- Numbness or paralysis of the muscles in the face
- Pain in the face, the chin, or the neck that does not go away
When to see a doctor
Make an appointment with your doctor or dentist if you have any persistent signs and symptoms that bother you and last more than two weeks. Your doctor will likely investigate other more common causes for your signs and symptoms first, such as an infection.
Factors that can increase your risk of mouth cancer include:
- Tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others
- Heavy alcohol use
- Excessive sun exposure to your lips
- A sexually transmitted virus called human papillomavirus (HPV)
- Occupational exposure to harmful fumes or particulate matter
- Epstein-Barr virus infection
- Ancestry (Asian ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer)
Treatment for head and neck cancer depends on your cancer’s location and stage, as well as your overall health and personal preferences. You may have just one type of treatment, or you may undergo a combination of cancer treatments. Discuss your options with your doctor.
Targeted drug therapy
Targeted drugs treat mouth cancer by altering specific aspects of cancer cells that fuel their growth. Cetuximab (Erbitux) is one targeted therapy approved for treating head and neck cancers in certain situations. Cetuximab stops the action of a protein that’s found in many types of healthy cells but is more prevalent in certain types of cancer cells.
Other targeted drugs are being studied in clinical trials. Targeted drugs can be used in combination with chemotherapy or radiation therapy.
Chemotherapy is a treatment that uses chemicals to kill cancer cells. Chemotherapy drugs can be given alone, in combination with other chemotherapy drugs or in combination with other cancer treatments. Chemotherapy may increase the effectiveness of radiation therapy, so the two are often combined.
The side effects of chemotherapy depend on which drugs you receive. Common side effects include nausea, vomiting, and hair loss.
Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. Radiation therapy can be delivered from a machine outside of your body (external beam radiation) or from radioactive seeds and wires placed near your cancer (brachytherapy).
Radiation therapy may be the only treatment you receive if you have an early-stage mouth cancer. Radiation therapy can also be used after surgery. In other cases, radiation therapy may be combined with chemotherapy. This combination increases the effectiveness of radiation therapy, but it also increases the side effects you may experience. In cases of advanced mouth cancer, radiation therapy may help relieve signs and symptoms caused by cancer, such as pain.
The side effects of radiation therapy to your mouth may include dry mouth, tooth decay, mouth sores, bleeding gums, jaw stiffness, fatigue and red, burn-like skin reactions.
Surgery for head and neck cancer may include:
Surgery to remove the tumor: Your surgeon may cut away the tumor and a margin of healthy tissue that surrounds it. Smaller cancers may be removed through minor surgery. Larger tumors may require more extensive procedures. For instance, removing a larger tumor may involve removing a section of your jawbone or a portion of your tongue.
Surgery to remove cancer that has spread to the neck: If cancer cells have spread to the lymph nodes in your neck, your surgeon may recommend a procedure to remove cancerous lymph nodes and related tissue in the neck (neck dissection).
Surgery to reconstruct the mouth: After an operation to remove your cancer, your surgeon may recommend reconstructive surgery to restore the appearance of your face or to help you regain the ability to talk and eat. Your surgeon may transplant grafts of skin, muscle or bone from other parts of your body to reconstruct your face. Dental implants may replace your natural teeth.
Surgery carries a risk of bleeding and infection: Surgery for mouth cancer often affects your appearance, as well as your ability to speak, eat and swallow. Your doctor may refer you to specialists who can help you cope with these changes.
No complementary or alternative medicine treatments can cure head and neck cancer. But complementary and alternative medicine treatments may help you cope with mouth cancer and the side effects of cancer treatment, such as fatigue.
Many people undergoing radiation therapy for cancer experience fatigue. Your doctor can treat underlying causes of fatigue, but the feeling of being utterly worn out may persist despite treatments. Complementary therapies can help you cope with fatigue.
Ask your doctor about trying:
Exercise: Try gentle exercise for 30 minutes on most days of the week. Moderate exercise, such as brisk walking or therapeutic yoga, during and after cancer treatment reduces fatigue. Talk to your doctor before you begin exercising, to make sure it’s safe for you.
Massage therapy: During a massage, a massage therapist uses his or her hands to apply pressure to your skin and muscles. Some massage therapists are specially trained to work with people who have cancer. Ask your doctor for names of massage therapists in your community.
Relaxation: Activities that help you feel relaxed may help you cope. Try listening to music or writing in a journal.