Head and Neck Cancer

Head and neck cancers are a broad category of cancers that occur in the head and neck region.

Head and neck cancer treatment depends on the type, location and size of your cancer.

Treatment for head and neck cancers often involves surgery, radiation therapy and chemotherapy. Treatments may be combined.

After treatment, recovery from head and neck cancers may involve working with rehabilitation specialists and other experts to cope with side effects, such as hearing loss, difficulty eating, dental problems, thyroid issues, difficulty breathing or difficulty speaking.

Types

• Esthesioneuroblastoma
• Floor of the mouth cancer
• Lip cancer
• Mouth cancer
• Nasal and paranasal tumors
• Nasopharyngeal carcinoma
• Pituitary tumors
• Salivary gland tumors
• Skin cancer
• Soft palate cancer
• Throat cancer
• Thyroid cancer
• Tongue cancer
• Tonsil cancer

Not everyone who is diagnosed with head and neck cancer has a known risk factor. Sometimes there is no clear reason why the disease develops.

Risk Factor.

Tobacco

Tobacco use includes both smoking and smokeless tobacco (snuff and chewing tobacco). People who are exposed to secondhand smoke are also at a greater risk of head and neck cancer.

If you smoke or chew tobacco, you can reduce your risk of head and neck cancer — and the risk to those around you — by stopping now. If you’ve been diagnosed with throat cancer or are in treatment, it’s not too late to quit.

Alcohol

Drinking alcohol is major risk factor for head and neck cancer.

Tobacco and Alcohol Together

The combination of tobacco and alcohol use increases the risk of head and neck cancer even more than either of the two alone. Studies have shown that people who use tobacco and alcohol together have a substantially greater risk of mouth cancer than people who only smoke or who only drink. According to the National Institutes of Health, nicotine and alcohol together account for around 80 percent of mouth cancer in men and around 65 percent of mouth cancer in women.

HPV 16 and HPV 18

Human papillomavirus (HPV) is most commonly associated with cervical cancer. There is, however, a strong link between HPV infection and head and neck cancer. This is particularly strong in relation to cancer that begins in the oropharynx (the middle part of the throat). In fact, HPV-positive oropharyngeal cancer is the fastest-growing type of head and neck cancer in the United States.

Your risk of developing HPV-positive oropharyngeal cancer depends in part on the strain of HPV to which you were exposed. For instance, some strains cause warts on the skin, mouth, or genitals but rarely, if ever, cause cancer. Other strains have a higher risk. These have a greater association with cancer. The strains most commonly linked to head and neck cancer are HPV 16 and, less often, HPV 18.

Thankfully, for most people, including those with high-risk HPV, the body will get rid of the infection on its own. Unfortunately, there is no way to predict who among those with HPV 16 or 18 will go on to develop cancer.

Betel Quid and Gutka

People who chew betel quid or gutka, which are more common in parts of Asia, have an increased risk of head and neck cancer.

Radiation Exposure

A history of radiation in the head and neck area increases the risk of salivary gland cancer and thyroid cancer.

Age

Some cancers, like those that begin in the mouth, can take years to develop. For example, most people diagnosed with mouth cancer are over 40. The average age of diagnosis is 60.

People diagnosed with HPV-positive oropharyngeal cancer, on the other hand, tend to be younger.

Ultraviolet Light

Lip cancer and skin cancer are more common among people who spend time in the sun. Tanning bed use can also increase the risk of lip cancer.

