Cancer Guide

What is Head & Neck Cancer?

Radiation treatment of the head and neck is a very challenging process because of the complex anatomy of the head and neck region of the body. The expertise of the Radiation Oncologists at Ocean Radiation Oncology, coupled with the cutting-edge TomoTherapy radiation therapy delivery system, makes Ocean Radiation Oncology an ideal center for patients to receive head and neck radiation treatments.

Definition

Many cancers of the head and neck region will potentially require radiation therapy. These include cancers involving the nasopharynx, nasal cavity, sinuses, tongue, palate, gums, tonsils, oropharynx, vocal cords/larynx, and hypopharynx. Sometimes a course of radiation therapy is delivered alone, but sometimes it is administered with chemotherapy or delivered after surgery.

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Causes

Tobacco (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) and alcohol use are the most important risk factors for head and neck cancers, particularly those of the oral cavity, oropharynx, hypopharynx, and larynx. Eighty-five percent of head and neck cancers are linked to tobacco use. People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone.

Other risk factors for cancers of the head and neck include the following:

  • Oral cavity: Sun exposure (lip); possibly human papillomavirus (HPV) infection.
  • Salivary glands: Radiation to the head and neck. This exposure can come from diagnostic X-rays or from radiation therapy for noncancerous conditions or cancer.
  • Paranasal sinuses and nasal cavity: Certain industrial exposures, such as wood or nickel dust inhalation. Tobacco and alcohol use may play less of a role in this type of cancer.
  • Nasopharynx: Asian, particularly Chinese, ancestry; Epstein-Barr virus infection; occupational exposure to wood dust; and consumption of certain preservatives or salted foods.
  • Oropharynx: Poor oral hygiene; HPV infection and the use of mouthwash that has a high alcohol content are possible, but not proven, risk factors.
  • Hypopharynx: Plummer-Vinson (also called Paterson-Kelly) syndrome, a rare disorder that results from iron and other nutritional deficiencies. This syndrome is characterized by severe anemia and leads to difficulty swallowing due to webs of tissue that grow across the upper part of the esophagus.
  • Larynx: Exposure to airborne particles of asbestos, especially in the workplace.

Immigrants from Southeast Asia who use paan (betel quid) in the mouth should be aware that this habit has been strongly associated with an increased risk for oral cancer. Also, consumption of mate, a tea-like beverage habitually consumed by South Americans, has been associated with an increased risk of cancers of the mouth, throat, esophagus, and larynx.

People who are at risk for head and neck cancers should talk with their doctor about ways they can reduce their risk. They should also discuss how often to have checkups.

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Symptoms

Symptoms of several head and neck cancer sites include a lump or sore that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice. Other symptoms may include the following:

  • Oral cavity: A white or red patch on the gums, tongue, or lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.
  • Nasal cavity and sinuses: Sinuses that are blocked and do not clear, chronic sinus infections that do not respond to treatment with antibiotics, bleeding through the nose, frequent headaches, swelling or other trouble with the eyes, pain in the upper teeth, or problems with dentures.
  • Salivary glands: Swelling under the chin or around the jawbone; numbness or paralysis of the muscles in the face; or pain that does not go away in the face, chin, or neck.
  • Oropharynx and hypopharynx: Ear pain.
  • Nasopharynx: Trouble breathing or speaking, frequent headaches, pain or ringing in the ears, or trouble hearing.
  • Larynx: Pain when swallowing, or ear pain.
  • Metastatic squamous neck cancer: Pain in the neck or throat that does not go away.

These symptoms may be caused by cancer or by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms.

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Diagnosis

To find the cause of symptoms, a doctor evaluates a person's medical history, performs a physical examination, and orders diagnostic tests. The exams and tests conducted may vary depending on the symptoms. Examination of a sample of tissue under the microscope is always necessary to confirm a diagnosis of cancer.

