What Is Head and Neck Cancer? Causes, Symptoms, Diagnosis, Treatment, and Prevention

Head and neck cancers can affect the throat, mouth, nose, sinuses, salivary glands, or voice box.

Head and neck cancer is a broad term that describes different types of cancers that develop in the head and neck region of the body.

According to the National Institutes of Health, head and neck cancers can affect the throat, mouth, nose, sinuses, salivary glands, or voice box. But the National Cancer Institute (NCI) points out that, despite their locations, cancers that start in the brain, eye, thyroid, or esophagus are not considered head and neck cancers and may require different treatments.

Most head and neck cancers are squamous cell cancers, which means they begin in the tissues that line the surface of the head and neck.

The Cleveland Clinic notes that the majority of head and neck cancers are preventable and, if caught early, often treatable.

The five main types of head and neck cancer are:

Laryngeal and hypopharyngeal cancer Laryngeal cancer develops in the larynx, which is commonly known as the voice box and is an important organ for talking, breathing, and swallowing. Hypopharyngeal cancer affects the hypopharynx, which is the bottom area of the throat that surrounds the voice box.
Nasal cavity and paranasal sinus cancer Nasal cavity cancer affects the area just behind the nose where air passes when making its way to the throat. Paranasal sinus cancer develops in the air-filled spaces that surround the nasal cavity.
Nasopharyngeal cancer This cancer forms in the nasopharynx, which is an air passageway that sits at the upper part of the throat.
Oral and oropharyngeal cancer These cancers occur in the oral cavity (the mouth and tongue) and the oropharynx, which runs from the tonsils to the edge of the voice box.
Salivary gland cancer This type of cancer occurs in the mouth’s salivary glands, which produce saliva.

According to Moffitt Cancer Center, researchers aren’t sure exactly what causes head and neck cancers to develop. But they have identified certain factors that increase the likelihood that a person will develop this type of cancer.

The Centers for Disease Control and Prevention (CDC) lists the following risk factors for head and neck cancer.

Tobacco use Seventy to 80 percent of head and neck cancers are linked to tobacco use, according to Cleveland Clinic. Tobacco use includes the use of cigarettes, cigars, pipes, chewing tobacco, snuff, or dip. Exposure to secondhand smoke is also a risk factor.
Alcohol consumption Excessive alcohol use increases the risk of head and neck cancer.
Human papillomavirus (HPV) HPV is a sexually transmitted virus. The CDC reports that about 70 percent of oropharyngeal cancers are linked to HPV.
Epstein-Barr virus This virus causes mononucleosis and other illnesses. People who are infected with the Epstein-Barr virus are more likely to develop cancer in the nose, behind the nose, and in the salivary glands.
Ultraviolet light exposure Exposure to the sun’s rays or artificial light from tanning beds can raise a person’s risk of developing head and neck cancer, especially cancer on the lips.
Radiation treatments Radiation treatments to the head and neck area have been linked to the formation of head and neck cancer.
A weakened immune system People with a weakened immune system may be more likely to develop head and neck cancer.
Exposure to occupational toxins Certain workplace chemicals, such as wood dust, formaldehyde, asbestos, and nickel, can increase the risk of head and neck cancer.
Sex More men than women develop head and neck cancer.
Genes Some genetic disorders can increase a person’s chance of developing head and neck cancer.
Asian ancestry People of Asian descent are more prone to nasopharyngeal cancer.
Age People older than 50 are more likely to develop head and neck cancer.

Symptoms of head and neck cancer are often difficult to identify because they can be mild or mimic other conditions. According to Cleveland Clinic, a sore throat that doesn’t go away is the most common sign.

Other symptoms may include:

A lump in the neck, throat, or mouth
A sore in the mouth or throat that doesn’t heal
Trouble swallowing or pain when swallowing
Trouble breathing or talking
Hoarseness or other voice changes
Headaches
Neck pain
Pain in the face or upper teeth
Facial numbness
Nosebleeds, phlegm, or bloody saliva
Frequent earaches or sinus infections
A white or red patch on the gums, tongue, or inside of the mouth
Swelling in the neck, jaw, or side of the face

Doctors may use different approaches to diagnose head and neck cancer. Some of these include:

A physical exam Health providers may check a person’s oral and nasal cavities, throat, neck, and tongue. Additionally, they may feel for lumps in the lips, neck, gums, or cheeks.
Endoscopy With this procedure, doctors use a thin lighted tube with a camera on the end to see inside a person’s nasal cavity, throat, voice box, or other areas.
Imaging tests Certain imaging techniques can create pictures of areas inside the head and neck. Doctors might recommend an X-ray, CT scan, MRI, or PET scan to make a diagnosis.
Biopsy In a biopsy, a small piece of tissue is removed and analyzed for cancer cells under a microscope.
Blood tests Health providers might suggest that patients have a blood test to look for certain proteins that are commonly found in head and neck cancers. Or they may want to find out if a patient has HPV or the Epstein-Barr virus.

After doctors diagnose head and neck cancer, they will attempt to determine the cancer’s stage. Staging is the process of finding out the extent of cancer in a person’s body. Identifying the cancer’s stage can help health providers recommend appropriate treatment options.

