Head and neck cancers include cancer of the tongue, throat, and larynx (voice box), but they can also include tumors in the nose, sinuses, lips, mouth, and salivary glands. These are cancers that begin in the cells on the moist surfaces inside the head and neck. (Cancers in the brain, eyes, esophagus, thyroid, or head and neck skin, muscles, and bones are not considered head and neck cancers.)
Alcohol and tobacco, including smokeless tobacco, are the top risk factors. People who smoke and drink heavily may raise their risk 100 times compared with nonusers: tobacco use alone is linked to 85% of head and neck cancers. Overall, the death rates for head and neck cancers have declined in the past 3 decades thanks to a reduction in smoking.
Human papillomavirus (HPV) infection is another main risk factor for head and neck cancers. The National Institutes of Health estimates that HPV infection is linked to 25% of these cancers, specifically throat (oropharyngeal) cancer, including the base of the tongue, soft palate, tonsils, and the sides and back of the throat.
The cases of head and neck cancers caused by HPV infection are increasing in younger people who are not smokers, and this has been linked to certain sexual behaviors, especially oral sex. According to the American Cancer Society, HPV infection is now found in 2 of 3 throat cancers, and to a smaller degree in cancers of the mouth.
Men are twice as likely to have head and neck cancers as women. Other risk factors include radiation or sun exposure, some genetic syndromes (such as Fanconi anemia and dyskeratosis congenita), and some rare disorders (such as Epstein-Barr virus and Plummer-Vinson syndrome).
Early symptoms include persistent gray or white patches in the mouth (leukoplakia), red sores in the mouth or throat that bleed easily and don’t heal (erythroplakia), ear pain, voice change, or neck mass. Trouble swallowing, chewing, or moving the tongue and jaw are often late symptoms. Constant nosebleeds, cheek numbness, and facial swelling or pain can be the symptoms of sinus cancer.
Approximately 50% of head and neck cancers are already at an advanced stage when they are diagnosed. A dentist may be the first to spot white or red areas (leukoplakia and erythroplakia), which may be classified as precancerous.
In addition to a physical exam, some doctors will use special dyes and lights to look for abnormal areas, and then do a biopsy to see if cancer is present.
For a neck mass, diagnosis involves a needle biopsy or a CT scan.
There is no test approved by the FDA for HPV infection of the mouth or throat, but researchers are studying whether testing for HPV could help the diagnosis of these cancers.
Standard treatment for head and neck cancers involves surgery and radiation. Different types of surgery can be used to remove the cancer and for reconstructive surgery. To slow the growth of cancerous cells, radiation can be used alone or in combination with targeted therapy that fights against a tumor protein called EGFR. Chemotherapy may be considered in advanced cancer. However, in addition to eliminating the cancer, patients and doctors must consider preserving the function of important nerves, organs, and tissues in the head and neck.
Treating head and neck cancers requires a multidisciplinary team consisting of surgeons, radiation and medical oncologists, plastic surgeons, otolaryngologists (ear, nose, and throat professionals), dentists, and speech therapists.
If this type of cancer is found early, the 5-year survival rate is 83%. However, with a late diagnosis, which is the case in most patients with head or neck cancer, the typical 5-year survival is much lower (63%).
Researchers are developing preventive medicines for people who are at increased risk for head and neck cancers (especially those with leukoplakia or erythroplakia). New radiation methods are focusing radiation precisely on the tumor, to limit the side effects to the important structures often damaged when treating head or neck cancer.
Genetic research has uncovered a genetic change (mutation) in the TP53 gene, which can lead to cancer development. Testing for these genetic changes would allow for early diagnosis of oral and throat tumors.