Head and Neck Cancers

Cancers are named for the place where they first begin. (Read about "Cancer: What It Is") Head and neck cancers involve the mouth, nose and throat. There are a number of cancers of the head and neck. According to the American Cancer Society (ACS), these cancers are more common in men and in people over age 50.

The National Cancer Institute (NCI) says that head and neck cancers account for approximately 3 to 5 percent of all cancers in the United States. Cancers that are not included in the NCI definition of head and neck cancers - and therefore not included in this article - are cancers of the brain, eye, thyroid and esophagus. These cancers are described elsewhere in our library. (Read about "Brain Tumors" "Eye Cancer" "Thyroid Cancer" "Esophagus Cancer")

This article includes information and/or links about the following cancers:

• oral cavity
• larynx
• pharynx
  • hypopharynx
  • nasopharynx
  • oropharynx
• paranasal sinuses and nasal cavity
• salivary glands

Sometimes, cancer cells are found in the lymph nodes (Read about "The Lymph System") of the upper neck when there is no evidence of cancer in other parts of the head and neck. When this happens, the cancer is called metastatic squamous neck cancer with unknown (occult) primary. This means that the cancer has started somewhere else, but where cannot be determined.

Someone with a head and neck cancer may develop a condition called hypercalcemia - too much calcium in the blood - which in turn can cause loss of appetite, nausea, thirst, fatigue, muscle weakness, restlessness, and confusion. This can often require medication and rehydration. (Read about "Hypercalcemia")

Read below to learn more about these different head and neck cancers.

Oral Cancer

The oral cavity includes the lips, the front two-thirds of the tongue, the gingiva (gums), the buccal mucosa (lining inside the cheeks and lips), the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area behind the wisdom teeth. Many oral cancers can be discovered early during routine exams by doctors or dentists. (Read about "Cancer Check-ups") People should also be aware of the symptoms of oral cancer, especially if they use tobacco.

(Read more about "Oral Cancer")

Laryngeal Cancer

The larynx is also called the voice box. It is located at the top of the windpipe and is about 2 inches long. The walls of the larynx are made of cartilage and it is the large front part that forms the so-called Adam's apple. Inside the larynx are two muscles that make up our vocal cords. The National Cancer Institute (NCI) says that 12,000 people a year are diagnosed with cancer of the larynx. Cancer can start anywhere in the larynx. The terms are:

• glottis, if it starts in the vocal cords
• supraglottis, if it starts above the cords
• subglottis, if it starts below the cords

NCI says that most cancers of the larynx start on the vocal cords. (Read about "Vocal Problems: Laryngitis and Vocal Growths") ACS says that 95 percent of the cancers start from squamous cells that line the larynx.

Many laryngeal cancers don't cause pain early in their development but often cause a hoarseness in the voice or other voice changes. If hoarseness lasts for a couple of weeks, it's a sure sign you should see a doctor. Other symptoms according to ACS and NCI include:

• cough that doesn't go away
• a long lasting sore throat (Read about "Sore Throat and Strep Throat")
• earache (Read about "Earache")
• lumps in the neck
• breathing problems or noisy breathing (Read about "Respiratory System")
• difficulty swallowing, even choking
• bad breath
• weight loss

Subglottic cancers are more subtle. ACS says they are often discovered later because they do not tend to cause hoarseness. Any of these symptoms should be checked by an Otolaryngologist (which is the formal name of an ear, nose and throat doctor). The doctor can use a physical exam to check for lumps and tenderness. They can also look inside the larynx using either a long handled mirror or a tube with lights to look directly into the throat. If cancer is suspected, a biopsy (Read about "Biopsy") can be taken to confirm the diagnoses. A patient may also need to undergo other tests to check if the cancer has spread.