Other Head and Neck Cancer Risk Factors

Other factors that may put you at a greater risk of head and neck cancer include:

• a diet low in fruits and vegetables
• a diet high in salt-cured fish and meat
• a diagnosis of Plummer-Vinson syndrome
• exposure to the Epstein-Barr virus
• Asian ancestry
• drinking yerba mate, a caffeinated drink from South America
• poor oral hygiene
• workplace exposure to inhalants such as asbestos, wood dust, nickel alloy dust, and silica dust
• gastroesophageal reflux disease (GERD)
• a weakened immune system
• graft versus host disease, a condition that sometimes occurs after a stem cell transplant
• lichen planus, a disease that often affects the skin
• certain genetic syndromes, such as Fanconi anemia and dyskeratosis congenital

Ways to Prevent Head and Neck Cancer

Here are the top ways to reduce your head and neck cancer risk:

1. If you smoke or use other tobacco products, reach out to a tobacco cessation program, like the one offered at MSK, to get help quitting.
2. If you drink alcohol, do so in moderation.
3. Protect yourself against HPV infection by practicing safe sex and getting the HPV vaccine.
4. Do not use tanning beds and avoid extended periods of time in the sun.
5. Wear a protective face mask if you are exposed to toxic fumes and dust. Companies can install air-filtration systems to minimize employees’ exposure to harmful fumes and dust.

It’s also important to schedule regular checkups with your dentist. This is particularly important if you use tobacco or drink heavily. Many oral cancers are found during routine dental appointments.

Symptoms.

• Swelling or a sore that does not heal; this is the most common symptom.
• Red or white patch in the mouth.
• Lump, bump, or mass in the head or neck area, with or without pain.
• Persistent sore throat.
• Foul mouth odor not explained by hygiene.
• Hoarseness or change in voice.

Diagnosis.

Head and Neck Cancer Screening

Cancer screening refers to the exams recommended by doctors to detect cancer before symptoms develop. The purpose is to find cancer at its earliest, most treatable stages.

At present, no screening method has been proven to improve survival for people with head and neck cancer. However, Memorial Sloan Kettering’s doctors advise a yearly physical exam of the head and neck by your primary care doctor. MSK experts also recommend a yearly routine dental evaluation. This should include an examination of the neck and inspection of the oropharynx and the mouth. To learn more, see our Screening Guidelines for head and neck cancer.

Physical Exam for Head and Neck Cancer

Your doctor will thoroughly examine the head and neck area, feeling for abnormalities, looking inside the mouth and throat, and using mirrors and lights to examine hard-to-see areas. An experienced doctor may be able to detect problems that a less-experienced one might not observe.

Endoscopy

In some cases, your doctor may use an endoscope (a thin lighted tube with a camera at its tip). This tool is helpful in examining areas of the head and neck that are more difficult to reach. The tube may be inserted through the nose or mouth. A topical anesthetic (a medication applied directly to the nose and throat) can make the examination more comfortable for you.

The exact name of the endoscopy procedure depends on where the tumor is located. For example, you may need a nasopharyngoscopy, pharyngoscopy, or laryngoscopy. Occasionally, a doctor will perform a more thorough type of endoscopic examination called a panendoscopy. This procedure requires general anesthesia.

Biopsy

Your doctor may be able to make a diagnosis based on a needle aspiration of the tumor. However, many people need to have a surgical biopsy. During a biopsy, a surgeon removes a small amount of abnormal tissue from the area where the cancer is suspected. A pathologist then examines the sample under a microscope and works with the other members of the care team to make a diagnosis.

At MSK, we have a team of pathologists whose sole focus is diagnosing cancer of the head and neck. This specialization allows us to make the most-precise diagnosis possible. A more-precise diagnosis can improve the effectiveness of your treatment or spare you from treatment that won’t work against the disease.

Diagnostic Imaging for Head and Neck Cancer

As part of making a diagnosis, a radiologist takes special X-rays of your throat. These may include CT scans, PET scans, MRIs, or a Panorex. (A Panorex is an X-ray that shows the full upper and lower jaw, plus the sinuses.)

Additional imaging tests may include a barium swallow (which helps show abnormalities in the esophagus), dental X-rays, chest X-rays, and radionuclide bone scanning (a sensitive method of measuring bone activity).

These imaging tests provide more details about the tissue. If cancer is found, the scans can show how deep the cancer is and if it has spread.