Some exams and tests that may be useful are described below:

  • Physical examination may include visual inspection of the oral and nasal cavities, neck, throat, and tongue using a small mirror and/or lights. The doctor may also feel for lumps on the neck, lips, gums, and cheeks.
  • Endoscopy is the use of a thin, lighted tube called an endoscope to examine areas inside the body. The type of endoscope the doctor uses depends on the area being examined. For example, a laryngoscope is inserted through the mouth to view the larynx; an esophagoscope is inserted through the mouth to examine the esophagus; and a nasopharyngoscope is inserted through the nose so the doctor can see the nasal cavity and nasopharynx.
  • Laboratory tests examine samples of blood, urine, or other substances from the body.
  • X-rays create images of areas inside the head and neck on film.
  • CT (or CAT) scan is a series of detailed pictures of areas inside the head and neck created by a computer linked to an X-ray machine.
  • Magnetic resonance imaging (or MRI) uses a powerful magnet linked to a computer to create detailed pictures of areas inside the head and neck.
  • PET scan uses sugar that is modified in a specific way so it is absorbed by cancer cells and appears as dark areas on the scan.
  • Biopsy is the removal of tissue. A pathologist studies the tissue under a microscope to make a diagnosis. A biopsy is the only sure way to tell whether a person has cancer.

If the diagnosis is cancer, 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 (in the operating room), X-rays and other imaging procedures, and laboratory tests. Knowing the stage of the disease helps the doctor plan treatment.

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Treatment

The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person's age and general health. The patient and the doctor should consider treatment options carefully. They should discuss each type of treatment and how it might change the way the patient looks, talks, eats, or breathes.

  • Surgery. The surgeon 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. Surgery may be followed by radiation treatment.

Head and neck surgery often changes the patient's ability to chew, swallow, or talk. The patient may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks. However, lymph node dissection can slow the flow of lymph, which may collect in the tissues; this swelling may last for a long time. After a laryngectomy (surgery to remove the larynx), parts of the neck and throat may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck may be weak and stiff. Patients should report any side effects to their doctor or nurse, and discuss what approach to take. Information about rehabilitation can be found at www.cancer.gov.

  • Radiation therapy, also called radiotherapy. This treatment involves the use of high-energy X-rays to kill cancer cells. Radiation may come from a machine outside the body (external radiation therapy). It can also come from radioactive materials placed directly into or near the area where the cancer cells are found (internal radiation therapy or radiation implant).

In addition to its desired effect on cancer cells, radiation therapy often causes unwanted effects. 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. Other problems that may occur during treatment are loss of taste, which may decrease appetite and affect nutrition, and earaches (caused by hardening of the ear wax). Patients may also notice some swelling or drooping of the skin under the chin and changes in the texture of the skin. The jaw may feel stiff and patients may not be able to open their mouth as wide as before treatment. Patients should report any side effects to their doctor or nurse and ask how to manage these effects.

More information about radiation therapy is available in the NCI booklet Radiation Therapy and You: Support for People With Cancer. NCI publications and materials are available by calling the Cancer Information Service (CIS) at 1-800-4-CANCER (1-800-422-6237), or through the NCI Publications Locator Web site at www.cancer.gov on the Internet.

Chemotherapy, also called anticancer drugs. This treatment is used to kill cancer cells throughout the body. The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, including blood cells that fight infection, cells that line the mouth and the digestive tract, and cells in hair follicles. As a result, patients may have side effects such as lower resistance to infection, sores in the mouth and on the lips, loss of appetite, nausea, vomiting, diarrhea, and hair loss. They may also feel unusually tired and experience skin rash and itching, joint pain, loss of balance, and swelling of the feet or lower legs. Patients should talk with their doctor or nurse about the side effects they are experiencing, and how to handle them. The NCI booklet Chemotherapy and You: Support for People With Cancer has more information about this type of treatment.

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Cancer reference provided by the web site of the National Cancer Institute (www.cancer.gov). The NCI Web site is periodically revised, and content may be deleted or moved. We try to ensure that existing links will redirect to the new page(s).

Cancer Guide