Once cancer of the larynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. In cancer of the larynx, the definitions of the early stages depend on where the cancer started. The following stages are used for cancer of the larynx, according to NCI:

• Stage I - The cancer is only in the area where it started and has not spread to lymph nodes in the area or to other parts of the body. Lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells. (Read about "The Lymph System") The exact definition of stage I depends on where the cancer started, as follows:
  • supraglottis - The cancer is only in one area of the supraglottis and the vocal cords can move normally.
  • glottis - The cancer is only in the vocal cords and the vocal cords can move normally.
  • subglottis - The cancer has not spread outside of the subglottis.
• Stage II - The cancer is only in the larynx and has not spread to lymph nodes in the area or to other parts of the body. The exact definition of stage II depends on where the cancer started, as follows:
  • supraglottis - The cancer is in more than one area of the supraglottis, but the vocal cords can move normally.
  • glottis - The cancer has spread to the supraglottis or the subglottis or both. The vocal cords may or may not be able to move normally.
  • subglottis - The cancer has spread to the vocal cords, which may or may not be able to move normally.
• Stage III - Either of the following may be true:
  • The cancer has not spread outside of the larynx, but the vocal cords cannot move normally, or the cancer has spread to tissues next to the larynx.
  • The cancer has spread to one lymph node on the same side of the neck as the cancer, and the lymph node measures no more than 3 centimeters (just over 1 inch).
• Stage IV - Any of the following may be true:
  • The cancer has spread to tissues around the larynx, such as the pharynx or the tissues in the neck. The lymph nodes in the area may or may not contain cancer.
  • The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches).
  • The cancer has spread to other parts of the body.

Treatments for cancer of the larynx include surgery, radiation, chemotherapy and biological therapy. (Read about "Cancer Treatments") Each has its own successes and side effects. NCI says that cancer of the larynx is usually treated with radiation or surgery, depending on how far the cancer has advanced. Surgery can be one of two types - partial or total laryngectomy. A total removal of the voice box leaves the patient with a stoma or opening in the neck to breathe by and they must learn to talk in a new manner. A partial laryngectomy leaves the voice but may change it. The patient is able to breath in the normal manner. Radiation therapy impacts the salvia, according to NCI. Because of that, special oral hygiene care is required. (Read about "Oral Health")

There are a number of things that have been identified as risk factors for cancer of the larynx. (Read about "Reduce Cancer Risks") Perhaps the greatest is smoking. (Read about "Quit Smoking") The American Cancer Society (ACS) says that the risk is five to 35 times greater for smokers. Heavy alcohol use increases the risk two to five times (Read about "Alcoholism") and ACS says some reports put the risk at 100 times higher for people who smoke and drink. Other risk factors cited by ACS and NCI are:

• age - most cancers are found in those over 55
• gender - four times more likely in men than women
• race - 50 percent more common in African-Americans
• weakened immune systems (Read about "The Immune System") brought on by things such as organ transplants or AIDS (Read about "Transplants" "HIV / AIDS")
• poor eating habits
• gastroesophageal reflux (GERD) (Read about "GERD")

Certain environmental factors also place a person at risk, according to ACS. Breathing things like paint fumes, wood dust and certain chemicals are suspected of increasing risk. NCI says people who work with asbestos need to be especially careful. (Read about "Respiratory System")

Hypopharyngeal Cancer

The hypopharynx surrounds the larynx. It is the entrance to the esophagus at the bottom of the throat. As with cancer of the larynx, this cancer is most likely to start in the squamous cells that line the hypopharynx, according to NCI.

Symptoms mirror those for cancer of the larynx according to ACS and include:

• cough that doesn't go away
• a long lasting sore throat (Read about "Sore Throat and Strep Throat")
• earache (Read about "Earache")
• lumps in the neck
• breathing problems or noisy breathing (Read about "Respiratory System")
• difficulty swallowing, even choking
• bad breath
• weight loss
• hoarseness or other voice changes

These symptoms could also indicate other problems and should be checked by a doctor. Diagnostic tests include physical exam, the use of a thin, lighted tube called an endoscope to examine areas inside the body, x-rays, CT scans, MRI, Pet scans and/or biopsy. (Read about "Endoscopy" "X-rays" "CT Scan - Computerized Tomography" "MRI - Magnetic Resonance Imaging" "PET - Positron Emission Tomography" "Biopsy")

Again, as with cancer of the larynx, treatment is usually radiation or surgery. The exact treatment depends on the extent of the cancer and how far it has progressed. Chemotherapy and biological therapy are also possible options. (Read about "Cancer Treatments") Treatment to the hypopharynx will often impact the larynx and the vocal cords.

