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What is Head and Neck Cancer?

Head and Neck can­cers are those that form in the throat, nose, sinus­es, mouth, lips, sali­vary glands, and lar­ynx (your voice box). When can­cer forms in the head or neck, it is one of three types. These include squa­mous cell car­ci­no­ma, thy­roid can­cer and lym­phoma.

The major­i­ty of head and neck can­cers are caused by a com­bi­na­tion of expo­sure to risk fac­tors or virus­es that cause healthy tis­sues to abnor­mal­ly func­tion and form lesions or tumors. Men are three times more like­ly than women to devel­op a case of head and neck can­cer and most cas­es become appar­ent after age 40 in both men and women.

Can­cers of the head and neck may devel­op with­out notice. How­ev­er, once a tumor pro­gress­es and begins to dis­turb near­by organs, the symp­toms that become appar­ent can be mild or mim­ic con­di­tions that are thought to be tem­po­rary, such as sore throat, sinus and aller­gy issues. If you notice some­thing abnor­mal or are expe­ri­enc­ing symp­toms that last sev­er­al weeks, you will need to have an exam with an oto­laryn­gol­o­gist to deter­mine your diag­no­sis. An oto­laryn­gol­o­gist is a spe­cial­ly trained sur­geon who treats dis­or­ders of the ear, nose and throat (ENT) in addi­tion to head and neck struc­tures.

Reg­u­lar den­tal check-ups and year­ly exams with a pri­ma­ry care physi­cian (includ­ing blood work) are your best defense for catch­ing silent changes in your health. Take heart in know­ing that when head and neck can­cers are found ear­ly, they can be cured with­out many unpleas­ant side effects. Addi­tion­al­ly, basic lifestyle changes can be effec­tive in pre­vent­ing most of these dis­eases.

1. Squa­mous Cell Car­ci­no­ma
Squa­mous cell car­ci­no­ma com­pris­es approx­i­mate­ly 90 per­cent of oral can­cers. It is named squa­mous cell car­ci­no­ma because lesions form in the flat (squa­mous) cells which line the mucos­al sur­face lay­ers in the ton­sils, throat, lips or base of the tongue.

Squa­mous cell car­ci­no­ma may appear as an ulcer in the mouth that will not heal. You may also expe­ri­ence unre­solv­able sinus con­ges­tion, ear­ache, unusu­al pain or bleed­ing in the mouth, sore throat, dif­fi­cul­ty swal­low­ing or breath­ing or changes in your voice. Pay atten­tion to the length of time you have these types of symp­toms so you can report the infor­ma­tion to your doc­tor.

Lifestyle habits typ­i­cal­ly con­tribute to the for­ma­tion of squa­mous cell car­ci­no­ma. Exces­sive tobac­co and alco­hol use in com­bi­na­tion can con­tribute to these can­cer types, as well as unpro­tect­ed UV ray expo­sure to the lips. The most recent and rapid­ly increas­ing risk fac­tor for devel­op­ing squa­mous cell car­ci­no­ma is infec­tion from the human papil­lo­ma virus (HPV).

HPV is a sex­u­al­ly trans­mit­ted dis­ease that can be passed by both men and woman pri­mar­i­ly through oral sex. You can proac­tive­ly fight this dis­ease by get­ting an HPV vac­cine which pre­vents the virus from infect­ing you. HPV vac­cine is only effec­tive in peo­ple who do not yet have the dis­ease. His­tor­i­cal­ly, the inoc­u­la­tion was rec­om­mend­ed for females between the ages of 9 – 26. Physi­cians are now encour­ag­ing par­ents to have males in the age range of 9 – 26 vac­ci­nat­ed in order to pro­tect against infec­tion. Now that oral can­cers have been asso­ci­at­ed with HPV infec­tion, it is more impor­tant than ever to dis­cuss chang­ing rec­om­men­da­tions for child­hood vac­ci­na­tions with your child’s pediatrician.

Because it is symp­tom­less, oral HPV is not like­ly to be detect­ed until abnor­mal tis­sue results in notice­able symp­toms in the mouth or throat. There­fore, pro­tect­ing your­self and your fam­i­ly from ever con­tract­ing this dis­ease is extreme­ly impor­tant. Cur­rent­ly, there is no screen­ing for HPV, how­ev­er, these infec­tions are 100 per­cent pre­ventable if patients are vac­ci­nat­ed before becom­ing sex­u­al­ly active. Con­dom use can low­er the risk of infec­tion but this method of pro­tec­tion is not known to be 100 per­cent effec­tive.

To deter­mine the stage and pro­gres­sion of squa­mous cell car­ci­no­ma, a CT scan may be ordered and an ini­tial biop­sy of the sus­pi­cious area using fine nee­dle aspi­ra­tion will be rec­om­mend­ed. Fine nee­dle aspi­ra­tion is pre­ferred instead of sur­gi­cal removal in order to avoid dis­lodg­ing abnor­mal cells as they could spread to oth­er areas of the body. Squa­mous cell car­ci­no­mas are cur­able and may be treat­ed with a com­bi­na­tion of surgery, radi­a­tion and chemora­di­a­tion if need­ed. Func­tion-spar­ing sur­gi­cal tech­niques are now avail­able that will lead to faster recov­ery with less dam­age to near­by tissues.

