Oral, head and neck cancer is a broad term that describes many different cancers that start in the head and neck. Most oral, head and neck cancers begin in the cells that make up the moist tissues (mucosal surfaces) of the mouth, nose and throat. Like other cancers, these cancers occur when abnormal cells begin to grow and divide uncontrollably and form a mass, called a malignant tumor. Doctors identify oral, head and neck cancers by the area in which the cancer begins:
Lip and oral cavity cancer occurs on the lips, the front two-thirds of the tongue, the gums, the lining of the cheeks and lips, the floor of the mouth under the tongue, the palate, and the area behind the wisdom teeth. Salivary gland cancer occurs in the glands that produce saliva, located in front of and just below each ear (parotid glands), under the tongue in the floor of the mouth (sublingual glands) and below the jawbone (submandibular glands). Paranasal sinus and nasal cavity cancer occurs in the small, air-filled pockets in the bones around the nose and in the nasal cavity, the passageway from the nose to the throat.
Nasopharyngeal, oropharyngeal and hypopharyngeal cancers occur in the pharynx, an approximately 5-inch long hollow tube that leads from the nose to the esophagus and the trachea. Laryngeal cancer occurs in the larynx, also called the voice box. The larynx includes the vocal cords and the epiglottis, a piece of tissue that moves to cover the trachea (windpipe) during swallowing. Note: Cancers of the brain, eye, thyroid, as well as the skin, bones, muscles and nerves of the head and neck are not included under the heading of “oral, head and neck” cancer.
What’s My Risk of Getting Oral, Head or Neck Cancer? People who have the following characteristics may be at increased risk of developing oral, head or neck cancers: Male Age 50 or older Heavy use of alcohol Use of tobacco, including smokeless tobacco The National Cancer Institute estimates that 85 percent of oral, head and neck cancers are linked to tobacco use. People who use both tobacco and alcohol are at greater risk than those who use either tobacco or alcohol alone.
Individual types of oral, head and neck cancers also have specific risk factors: Lip and oral cavity cancer: Exposure to sun and, possibly, infection with the human papillomavirus (HPV). Salivary gland cancer: Radiation to the head and neck from diagnostic X-rays or from treatment for cancer or other conditions. Paranasal sinus and nasal cavity cancer: Exposure to some industrial materials, including dust from wood or nickel. Use of tobacco and alcohol may play a lesser role than in other oral, head and neck cancers.
Nasopharyngeal cancer: Asian ancestry, particularly Chinese. Infection with Epstein-Barr virus, exposure to wood dust, and consumption of some preservatives or salted foods. Oropharyngeal cancer: Potential but not proven risk factors include poor oral hygiene, HPV infection and use of mouthwashes with high alcohol content. Hypopharyngeal cancer: Having a rare disorder called Plummer-Vinson Syndrome, which is also called Paterson-Kelly Syndrome. Laryngeal cancer: Exposure to airborne asbestos particles, especially in the workplace.]