Risk factors for hypopharyngeal cancer are the same as they are for cancer of the larynx, according to ACS, with smoking and heavy alcohol consumption the major factors. (Read about "Quit Smoking" "Alcoholism") Some of those other risk factors according to NCI and ACS are:

• age, most cancers occur in those over 55
• gender, four times more likely in men than women
• race, 50 percent more common in African-Americans
• weakened immune systems (Read about "The Immune System") brought on by things such as organ transplants or AIDS (Read about "Transplants" "HIV / AIDS")
• poor eating habits
• gastroesophageal reflux (GERD) (Read about "GERD")

ACS says that often cancers in the hypopharynx can spread to other nearby organs or the cancer can reappear somewhere else. Both NCI and ACS recommend regular follow-up exams.

Nasopharyngeal Cancer

The nasopharynx is located between your nose and your throat. When you breathe, the air enters your nostrils, passes through the nasopharynx and into your throat. The adenoids are located in the nasopharynx.

Nasopharyngeal cancer is fairly rare in North America, according to ACS. It makes up about a quarter of one percent of all cancers and only 2 percent of head and neck cancers. It is much more common in parts of Asia and North Africa and the Arctic. In Southeast China, ACS says, 18 percent of all cancers are nasopharyngeal.

Diet is a suspected risk factor for this cancer. ACS says the diets in the areas most affected are high in salt-cured fish and meats. The Epstein-Barr virus (EBV) is also a suspect, according to ACS. EBV is the culprit in infectious mononucleosis, also known as mono. (Read about "Mononucleosis")

Nasopharyngeal cancer can be found early, according to ACS, because many of the symptoms cause patients to seek medical attention. They include according to NCI:

• difficulty breathing (Read about "Respiratory System")
• a lump or mass in the nose
• nosebleeds
• headaches (Read about "Headaches")
• ringing in the ear (Read about "Tinnitus")
• trouble hearing, especially on one side (Read about "The Ear and Hearing")
• difficulty opening the mouth
• double or blurred vision

ACS also says that 75 percent of patients have a lump or mass in the neck area when the cancer is discovered. In some cases, this can be the only sign.

If cancer is present, the doctor will want to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia (Read about "Anesthesia"), x-rays and other imaging procedures and laboratory tests. (Read about "X-rays") The primary treatment options are radiation and chemotherapy. (Read about "Cancer Treatments") Radiation involves the use of high-energy x-rays to kill cancer cells. It can result in redness, irritation, mouth sores, dry mouth, difficulty in swallowing and/or nausea. Chemotherapy is used to kill cancer cells throughout the body. The side effects of chemotherapy depend on the drugs that are given. Surgery may also be used with this type of cancer, especially to see if it has spread.

Oropharyngeal Cancer

The oropharynx is in the middle of the throat. It includes our soft palate, the base of the tongue and the tonsils. The symptoms of this rare cancer according to NCI include:

• a persistent sore throat (Read about "Sore Throat and Strep Throat")
• difficulty swallowing
• lump or lumps in the back of the mouth or throat
• voice changes
• earaches (Read about "Earache")

Any of these symptoms should send you to you doctor for a closer examination. Diagnostic tests include physical exam, the use of a thin, lighted tube called an endoscope to examine areas inside the body, x-rays, CT scans, MRI, Pet scans and/or biopsy. (Read about "Endoscopy" "X-rays" "CT Scan - Computerized Tomography" "MRI - Magnetic Resonance Imaging" "PET - Positron Emission Tomography" "Biopsy") If cancer of the oropharynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the oropharynx.

• Stage I - The cancer is no more than 2 centimeters (about 1 inch) and has not spread to lymph nodes in the area. (Read about "The Lymph System")
• Stage II - The cancer is more than 2 centimeters, but less than 4 centimeters (less than 2 inches), and has not spread to lymph nodes in the area.
• Stage III - Either of the following may be true:
  • The cancer is more than 4 centimeters.
  • The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimeters (just over one inch).
• Stage IV - Any of the following may be true:
  • The cancer has spread to tissues around the oropharynx. The lymph nodes in the area may or may not contain cancer.
  • The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches).
  • The cancer has spread to other parts of the body.

