Head and Neck Cancer
Cancer of the head and neck is an umbrella term used to describe a variety of malignant tumors that occur in the mouth, lips, throat, nose, sinuses, larynx, and salivary glands. Together, head and neck cancers account for about 4% of all cancers in the United States.
A diagnosis of head and neck cancer can be overwhelming. Fortunately, effective treatments are available, including surgery, radiation therapy, chemotherapy, targeted drugs, and immunotherapy.
“The recommended treatment plan may include more than one of the above treatments and will be personalized based on the location and stage of the cancer,” says Smilow Cancer Hospital oncologist Aarti Bhatia, MD, MPH.
What are head and neck cancers?
About 90% of head and neck cancers are squamous cell carcinomas (or squamous cell cancer), meaning they arise from cells known as squamous cells. Squamous cells are thin, flat cells that form the top layer of the moist mucous membranes that line the mouth, nose, and throat.
There are rarer forms of head and neck cancer, too, such as adenocarcinomas, which form in glandular cells, sarcomas, and lymphomas.
What are the types of head and neck cancer?
There are several types of head and neck cancer, each named for part of the head or neck in which they form (examples below). The most common sites of head and neck cancer are in the oral cavity, the larynx, and the oropharynx.
- Oral cavity and oropharyngeal cancer. Oral cancer, also called oral cavity cancer, starts in the oral cavity, which includes the lips, gums, the front two-thirds of the tongue, and the bottom and top of the mouth (the floor and hard palate). Oropharyngeal cancer occurs in the oropharynx, the area at the back of the mouth, the rear third of the tongue, and the tonsils.
- Laryngeal and hypopharyngeal cancer. Laryngeal cancer starts in the larynx (also known as the voice box). Situated at the top of the windpipe leading to the lungs, the larynx contains the vocal cords and is critical to speaking and breathing. Cancer that forms in the hypopharynx—the bottom section of the throat—is called hypopharyngeal cancer.
- Nasopharyngeal cancer: This type of head and neck cancer occurs in the nasopharynx, the upper part of the throat that connects to the nasal cavity at the back of the nose.
- Nasal cavity and paranasal sinus cancer: The nasal cavity is the passageway through which air travels from the nostrils to the top of the throat (the nasopharynx). The paranasal sinuses are small hollow pockets within the bones surrounding the nasal cavity.
- Salivary gland cancer: The salivary glands sit under the floor of the mouth, below the jaw, and inside the upper cheeks—just in front of the ears. Squamous cell carcinomas are rare in the salivary glands. The other forms of cancer usually found in the salivary glands include adenoid cystic, mucoepidermoid, and pleomorphic.
Cancer of unknown primary in the head and neck. The part of the body where cancer begins is known as the primary site. Cancers can spread from the primary site to other tissues around the body. In cancer of unknown primary (CUP) in the head and neck, cancer cells are found in the lymph nodes in the head and neck region, but doctors are unable to determine where in the head or neck the cancer began. Most cancers of unknown primary in the head and neck are squamous cell cancers, but they can also occur with adenocarcinomas or other types of cancer. Finding the primary site of the cancer helps doctors determine the best course of treatment.
What are risk factors for head ad neck cancers?
Several factors have been linked to increased risk for head and neck cancer, including:
- Tobacco use, including smokeless tobacco products
- Alcohol consumption
- Human papillomavirus (HPV) infection
- Epstein-Barr viral infection can increase risk for nasopharyngeal cancer
- Radiation exposure such as previous radiation therapy to the head and neck can increase risk. Ultraviolet (UV) radiation from the sun can increase risk for lip cancer.
- Male gender. Head and neck cancers are two to three times more common in men than in women.
- Diet. Chewing betel quid, a mixture made up of areca (betel) nut and other ingredients is a risk factor for cancers of the oral cavity, pharynx, and esophagus. Some studies have linked high consumption of processed meat with oral and oropharyngeal cancers, and some evidence suggests diets low in vitamins A and B may increase risk.
- Environmental and workplace inhalants including exposure to asbestos, wood dust, formaldehyde, and other chemicals
- Certain genetic disorders including Fanconi anemia, Plummer-Vinson syndrome, and Li Fraumeni syndrome.
What are the symptoms of head and neck cancer?