2. Thy­roid Cancer

Thy­roid can­cer begins in the thy­roid gland which is locat­ed in the front of your neck. It is made of two lobes that are sym­met­ri­cal and shaped like a but­ter­fly, the lobes rest on top of your tra­chea, or wind pipe. The thy­roid gland is respon­si­ble for reg­u­lat­ing impor­tant bod­i­ly func­tions such as heart rate and rate of metab­o­lism. Sev­er­al dif­fer­ent types of thy­roid can­cer can form depend­ing on which cells with­in the gland begin to grow abnor­mal­ly.
Thy­roid can­cer can devel­op with­out any symp­toms. Typ­i­cal­ly, patients with thy­roid can­cer go to their doc­tor due to oth­er issues that occur when a tumor (called a thy­roid nod­ule) is plac­ing pres­sure on anoth­er struc­ture in their neck. Those symp­toms would include; swollen lymph node in the front of the neck, recur­rent hoarse­ness, dif­fi­cul­ty swal­low­ing or breath­ing, sore throat or neck pain. If your symp­toms linger for more than sev­er­al weeks, the best course of action is to see your doc­tor, an oto­laryn­gol­o­gist or an endocrine sur­geon for an eval­u­a­tion. Often, the tumor (nod­ule) is benign but will still need to be treat­ed to alle­vi­ate symp­toms.

Risk fac­tors for the dif­fer­ent thy­roid can­cer types include high lev­els of radi­a­tion expo­sure (result­ing from med­ical treat­ment or con­tact with pow­er plant acci­dents or nuclear weapons), hered­i­tary con­di­tions and fam­i­ly his­to­ry of genet­ic con­di­tions. Women are more like­ly than men to devel­op thy­roid can­cer, women are most com­mon­ly diag­nosed after age 40, but men who devel­op the dis­ease usu­al­ly reach age 60 before hav­ing sus­pi­cious symp­toms.

In addi­tion to a phys­i­cal exam to eval­u­ate the size and firm­ness of your thy­roid or enlarged lymph nodes in your neck, your physi­cian may need to order blood tests, a radioio­dine scan, ultra­sound and pos­si­bly a biop­sy to remove cells and flu­id from the enlarged area for micro­scop­ic exam­i­na­tion. If you require a biop­sy, you can have this pro­ce­dure in your physi­cian’s office and they will use numb­ing med­ica­tion (anes­the­sia) and fine nee­dle aspi­ra­tion to obtain the nec­es­sary cells for test­ing. Most patients do not need a gen­er­al anes­thet­ic dur­ing this pro­ce­dure.

Although treat­ment for thy­roid can­cer may include par­tial or full removal of the gland, the good news is that cure rates are more than 90 per­cent for this dis­ease.

3. Lym­phoma
Lym­phoma is the least com­mon of the three head and neck can­cers. Lym­phoma is a gen­er­al term that encom­pass­es can­cers that involve the cells (lym­pho­cytes) of the immune sys­tem. These cells are orga­nized in groups called nodes. When lym­pho­cytes begin to grow and mul­ti­ply in an uncon­trolled state, a mass may become appar­ent in the neck or face.

Lym­phoma has many sub­types, most are clas­si­fied as Hodgk­in’s or Non-Hodgk­in’s lym­phoma. A fine nee­dle aspi­ra­tion is rec­om­mend­ed as the first step to rule out anoth­er type of head and neck malig­nan­cy. An exci­sion of the lesion is fre­quent­ly need­ed for your physi­cian to find your diag­no­sis. Symp­toms that may lead your doc­tor to order a biop­sy include changes in voice, dif­fi­cul­ty swal­low­ing or an abnormal/​discolored area in your mouth (your den­tist would iden­ti­fy this upon reg­u­lar clean­ings and X‑rays). If not caught ear­ly with pre­ven­tive care, oth­er symp­toms you may notice could include any of the fol­low­ing: enlarged lymph nodes, loss of appetite, rapid weight loss, fatigue, recur­ring fever or night sweats.

Patients at risk for devel­op­ing lym­phoma usu­al­ly have a com­bi­na­tion of fac­tors that, in com­bi­na­tion, have caused cells in the lymph nodes to become repro­grammed so that they no longer progress through the break down process. This results in a mass, or tumor. Some risk fac­tors include: treat­ment for HIV or hepati­tis B or C, pro­longed expo­sure to tox­ic chem­i­cals and inher­it­ed immun­od­e­fi­cien­cy dis­eases.

The first step in treat­ing lym­phoma is for your oto­laryn­gol­o­gist to deter­mine if the can­cer is grow­ing on the out­side of the lymph node or if it has pen­e­trat­ed the cap­sule of the node and spread to oth­er areas of the body. Your oto­laryn­gol­o­gist will per­form a biop­sy, or removal of some or all of the lymph node that is in ques­tion. Tests will be run to find out stage of the tumor and the type of can­cer that has formed. At that point, your physi­cian will rec­om­mend the best treat­ment options for your indi­vid­ual case.

Head and neck can­cers are high­ly treat­able when caught ear­ly. It is impor­tant to keep reg­u­lar appoint­ments for check-ups with your pri­ma­ry care physi­cian and den­tist so that your health is mon­i­tored and abnor­mal­i­ties are iden­ti­fied as soon as possible.

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