Head and neck oncology describes a variety of malignant tumors that form in or near the mouth, throat, sinuses, nose, and larynx. Often, they begin in the squamous cells that line the mucosal surfaces within the neck and head. This lining is known as the epithelium. Below this layer is another one called the mucosa.
Cancer cells that are only found in the epithelium are called carcinoma in situ. If they spread beyond the squamous cells, it’s called invasive small cell carcinoma.
Cancers of the head and neck can also begin in the salivary glands, but this is not common. There are many different cells inside salivary glands that can develop cancer. As a result, many different types of salivary gland cancers exist. Tumors in these areas will be classified as mucoepidermoid carcinoma, adenocarcinoma, and adenoid cystic carcinoma.
Studies estimated that over 65,000 women and men in the U.S. would be diagnosed with cancers of the neck and head in 2017. These cancers make up about four percent of all cancers in America patients. They are more common in men than women and in people over 50 years of age.
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Kinds of Head and Neck Cancer
There are five primary types of cancer located in the head and neck.
- Oropharyngeal and oral cancer- Oral cancer affects the front of the tongue, lips, the lining of the lips and cheeks, gums, the areas of the gums that lay behind the wisdom teeth, the hard palate, and the bottom part of the mouth beneath the tongue. Oropharyngeal cancer develops in the tip of the larynx, middle of the throat, and tonsils.
- Salivary gland cancer- This kind of cancer begins in the glands that produce saliva. The body uses saliva to start the process of breaking down food and keeping the mouth moist. These glands are primarily located in the jawbone and mouth floor.
- Hypopharyngeal and laryngeal cancer- The hypopharynx, also known as the gullet, is found in the lower area of the throat around the larynx. Commonly known as the voice box, the larynx is a short, tube-like structure made up of cartilage and vital for swallowing, breathing, and talking. The voice box is located at the top of the trachea or windpipe. It also contains the epiglottis and vocal cords. The epiglottis covers the larynx to keep food out of the airway.
- Paranasal and nasal cavity cancer- The nasal cavity is the hollow area inside the nose. The paranasal sinuses are the hollow cavities that are located in the head around the nasal cavity.
- Nasopharyngeal cancer- This passageway is behind the nose in the upper throat area.
Other types of cancer can form in the head and neck. Treatment and diagnosis are different for them. These cancers include thyroid cancer, brain tumors, sarcoma, parathyroid cancer, eye cancer, and esophageal cancer.
Head & Neck Cancer Symptoms
Some symptoms of neck or head cancer are a sore throat that never goes away, sores or lumps that don’t heal, hoarseness or a voice change, and problems with swallowing.
However, since other conditions share these symptoms, it's difficult to know when you have cancer. It's best to check with a dentist or doctor if any of these symptoms occur.
Here is a more in-depth list of symptoms and areas where they are found:
- Larynx- ear pain or pain with swallowing
- Oral cavity- red or white patches on the lining of the mouth, gums, or tongue; unusual pain or bleeding in the mouth; swelling in the jaw
- Salivary glands- paralysis or numbness of face muscles, swelling around the jawbone or beneath the chin, pain that never goes away in the neck, face, or chin.
- Pharynx- painful swallowing, difficulties speaking or breathing, trouble hearing, ringing inside the ears, pain in the throat or neck that will not go away, and frequent headaches
- Nasal cavity and paranasal sinuses- chronic sinus infections that never heal, even with antibiotics; blocked sinuses; headaches; nosebleeds; trouble or swelling around the eyes; denture problems, or upper tooth pain
Head & Neck Cancer Causes
Approximately 75 percent of neck and head cancers are caused by alcohol and tobacco use. This is especially so for cancers that develop in the larynx, oral cavity, hypopharynx, and oropharynx. Alcohol and tobacco use are not the cause of cancer in the salivary glands. Also, cancer-causing infections like HPV, the human papillomavirus are also risk factors, especially for oropharyngeal cancers of the base of the tongue or tonsils.
Other known causes and risk factors include:
- Salted or preserved foods- Consuming certain foods like this in childhood increases your risk for nasopharyngeal cancer.
- Occupational exposure- There are some industrial exposures such as synthetic fibers or asbestos that are associated with larynx cancers as well as people with jobs in the metal, construction, food, logging, textile, or ceramic industries. Exposure to wood dust puts you at risk for nasopharyngeal cancer. Also, occupational exposure to nickel dust, formaldehyde, and wood increase your risk for nasal cavity and paranasal sinus cancers.
- Paan- people from Southeast Asia who use Paan or betel quid in the mouth are at risk of oral cancer
- Ancestry- Asians have an increased risk of developing oral cancer, specifically those of Chinese ancestry
- Oral health- Missing teeth or poor oral hygiene could be risk factors for oral disease. Mouthwashes high in alcohol may also contribute to oral cancers.
- Epstein-Barr virus- This disease puts you at risk for cancer in the salivary glands and nasopharyngeal cancer
- Radiation exposure- Radiation in areas of the neck and head for conditions other than cancer can increase your risk of salivary gland cancer.
Head & Neck Cancer Treatment
Treatment for neck and head cancers depends on several factors such as the stage of the cancer, location of the disease, and the patient’s health and age. Standard treatments are radiation therapy, surgery, chemotherapy, targeted therapy, or any combination of these.
People with HPV-positive oropharyngeal cancer may require different treatment than those patients with HPV-negative oropharyngeal cancer. Those with HPV-positive cancer may do better on treatment that is less intense. This theory is currently being investigated with clinical trials.