Keeping in mind that less serious conditions may cause symptoms similar to those of oral, head or neck cancer, check with your doctor or dentist if you have: A lump or sore that does not heal, such as on the lip or in the mouth Persistent sore throat Trouble swallowing A change in voice or hoarseness Other symptoms apply to specific types of oral, head and neck cancer: Lip and oral cavity cancer: White or red patches on the gums, tongue or lining of the mouth, swelling in the jaw, unusual bleeding or pain in the mouth. Salivary gland cancer:
Swelling around the jawbone or under the chin, numbness in face muscles, persistent pain in the face, chin or neck Paranasal sinus and nasal cavity cancer: Blocked sinuses that do not clear, sinus infections that do not respond to antibiotic treatment, nosebleeds, frequent headaches, swelling in the eyes, pain in the upper teeth, problems with dentures Nasopharyngeal cancer: Trouble breathing or speaking, frequent headaches, ringing in the ears, pain in the ears, trouble hearing Oropharyngeal and hypopharyngeal cancers: Pain in the ears Laryngeal cancer:
Ear pain, pain when swallowing If symptoms warrant further action, physicians usually begin by taking a person’s medical history and by performing a thorough physical examination. They may insert a thin, lighted tube called an endoscope to examine areas that they cannot see during a physical exam. For example, an esophagoscope is inserted through the mouth to examine the esophagus and a nasopharyngoscope is inserted through the nose to examine the nasal cavity and nasopharynx. Doctors may also use imaging techniques to check other parts of the body for signs of cancer, such as:
Standard X-rays: Before an X-ray, patients may be asked to swallow barium, a substance that helps doctors spot tumors on X-ray images. Computed axial tomography (CT or CAT scan): A CT scan uses several X-ray beams and a sophisticated computer system to make three-dimensional images that look like slices of the body. CAT scans can identify tumors that are much smaller than those seen with an X-ray. Magnetic resonance imaging (MRI): MRI uses energy from radio waves and strong magnets to make a detailed picture of the body. No X-rays are involved.
The test is especially helpful in finding cancer that has spread to the other parts of the body. Finally, all diagnoses of cancer are confirmed with a biopsy, in which doctors remove a small amount of tissue and examine it under a microscope to look for cancer cells. With many cancers of the head and neck, physicians use a procedure called fine needle biopsy, which employs a thin needle to remove tissue or fluid for examination. Doctors use “staging” to characterize the cancer and help determine prognosis and treatment plans. Staging is based on: The exact location of the cancerю
The size of the cancer Whether or not cancer has spread to other places in the body If cancer has spread, which parts of the body are affected Most oral, head and neck cancers have a number of stages. Lip and oral cavity cancer: There are seven stages, numbered 0, I, II, III, IVA, IVB, IVC, based on the size of the cancer and whether it has spread. People who have had lip and oral cavity cancer are at an increased risk of developing a second cancer in the head or neck, so follow-up care is especially important. Salivary gland cancer: Stages are I, II, III, IVA, IVB, IVC.
A person’s prognosis depends on stage, tumor size, the type of gland the cancer is in and the kind of cancer cells present, as well as a person’s age and general health. Paranasal sinus and nasal cavity cancer: These cancers (actually four types) are especially complex. There is no standard staging system for sphenoid and frontal sinus cancer, and different definitions exist for stages of cancers involving the maxillary and ethmoid sinuses, as well as for nasal cavity cancers. By the time they are diagnosed, paranasal sinus and nasal cavity cancers often have spread and can be difficult to cure.
People who have had these cancers are at an increased risk of developing a second head or neck cancer, making follow-up treatment very important. Nasopharyngeal cancer: Stages are 0, I, IIA, IIB, III, IVA, IVB, IVC. A person’s prognosis depends on stage, tumor size, the type of nasopharyngeal cancer, as well as a person’s general health. Oropharyngeal cancer: Stages are 0, I, II, III, IVA, IVB, IVC, based on location and extent of spread, possibly to the main artery in the neck, the bones in the jaw or skull, the muscle in the side of the jaw or the upper part of the throat, and the nearby lymph nodes or other parts of the body.
A person’s prognosis depends on cancer stage, location and whether the cancer is associated with HPV infection. Hypopharyngeal cancer: Stages are 0, I, II, III, IVA, IVB, IVC. Because early symptoms are rare, hypopharyngeal cancer is usually detected in later stages. A person’s prognosis depends on cancer stage and location, as well as a person’s age and general health, and whether he or she smokes during radiation therapy. Laryngeal cancer: Stage depends on where in the larynx the cancer started: the supraglottis, the glottis or the subglottis.
Beside stage 0, where the cancer is found only in the cells that line the larynx, stages I through III are defined differently for the supraglottis, glottis or subglottis, and in stage IVA through C, each substage is the same for cancers in the supraglottis, glottis or subglottis. A person’s prognosis depends on the cancer stage and location, tumor size and grade, his or her age, gender and general health. Smoking tobacco and drinking alcohol decrease the effectiveness of treatment, so people who continue to smoke and drink are less likely to recover and more likely to develop a second tumor.
