Head and Neck Cancer: Overview

What is head and neck cancer?

Cancer starts when cells change (mutate) and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. They can spread to other parts of the body, too. This is called metastasis.

Head and neck cancer is the term given to cancers that start in cells found in the head and neck region. Some of the most common types are:

• Cancer of the hypopharynx, or hypopharyngeal cancer. It starts in the bottom part of the throat, behind and beside the voice box.

• Cancer of the nasopharynx, or nasopharyngeal cancer. It starts in the upper part of the throat, behind the nose.

• Cancer of the oropharynx, or oropharyngeal cancer. It starts in the back of the mouth or the middle part of the throat.

• Cancer of the paranasal sinus. It starts in the small hollow spaces around the nose called sinuses.

• Cancer of the nasal cavity. It starts in the space just behind the nose.

• Cancer of the salivary gland. It starts in the salivary glands. These glands are found just below the tongue, on the sides of the face in front of the ears, and under the jawbone. There are also salivary glands in different parts of the upper digestive tract.

Who is at risk for head and neck cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors are not in your control. But others may be things you can change.

The most important risk factors for head and neck cancer are:

• Using any form of tobacco, including smokeless tobacco

• Drinking alcohol

More than 3 out of 4 head and neck cancers are caused by these 2 risk factors. People who use both tobacco and alcohol are at even higher risk for 1 of these cancers.

Other risk factors for head and neck cancer include:

• Unhealthy diet

• Poor mouth care

• Betel quid or gutka chewing

• Human papillomavirus (HPV) infection

• Exposure to certain chemicals

• Weakened immune system

• Epstein-Barr virus infection

Talk with your healthcare provider about your risk factors for head and neck cancer and what you can do about them.

Can head and neck cancer be prevented?

There is no sure way to prevent head and neck cancers, but some things may help lower your risk for certain types of head and neck cancer, such as:

• Not using tobacco in any form

• Limiting or not drinking alcohol

• Reducing your risk for HPV infection. Get the HPV vaccine. Ask your healthcare provider if you are eligible for the vaccine.

• Limiting sexual partners and use condoms every time you have any type of sex. (Condoms do not fully protect against HPV.)

• Eating a healthy diet with lots of fruits and vegetables

• Getting regular dental care

• Having proper-fitting dentures

Talk with your healthcare provider about what you can do to lower your risk. Ask for resources to help. Making changes can be hard, but you don’t have to make them alone. 

What are the symptoms of head and neck cancer?

Symptoms of head and neck cancer depend on where the tumor is and how big it is. Common symptoms of head and neck cancer can include:

• Growth or sore in the mouth

• Lump in the neck

• Lump or sore inside the nose, on the lip, or in the mouth that won’t heal

• Sore throat that does not go away

• Feeling that something is stuck in the throat

• Blocked sinuses or nasal congestion that won’t clear

• Chronic sinus infections

• Cough that doesn't go away

• Voice changes or hoarseness

• Coughing up blood or bleeding in the mouth

• Trouble swallowing, speaking, or breathing

• Pain when swallowing

• Frequent headaches or pain around the nose, cheeks, or forehead

• Frequent nosebleeds or ones that don’t stop

• Weakness in the muscles of the face

• Double vision

• Numbness in the face

• Pain in the ear, face, chin, neck, upper back, jaw, or upper teeth

• Ringing in the ears or hearing problems

• Swelling of the eyes or under the chin or around the jaw

• Vomiting

• Bad breath even when correct oral hygiene is practiced

• Red or white patches in the mouth

• Loose or painful teeth

• Dentures not fitting like they should

• Unexplained weight loss

Many of these may be caused by other health problems. Still, it's important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is head and neck cancer diagnosed?

If your healthcare provider thinks you may have head and neck cancer, you'll need some tests to be sure. You'll be asked about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done. You may also have one or more tests, such as blood tests, X-rays, or a computed tomography (CT) scan.

A biopsy is the only way to know for sure that you have cancer. Small pieces of the tumor are taken out and checked for cancer cells. They may also be tested for signs of HPV infection. Your results will come back in about a week.

After a diagnosis of head and neck cancer, you’ll need more tests. These help learn more about your overall health and the cancer. They're used to find the stage of the cancer. The stage is how much cancer there is and how far it has spread (metastasized) in your body. It's one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the details of your cancer to you in a way you can understand.

How is head and neck cancer treated?

Your treatment choices depend on the type of head and neck cancer you have, the location of the tumor, test results, the stage of the cancer, and your overall health. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and any risks and side effects. Be sure you understand how treatment can change the way you look and the way your body works.

Cancer treatments are either local or systemic. Local treatments remove, destroy, or control cancer in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. You may have just one treatment or a combination of treatments.

Common treatments for head and neck cancer include:

• Radiation therapy

• Surgery

• Chemotherapy

• Targeted therapy

• Immunotherapy

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects?

Side effects will vary depending on your overall health and the type of treatment. You may experience many or few side effects. Cancer treatment like chemotherapy and radiation can damage normal cells. This can cause side effects, such as hair loss, mouth sores, or vomiting. Radiation may cause skin changes, jaw stiffness, and fatigue. Surgery may change the way your body works and looks. It may impact your ability to chew, swallow, or talk. Your face or neck may look different after surgery. Targeted therapy may cause nausea, low blood counts, and skin changes. Immunotherapy may cause fatigue, nausea, or a rash. Talk with your healthcare provider about side effects linked to your treatment. Know what to watch for. There may be things you can do to help prevent side effects, and there are often ways to manage them.

Coping with head and neck cancer

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you may have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group online or in person.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with as many protein foods as possible.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse

• Signs of an infection, such as a fever

• Side effects of treatment that affect your daily function or don't get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays. 

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions.