Risk Factors

Tobacco (including smokeless tobacco) and alcohol use are the greatest risk factors for head and neck cancers, particularly those of the oral cavity, pharynx, and larynx. Tobacco use is linked to 85% of head and neck cancers. People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone.

Several other factors influence the risk of developing different types of head and neck cancers:

• Oral cavity: Sun exposure (especially on the lips); possibly human papillomavirus (HPV) infection
• Salivary glands: Radiation to the head and neck
• Paranasal sinuses and nasal cavity: Certain industrial exposures such as wood or nickel dust inhalation
• Pharynx: Epstein-Barr virus infection; HPV infection; Plummer-Vinson syndrome; occupational exposure to wood dust; poor oral hygiene; use of mouthwash with a high alcohol content; consumption of certain preservatives or salted foods; Chinese ancestry (a risk factor specifically for cancer of the nasopharynx)
• Larynx: Exposure to airborne particles of asbestos, especially in the workplace

Thyroid cancer is discussed in another section.

Symptoms

Symptoms of several head and neck cancers include a lump or sore that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice. Other symptoms may include the following:

• Oral cavity: A white or red patch on the gums, tongue, or lining of the mouth; swelling of the jaw that causes dentures to fit poorly or become uncomfortable; unusual bleeding or pain in the mouth
• Nasal cavity and sinuses: Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; nosebleeds; frequent headaches; swelling or other trouble with the eyes; pain in the upper teeth; problems with dentures
• Salivary glands: Swelling under the chin or around the jawbone; numbness or paralysis of the muscles in the face; pain in the face, chin, or neck that does not go away
• Pharynx: Trouble breathing or speaking; frequent headaches; pain or ringing in the ears; trouble hearing; ear pain
• Larynx: Pain when swallowing; ear pain

These symptoms can be caused by conditions other than cancer. It is important to check with a doctor or dentist about any of these symptoms.

Screening and Diagnosis

To find the cause of symptoms, a doctor evaluates the patient's medical history, performs a physical examination, and orders diagnostic tests. The exams and tests may vary depending on the symptoms. Examining a tissue sample under a microscope (called a biopsy) is always necessary to confirm a diagnosis of cancer.

Some exams and tests that may be useful are described below:

• Physical exam: The doctor closely looks at the oral and nasal cavities, neck, throat, and tongue using a small mirror and/or lights. The doctor may also feel for lumps on the neck, lips, gums, and cheeks.
• Endoscopy: The use of a thin, lighted tube called an endoscope to examine areas inside the body. The type of endoscope the doctor uses depends on the area being examined. For example, a laryngoscope is inserted through the mouth to view the larynx; an esophagoscope is inserted through the mouth to examine the esophagus; and a nasopharyngoscope is inserted through the nose so the doctor can see the nasal cavity and nasopharynx.
• Lab tests: Tests that examine samples of blood, urine, or other substances from the body.
• X-rays: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan: Doctors often use CT scans to take pictures of tissue inside the body. An x-ray machine linked to a computer takes several pictures. The pictures may show a tumor, abnormal fluid, swollen lymph nodes, or if the cancer has spread to other parts of the body.
• Magnetic resonance imaging (MRI): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the head and neck.
• PET scan: Doctors use a PET scan to find cancer that has spread. The patient receives a small amount of radioactive sugar by injection. A machine makes computerized pictures of the sugar being used by cells in the body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures.
• Biopsy: The doctor removes tissue to look for cancer cells. A biopsy is the only way to know for sure if cancer is present.

Staging

If the biopsy shows that cancer is present, the doctor needs to know the stage (extent) of the disease to plan the best treatment. The stage is based on whether the cancer has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

Staging may involve surgery, x-rays and other imaging procedures, and lab tests. Knowing the stage of the disease helps the health care team plan treatment.

Staging is usually described in a number between one and four. The stage is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Because each type of head and neck cancer is different, patients should discuss their specific stage and treatments with their health care teams.

Treatment

At Huntsman Cancer Institute, head and neck cancers are treated by a team of specialists, including oral surgeons, otolaryngologists (doctors who specialize in diseases of the ear, nose, and throat), medical oncologists, radiation oncologists, nurses, dietitians, social workers, speech therapists, and other professionals.

There are several options for head and neck cancer treatment:

• Surgery
• Radiation therapy
• Chemotherapy
• Biological therapy
• Clinical trials

A patient may receive more than one type of treatment. The treatment that's right for each patient depends on the stage of the cancer and the patient's overall health before diagnosis.

Surgery

This treatment removes the cancer in an operation. It is a common treatment for all types of head and neck cancers. The following factsheets describe common head and neck surgeries:

• Glossectomy
• Laryngectomy
• Maxillectomy
• Neck Dissection
• Parotidectomy
• Pharyngectomy
• Tracheostomy

Radiation therapy

This treatment uses high-energy x-rays to kill cancer cells. The way the radiation therapy is given depends on the type and stage of the cancer being treated. There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Also see our factsheet Radiation to the Head and Neck for information on managing side effects related to radiation treatment.

Chemotherapy

This treatment uses drugs to destroy or control cancer throughout the body. Learn more about this treatment in our introduction to chemotherapy video.

Biological therapy

This treatment helps the body fight cancer, manage side effects, and help prevent cancer. Examples of this include monoclonal antibodies, growth factors, and vaccines.

Clinical trials

These are studies that discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctor about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.