Depending on the stage of the cancer, treatment options include surgery, radiation and sometimes chemotherapy. (Read about "Cancer Treatments") Radiation involves the use of high-energy x-rays to kill cancer cells. Patients who receive radiation to this area may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Chemotherapy is used to kill cancer cells throughout the body. The side effects of chemotherapy depend on the drugs that are given.

Paranasal Sinus and Nasal Cavity Cancer

The paranasal sinuses are hollow spaces that surround the nose. Symptoms of paranasal sinus and nasal cavity cancer include:

• sinuses that won't open up
• nosebleeds
• lumps in the nose
• sores in the nose that won't heal
• headaches in the region (Read about "Headaches")
• eye problems (Read about "The Eye")
• discomfort with the upper teeth or dentures

A doctor should be consulted concerning any of these symptoms. Diagnostic tests include physical exam, the use of a thin, lighted tube called an endoscope to examine areas inside the body, x-rays, CT scans, MRI, Pet scans and/or biopsy. (Read about "Endoscopy" "X-rays" "CT Scan - Computerized Tomography" "MRI - Magnetic Resonance Imaging" "PET - Positron Emission Tomography" "Biopsy")

If cancer is found, the doctor will want to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia (Read about "Anesthesia"), x-rays and other imaging procedures and laboratory tests. Treatment options include surgery, radiation, chemotherapy and biological therapy. (Read about "Cancer Treatments") NCI says surgery is commonly used to remove the cancer and some of the healthy tissue around it. Lymph nodes in the neck may also be removed. Like other head and neck surgeries, this can affect how the patient looks, and their ability to talk. Radiation involves the use of high-energy x-rays to kill cancer cells. Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Chemotherapy is used to kill cancer cells throughout the body. The side effects of chemotherapy depend on the drugs that are given.

Salivary Cancer

Our salivary glands are mainly in the mouth. They are part of the digestive system, helping to break down foods before we swallow them. (Read about "Digestive System") The salivary glands produce saliva, the fluid that keeps mucosal surfaces in the mouth and throat moist. There are many salivary glands; the major ones are in the floor of the mouth, and near the jawbone. Salivary cancer is considered very rare, according to ACS. It accounts for less than one percent of all cancers and about 7 percent of cancers of the head and neck.

The main clusters of our salivary glands are below the tongue, on the sides of the mouth, just in front of the ears and under the jawbone. Any swelling in those areas is reason to see a doctor. ACS says some of the other symptoms are:

• numbness in the face
• pain that is persistent in the cheeks, jaw or under the tongue
• weakness on one side of the face

ACS also says risk factors for salivary cancer include smoking (Read about "Quit Smoking"), exposure to radioactive substance or radiation treatment of the head and neck, environmental exposure to things such as nickel alloy dust or silica dust and a high fat, low fiber diet. (Read about "Fiber & Health")

Diagnostic tests include physical exam, the use of a thin, lighted tube called an endoscope to examine areas inside the body, x-rays, CT scans, MRI, Pet scans and/or biopsy. (Read about "Endoscopy" "X-rays" "CT Scan - Computerized Tomography" "MRI - Magnetic Resonance Imaging" "PET - Positron Emission Tomography" "Biopsy")

If cancer is present, the doctor will want to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia (Read about "Anesthesia"), x-rays and other imaging procedures and laboratory tests. Treatment options include surgery, radiation, chemotherapy and biological therapy. (Read about "Cancer Treatments") NCI says treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. Surgery may remove the cancer and some of the healthy tissue around it. Lymph nodes in the neck may also be removed (lymph node dissection), if the doctor suspects that the cancer has spread. Radiation involves the use of high-energy x-rays to kill cancer cells. Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Chemotherapy is used to kill cancer cells throughout the body. The side effects of chemotherapy depend on the drugs that are given. Because the salivary glands help in eating and digesting food, patients may need special help adjusting to the side effects of the cancer and its treatment.

Metastatic Squamous Neck Cancer with Occult Primary

Occasionally cancer will show up in the head or neck and not have started there. The doctor will then try to find the main tumor where the cancer began. If it can't be found the cancer is called metastatic squamous neck cancer with occult primary, meaning doctors are unsure of where it started.

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

Related Information:

    Microorganisms

    Digestive System