How Is Oral, Head and Neck Cancer Treated? [illo of patient receiving treatment? ] Treatment for oral, head and neck cancers depends on: The stage of the cancer The size and location of the tumor A person’s general health Whether a person smokes tobacco or is a heavy drinker Many other factors that can vary greatly from person to person In general, however, doctors choose from among three treatment types for oral, head and neck cancers – surgery, radiation therapy, and/or chemotherapy. Some of the most common treatments for specific oral, head and neck cancers are:
Lip and Oral Cavity Cancer: Surgery and radiation therapy, either alone or in combination. After the cancer is removed, many people have reconstructive surgery to repair parts of the mouth, throat or neck. These surgeries, which include skin grafts and dental implants, help to restore both function and appearance. Radiation therapy for lip and oral cancer works best for smokers if they stop using tobacco before treatment begins. People who smoke while undergoing radiation therapy seem to have lower response rates and shorter survival times than people who don’t smoke during treatment.
Salivary Gland Cancer: Standard treatments are surgery and radiation therapy. Chemotherapy is used less often, though some drugs are under evaluation in clinical trials. Paranasal Sinus and Nasal Cavity Cancer: Most types of paranasal sinus and nasal cavity cancer are treated either with surgery, radiation therapy or surgery followed by radiation therapy. Nasopharyngeal Cancer: High-dose radiation therapy, sometimes combined with chemotherapy, is the primary treatment for nasopharyngeal cancer.
Oropharyngeal Cancer: In general, surgery and radiation therapy. Sometimes, especially in more advanced cases, physicians may suggest both treatments – surgery followed by radiation therapy. Hypopharyngeal Cancer: Surgery, radiation therapy, chemotherapy or a combination of these treatments. Except for cancers in very early stages, primary treatment for hypopharyngeal cancer is surgery, usually followed by radiation therapy. Laryngeal Cancer: Surgery, radiation therapy, chemotherapy or a combination of these treatments.
Because laryngeal cancer may affect the voice box, doctors and patients must give careful consideration to treatments that preserve the voice. After the cancer is removed from the lip or oral cavity, many people have reconstructive surgery to repair parts of the mouth, throat or neck. These surgeries, which can include skin grafts and dental implants, help to restore both function and appearance. Speech and occupational therapy are also commonly recommended to restore speech patterns and help a patient return to normal social functioning.
When considering surgery for oropharyngeal cancer, because a tumor can be located in the base of the tongue or the tonsils, doctors and patients must carefully weigh the effect removing a tumor will have on function and appearance. In cases where the effect will be great, doctors may recommend radiation therapy only, especially for stage I and II cancers. Scientists are testing several potential treatments in clinical trials to see if they are effective against oral, head and neck cancer. They include:
Chemotherapy – used to shrink tumors before surgery or radiation therapy, and combinations of drugs are sometimes used in addition to surgery Radiation therapy – given in smaller than usual doses two or three times a day Hyperthermia treatment – heating the body tissues above normal temperatures to damage and kill cancer cells or make them more sensitive to radiation therapy or medications.
Radiosensitizer drugs – given to make cancer cells more sensitive to radiation Intensity-modulated radiation therapy (IMRT) – using computer-generated images to show the size and shape of a tumor so that beams of differing intensity radiation can be aimed at it from many angles Biologic therapy – using proteins made in living cells or organisms that are highly targeted to act on specific proteins in the body that are involved in a disease process.
Chemoprevention – taking drugs, vitamins and other substances in an effort to reduce the risk of either developing cancer or having it come back For information on ongoing clinical trials, see the National Cancer Institute’s listing of cancer clinical trails or call the NCI at 1 (800) 4-CANCER.