Common symptoms of head and neck cancer include:
- Lump in the neck
- Sore on the lip—or in the mouth or throat that doesn’t heal
- Persistent sore throat
- Difficulty or painful swallowing
- Hoarseness or change in voice
- Ear pain
Additional symptoms can vary based on the location of the cancer.
How is head and neck cancer diagnosed?
Diagnosing head and neck cancer typically involves several steps, including:
- Medical history, physical exam, and laboratory tests. Your doctor will ask about your medical history, including about any risk factors associated with head and neck cancers, and about symptoms you are experiencing. During the physical exam, your doctor will feel your neck for masses and swollen lymph nodes. He or she will examine the nose, mouth, tongue, gums, and throat for irregularities. Blood and urine tests can reveal markers that may indicate the presence of cancer.
- Imaging tests. Doctors use imaging tests such as computed tomography (CT) scans, positron emission tomography (PET) scans, and magnetic resonance imaging (MRI) scans to get a clearer picture of what’s going on inside the head and neck, and to find a suspected tumor.
- Biopsy. A biopsy can determine whether a tumor is cancerous or benign. Your doctor may use a needle to remove a tissue sample from the tumor or lymph node. In other cases, a surgeon may perform a sentinel lymph node biopsy to determine if the cancer has spread to nearby lymph nodes. A pathologist will examine the tissue sample under a microscope to check for the presence of cancer cells. Additional tests, including genetic testing, may also be carried out for cancers of unknown primary to help identify the primary tumor site.
- Endoscopy. In this procedure, your doctor will insert an endoscope—a thin tube equipped with a camera—through the nose, into the mouth, and down the throat to examine the pharynx, larynx, esophagus, trachea, and/or the airways in the lungs. If endoscopy reveals abnormal tissues, your doctor may biopsy a tissue sample during the procedure.
- Staging. If a head and neck cancer is diagnosed, your doctor may order additional imaging and other tests to see whether the cancer has spread to other parts of the body. The doctor uses information about the type of cancer and the extent of its spread to determine its stage and to help guide treatment decisions.
How is head and neck cancer treated?
Several types of treatment are available for head and neck cancers. The choice of treatment varies based on the location of the cancer, whether it is localized or has spread to other parts of the body, and other factors.
Surgery. Surgical removal of the tumor is often used to treat head and neck cancers. It may be used alone or in combination with radiation therapy and chemotherapy. In some cases, nearby lymph nodes are removed as part of treatment.
Radiation therapy. This therapy, commonly used to treat head and neck cancers, kills cancer cells by exposing them to radiation. It may be used alone or in combination with surgery. It may also be used before or after surgery to shrink the tumor or destroy any remaining cancer cells, respectively. For advanced-stage cancer, radiation therapy is frequently used in combination with surgery and/or chemotherapy.
Chemotherapy. Chemotherapy uses drugs to destroy or damage cancer cells. For head and neck cancers, it is usually used in combination with surgery, radiation therapy, or both. It may be given before or after surgery. For advanced-stage cancer, it may be used in combination radiation therapy (known as chemoradiation).
Targeted therapy. Drugs designed to target epidermal growth factor receptor (EGFR), a protein found on the surface of cells that helps them grow, may be used to treat some head and neck cancers.
Immunotherapy. These drugs stimulate the patient’s immune system to help it better fight cancer.
Reconstructive surgery to restore function of structures damaged by disease or treatment may be necessary. In some cases, patients will need to undergo rehabilitation therapy for speech and swallowing.
How is Yale Medicine's approach to treating head and neck cancer unique?
The head and neck cancer team at Yale Medicine comprises nationally and internationally renowned experts in the fields of head and neck surgery, radiation oncology, medical oncology, plastic and reconstructive surgery, oral and maxillofacial surgery, dentistry, pathology, radiology, speech language pathology and swallowing/voice therapy. These specialists focus only on the management of head and neck cancers.
Research has shown that the best treatment plans and long-term outcomes for head and neck cancers come from multidisciplinary evaluations. Yale Medicine coordinates evaluations with patients’ expert team so they have the most comprehensive and personalized treatment plan.
“Being a world-class center, we are always thinking of ways to enhance the experience for our patients by decreasing treatment-related morbidity and improving outcomes,” says Dr. Bhatia. “We engage in cutting-edge science, as well as lead and participate in several clinical trials testing safer and more effective strategies for head and neck cancer treatment.”