Head and Neck Cancer

The head and neck is an anatomically diverse part of the body, made up of soft tissues, bones, and a variety of glands and organs. Cancer can arise in any of these areas. Skin cancers that develop on the scalp, face, or neck may also be considered head and neck cancers. RISK FACTORS Most head and neck cancers arise after prolonged exposure to known risk factors -- tobacco, alcohol, and cancer-causing agents in the workplace -- so these cancers are generally considered preventable. Some people who develop head and neck cancers, however, have no known risk factors.
Tobacco & Alcohol Use People who use tobacco (including smokeless tobacco) or drink alcohol excessively are at much greater risk for head and neck cancers. Smokers' risk of developing cancer of the larynx (voice box) or hypopharynx (the top portion of the esophagus) is five to 35 times that of nonsmokers. Heavy use of alcohol raises the risk of those cancers two to five times. Those who smoke and also drink heavily may be raising their risk to 100 times that of nonusers. Extensive Exposure to Sunlight & Other Forms of Radiation People who have had substantial exposure to the sun are at higher than average risk for skin cancers of the head and neck region. Extensive radiation to the head and neck from diagnostic x-rays or radiation therapy increases the risk for cancer of the skin, salivary glands, and thyroid in particular. Other Possible Risk Factors Other risk factors for head and neck cancer include poor oral hygiene, exposure to occupational inhalants such as asbestos or wood dust, poor nutrition, gastroesophageal reflux (heartburn), human papilloma virus (HPV) infection, and a weakened immune system.

Below are some generalized symptoms and warning signs of head and neck cancer. Many of these symptoms can also be caused by other, noncancerous conditions. See your doctor if you notice any of these symptoms:

  • a sore in the mouth that won't heal (the most common symptom) or that bleeds easily
  • a red or white patch in the mouth that doesn't go away
  • frequent nosebleeds, ongoing nasal congestion, or chronic sinus infections that do not respond to treatment
  • persistent sore throat
  • persistent hoarseness or a change in the voice
  • persistent pain in the neck, throat, or ears
  • blood in the sputum
  • difficulty chewing, swallowing, or moving the jaws or tongue
  • numbness in the tongue or other areas
  • loosening of teeth
  • dentures that no longer fit
  • a lump or swelling in the neck
  • changes or discoloration in a mole; a skin sore that is crusting or ulcerated, or that fails to heal (these are also signs of skin cancer.
Treatment Many cancers of the head and neck can be cured, especially if they are found early. Treatment varies according to the type, severity, and location of the disease, and may include surgery, radiation therapy, or chemotherapy. Curing head and neck cancer is the physician's primary goal, but preserving our patients' appearance and ability to function -- quality of life -- is also extremely important and is an integral part of treatment. Today, advances in surgical techniques, reconstruction, and nonsurgical treatment methods mean that nearly every patient attains those quality-of-life goals. Surgery Surgery is the mainstay of treatment for most cancers of the head and neck, and advances in surgical techniques mean that in a growing number of patients, surgeons can remove tumors while preserving nearby structures that are key to function When surgery is extensive, immediate reconstruction of the area is often possible. For example, in cases where the jaw bone must be removed, the surgeon can fashion a new jaw using part of a bone in the patient's own leg. Special microsurgical techniques are used to move blood vessels along with the leg bone and reattach them to blood vessels in the neck, creating a blood supply for the new jaw. Similarly, surgeons can now use skin and muscle from a patient's back or abdomen to replace part of the scalp. Dental and maxillofacial surgeons use implants to replace teeth lost during treatment. Minimally Invasive Surgery To remove certain tumors in the larynx and pharynx, our surgeons may use a minimally invasive procedure called endoscopic laser surgery. This form of surgery involves inserting a thin, lighted tube called an endoscope with a camera on its tip in the patient's mouth and down into the patient's throat. Surgeons then remove the tumor using a special laser. The procedure helps preserve speech and swallowing functions, and allows the patient to recover far more quickly than he or she would after traditional open surgery. Endoscopic laser surgery can often be performed on an outpatient basis. Patients receive an anesthetic that will relax and sedate them to ensure comfort during the surgical procedure. The anesthetic is very safe, works rapidly, and wears off quickly, so that patients awaken soon after the procedure is completed. Radiation Therapy Radiation therapy given together with chemotherapy is a standard of care for patients with locally advanced head and neck cancer. In select situations, such as oral cavity tumors, the patient will undergo surgery followed by radiation therapy and/or chemotherapy. This combination treatment is often used in patients who would develop significant side effects from surgery, in patients with inoperable cancers, and after surgery for certain patients who have a poor prognosis. In addition, radiation therapists may treat head and neck cancer using external beam treatment or high-dose brachytherapy, a technique in which tiny radioactive seeds are implanted directly in a tumor. In some cases, doctors use both approaches. Cancer Associate radiation oncologists use a three-dimensional method of delivering external beam radiation called intensity-modulated radiation therapy (IMRT) to deliver radiation therapy to tumors with great precision, while sparing healthy tissues, thereby reducing the side effects. These new approaches can often preserve patients' ability to speak and swallow normally, especially those with advanced disease. Chemotherapy Doctors are increasingly using chemotherapy to treat head and neck cancers, especially for patients whose disease would have been considered untreatable not long ago. Chemotherapy can enhance the response of cancer cells to radiation therapy; this combination makes it possible to preserve organs such as the larynx, which surgeons would have removed in the past. For patients with advanced disease, too, chemotherapy is helping to increase longevity; this is especially true for patients who have cancer of the nasopharynx or other areas that are not easily treated surgically. Chemotherapy alone is not considered a curative treatment for most head and neck cancers. However, as our understanding of the molecular basis of these tumors grows, physicians are gaining many new targets for drug therapy. The options for patients whose disease will not respond to standard agents are expanding, offering hope to patients with the most difficult tumors.