To stage head and neck cancers, doctors use a system called TNM (tumor, node, metastasis). The TNM system takes different factors into account, including the tumor’s size and location; whether it has spread to lymph nodes; and whether it has metastasized.

After analyzing this information, health providers assign head and neck cancers a numerical stage of 1, 2, 3, or 4. The higher the number, the more advanced the cancer.

Treatment options for head and neck cancer will depend on the location of the cancer, how advanced it is, a person’s overall health, and other factors. Sometimes, doctors might recommend a combination of treatments.

Surgery

Surgery may be an option for some head and neck cancers. Typically, surgeons aim to remove the tumor and a margin of healthy tissue. Lymph nodes may also need to be removed if the cancer has spread to them. Some people with head and neck cancer may require more than one surgery.

Chemotherapy

Chemotherapy is a treatment that uses drugs to destroy cancer cells in the body. Chemotherapy is used more often in advanced head and neck cancers.

Radiation

Radiation therapy delivers beams of high energy to kill cancer cells. People with head and neck cancers might receive radiation only, or it might be combined with other treatments. Sometimes, radiation is used for the sole purpose of relieving symptoms of head and neck cancer.

Targeted Therapy

Targeted therapy involves medicines that target specific proteins that control how cancer cells grow, divide, and spread. These therapies can be effective if an individual’s tumor contains specific abnormalities.

Some examples of targeted therapies that are used for certain types of head and neck cancer include:

Cetuximab (Erbitux) This drug targets a tumor protein called epidermal growth factor (EGFR).
Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) These drugs are used to treat tumors that contain NTRK gene mutations.

Targeted treatments are often used in combination with other therapies for people with advanced head and neck cancers.

Immunotherapy

Immunotherapy is a treatment that harnesses the body’s own immune system to identify and fight cancer cells. The two immunotherapies approved to treat specific types of advanced head and neck cancer include the drugs pembrolizumab (Keytruda) and nivolumab (Opdivo).

Clinical Trials

Clinical trials are studies that are conducted to test the safety and effectiveness of new treatments. Some people with head and neck cancer may opt to participate in a clinical trial in hopes of receiving a novel therapy that isn’t yet available to the public. Cleveland Clinic notes that new immunotherapy drugs and radiation techniques are currently being researched for head and neck cancer in clinical trials.

Complications associated with head and neck cancer are often due to the treatments received.

Head and neck cancer surgery can affect how people swallow, chew, breathe, hear, or talk. Some patients will need to undergo rehabilitation approaches, such as physical therapy, speech therapy, or dietary counseling to cope with these side effects.

If lymph nodes are removed during surgery, some people may experience lymphedema, a condition that causes lymph fluid to build up in the fatty tissues just under the skin. Additionally, surgical procedures may lead to facial disfigurement, which might require reconstructive procedures.

Radiation therapy to the head and neck may cause the following problems:

Voice changes
Difficulty swallowing
Dry mouth
An underactive thyroid
A change in the sense of taste
Lymphedema
Skin irritation
Bone pain
Swelling
Fatigue
Nausea
Mouth sores
Sore throat

Side effects of medicines, such as chemotherapy, might include:

Fatigue
Infection
Nausea or vomiting
Hair loss
Loss of appetite
Diarrhea

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Head and Neck Cancer Prognosis

The outlook for someone with head and neck cancer depends on the stage of the cancer, the type of cancer, the treatments received, a person’s overall health, and other factors.

According to Cleveland Clinic, the five-year survival rate for individuals with stage 1 or stage 2 head and neck cancer ranges from 70 percent to 90 percent. This means that between 70 percent and 90 percent of people who are diagnosed with these earlier stages of head and neck cancer are alive five years later.

Head and neck cancers are relatively rare, accounting for about 4 percent of all cancers in the United States, according to the NCI. Nearly 67,000 Americans are diagnosed with head and neck cancers each year. Most of these cancers are cancers of the throat, mouth, or voice box.

Researchers estimate that about 15,400 deaths from head and neck cancer will occur in the United States in 2023, according to Cancer.Net.

According to Moffitt Cancer Center, there are currently no head and neck cancer screening techniques that have been shown to improve outcomes. But the NCI says dentists should check the mouth for signs of cancer during routine checkups.

While head and neck cancers can’t be completely prevented, the CDC says there are some effective strategies to lower the risk of this disease, including the following:

Don’t smoke or use smokeless tobacco products. If you already smoke or use tobacco products, quit.
Limit alcohol consumption. The CDC says men should have no more than two drinks per day. For women, the recommendation is no more than one drink a day.
Get the HPV vaccine. For those who are candidates, HPV vaccination can prevent new infections.
Practice safe sex. Condom use can lower a person’s chances of getting HPV.
Use sun safety measures. Wide-brimmed hats, lip balm that contains sunscreen, and abstention from tanning salons protect a person from exposure to cancer-causing rays.
Schedule regular dental visits. A dentist may detect cancers in the mouth at an earlier stage.
Limit exposure to workplace chemicals Wear appropriate gear to protect yourself against toxins.