At MSK, our radiologists use the most-advanced imaging technologies to safely detect and monitor cancer. Our extensive knowledge of head and neck cancer allows us to choose the imaging approach that’s best for you and to define the precise extent of the tumor.

HPV Testing for Throat Cancer

At Memorial Sloan Kettering, human papillomavirus (HPV) testing is routine for many people with throat cancer. We use a variety of different testing options to help us classify a tumor.

People with an HPV-positive throat cancer have a better prognosis than those with other forms of the disease. We may be able to offer you a less-intensive treatment plan that reduces your side effects without affecting your chances for a cure.

Thyroid Nodule Assessment for Thyroid Cancer

Our doctors are experts at evaluating thyroid nodules to determine whether you have thyroid cancer. If so, they can determine the cancer’s risk level. We will offer treatment options to you based on whether your disease is low-risk or high-risk.

We provide thyroid nodule assessment at multiple locations. For people in New Jersey we offer a specialized thyroid nodule assessment program at our Basking Ridge location.

Genomic Testing for Advanced Head and Neck Cancer

Genomic testing is also called tumor sequencing or molecular profiling. It involves looking at the cells taken from a tumor to see if there are any genetic mutations (changes in the genes) that could be linked to the type of cancer you have.

For people with advanced head and neck cancer, our experts use a testing approach called MSK-IMPACT^™. This test, developed by MSK experts, screens for mutations in more than 450 genes at once.

Based on which mutations we find, we may be able to help you avoid treatments that won’t work for you. In some cases, we may be able to recommend a drug that has been approved for the specific changes in the tumor you have. Or you may be able to join a clinical trial testing a new approach, such as a targeted therapy or immunotherapy.

Genetic information about the tumor can help us predict the chances that the cancer will return after treatment.

Almost all of these genetic changes are found only in cancer cells, not in normal cells, which means they cannot be passed on to your children.

Head and Neck Cancer Staging

These are the basic stages of head and neck cancer:

Stage 0 Head and Neck Cancer

Also called carcinoma in situ, this is the very beginning of the scale. It describes abnormal cells in the lining of the affected area that have the potential to become cancer.

Stage I Head and Neck Cancer

Stage I describes a very early stage of cancer. The tumor is not more than two centimeters. The cancer has not reached the lymph nodes.

Stage II Head and Neck Cancer

Stage II describes a tumor that is larger than two centimeters but not more than four centimeters. Stage II cancer has not reached the lymph nodes.

Stage III Head and Neck Cancer

Stage III head and neck cancer describes cancer that either is larger than four centimeters or has spread to a lymph node on the same side of the neck as the tumor and the lymph node is smaller than three centimeters.

Stage IV Head and Neck Cancer

Stage IV is the most advanced stage of head and neck cancer. The tumor may be any size, but it has spread to:

• nearby tissue or other areas of the head and neck
• one large lymph node (more than three centimeters in size) and on the same side of the neck as the tumor, multiple lymph nodes of any size on the same side of the neck as the tumor, or one lymph node of any size on the side of the neck opposite the tumor
• distant parts of the body beyond the head and neck, such as the lungs

Head and neck cancer may be stage IV when it is first diagnosed. Stage IV head and neck cancer can also be recurrent head and neck cancer. Recurrent means the cancer has come back after treatment. The cancer may come back in the part of the body where it originally developed (regional recurrence), in the lymph nodes (regional relapse), or in another part of the body (distant recurrence).

Stage III and stage IV head and neck cancers are more likely to recur than earlier-stage cancers.

Staging for HPV-Positive Head and Neck Cancer

Head and neck experts have developed a separate staging system for HPV-positive cancer. This approach reflects the fact that HPV-positive tumors have a better prognosis than HPV-negative ones.

Treatment.

There are several ways to treat head and neck cancer, including:

• head and neck surgery to remove the tumor
• radiation to the head and neck, using high-energy rays such as X-rays to destroy cancer cells
• chemotherapy with drugs designed to kill head and neck cancer cells
• radioactive iodine therapy (for thyroid cancer)