Head and neck cancers

Overview

Head and neck cancers are cancers that start in the head and neck area. There are many kinds of cancer that can happen in the head and neck. Each kind begins as a growth of cells that can invade and destroy healthy body tissue.

Head and neck cancer often refers to cancers that start in the mouth, throat, sinuses and salivary glands. But other cancers can happen in the head and neck and are sometimes considered part of this category too.

Head and neck cancer isn't a diagnosis. Instead, it's a category of cancers that have some things in common. For example, many head and neck cancers share some risk factors and treatments. Most head and neck cancers begin in squamous cells. These thin, flat cells make up the outer layer of the skin. They also line the inside of the nose, mouth and throat. Cancers that begin in the squamous cells are called squamous cell carcinomas. Cancers can begin in other kinds of cells in the head and neck area, though these are less common.

Which treatment you'll have for your head and neck cancer depends on many factors. These might include the location of the cancer, its size and the type of cells involved. Your healthcare team also considers your overall health. Treatment options might include surgery, radiation therapy, chemotherapy and others.

Symptoms

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

Causes

Experts aren't certain exactly what causes head and neck cancers. What causes a cancer may depend on where the cancer starts. Head and neck cancers include cancers that start in the mouth, throat, sinuses and salivary glands.

In general, head and neck cancer starts when a cell in the head and neck area develops changes in its DNA. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Risk factors

Head and neck cancers have some risk factors in common. These include using tobacco and drinking alcohol. Other risk factors depend on the location of the cancer. Head and neck cancers include cancers that start in the mouth, throat, sinuses and salivary glands.

In general, things that increase the risk of head and neck cancers include:

• Using tobacco. Using tobacco of any kind increases the risk of many types of head and neck cancer. Examples of kinds of tobacco include cigarettes, cigars, pipes, chewing tobacco and snuff.
• Drinking alcohol. Frequent and heavy drinking increases the risk of many types of head and neck cancer.
• Being exposed to human papillomavirus, also called HPV. HPV is a common virus that's passed through sexual contact. For most people, it causes no problems and goes away on its own. For others, it can cause changes in cells that can lead to many types of cancer. Many throat cancers are thought to be caused by HPV.
• Breathing chemicals in the air. Exposure to chemicals in the air can increase the risk of cancer in the nose and sinuses. Chemicals at home and at work can increase the risk.
• Being exposed to the sun or tanning lamps. Ultraviolet light from the sun increases the risk of skin cancer of the head and neck. Ultraviolet light also can come from the lights used in tanning beds.

Prevention

To help prevent head and neck cancers, don't smoke and limit the amount of alcohol you drink. Other steps you can take may depend on the specific type of cancer. Head and neck cancers include cancers that start in the mouth, throat, sinuses and salivary glands.

To lower the risk of head and neck cancer:

Don't use tobacco

If you don't smoke or use other kinds of tobacco, don't start. If you do use tobacco, make a plan to quit. Talk with a healthcare professional about things that can help you quit.

Drink alcohol in moderation, if at all

If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.

Ask about the HPV vaccine

Receiving a vaccination to prevent HPV infection may reduce the risk of HPV-related cancers. Ask a healthcare professional whether the HPV vaccine is right for you.

Protect your head and neck from the sun

Wear a hat with a wide brim to shade your head and neck. Use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Apply sunscreen generously. Reapply every two hours, or more often if you're swimming or sweating.

Diagnosis

Head and neck cancer diagnosis often begins with an exam of the head and neck area. Other tests might include imaging tests and a procedure to remove some cells for testing. The tests used for diagnosis may depend on the cancer's location. Head and neck cancers include cancers that start in the mouth, throat, sinuses and salivary glands.

Examining the head and neck area

A healthcare professional may look at your head and neck area for sores or other issues. The health professional might feel your neck for lumps or swelling. To see inside your mouth, the health professional might use a light and a mirror. To see inside the throat, sometimes a tiny camera is put down the throat. The camera transmits images that let the health professional look for signs of cancer. To see inside the nose, a tiny camera can go through the nostrils.

Imaging tests

Imaging tests make pictures of the inside of the body. The pictures can show the size and location of the cancer. Imaging tests used for head and neck cancer include CT, MRI and positron emission tomography scans, also called PET scans.

Removing a sample of tissue for testing

A biopsy is a procedure to remove a sample of tissue for testing in a lab. How the cells are collected depends on the cancer's location. If the cancer is easy to access, a healthcare professional might cut out some of the tissue with a cutting tool. Sometimes a needle can go through the skin and into the cancer to draw out some cells. Special tools can collect cells from inside the throat or inside the nose.

Testing the tissue sample in the lab

The tissue sample collected during a biopsy goes to a lab for testing. Tests can show if the cells are cancerous. Other special tests give more details about the cancer cells. For instance, the cells might be tested for signs of HPV infection. Your healthcare team uses this information to make a treatment plan.

Treatment

Head and neck cancer treatment often involves surgery to remove the cancer. Other treatments might include radiation therapy, chemotherapy and other medicines. Treatment may depend on the location of the cancer. Head and neck cancers include cancers that start in the mouth, throat, sinuses and salivary glands.

Surgery

When possible, surgeons use cutting tools to cut out all of the cancer. They also take a small amount of the healthy tissue around the cancer. This margin of healthy tissue helps ensure that all the cancer cells are removed.

Sometimes the cancer grows into nearby structures and can't be removed. Treatment might start with other options instead, such as radiation therapy and chemotherapy.

Some operations for head and neck cancer can affect your ability to eat and speak. Your healthcare team works to minimize this risk. Reconstructive surgery can help replace bones and tissue that are removed during an operation. Rehabilitation specialists can help you regain the ability to eat and speak.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

Radiation might be used after surgery to kill any cancer cells that are left. If surgery isn't an option, treatment might start with radiation instead.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Chemotherapy is sometimes used at the same time as radiation therapy. When they are used at the same time, chemotherapy helps the radiation therapy work better. If the cancer spreads to other parts of the body, chemotherapy might be used to control the cancer.

Targeted therapy

Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. For head and neck cancer, targeted therapy may be used when the cancer spreads to other parts of the body.

Immunotherapy

Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. It might be an option for head and neck cancer that spreads to other parts of the body.

Palliative care

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. Palliative care is done by a team of healthcare professionals. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family.

Palliative care specialists work with you, your family and your care team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as strong cancer treatments, such as surgery, chemotherapy or radiation therapy. Ask your healthcare team if palliative care is an appropriate option for you.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Clinical trials

Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare professional if you might be able to be in a clinical trial.

Coping and support

People facing a serious illness like cancer often say they feel scared and worried for the future. With time, you'll find ways to cope with your feelings, but you may find comfort in these strategies:

Ask questions about your cancer

Write down questions you have about your cancer. Ask these questions at your next appointment. Also ask your healthcare team for reliable sources where you can get more information. It may help to bring someone with you to your appointments to help you remember all the information you receive.

Knowing more about your cancer and your treatment options may make you more comfortable when you make decisions about your care.

Stay connected to friends and family

Your cancer diagnosis can be stressful for friends and family too. Try to keep them involved in your life.

Your friends and family will likely ask if there's anything they can do to help you. Think of tasks you might like help with, such as caring for your home if you have to stay in the hospital or just listening when you want to talk.

Find someone to talk with

Find someone you can talk with who has experience helping people facing a life-threatening illness. Ask your healthcare team to suggest a counselor or medical social worker you can talk with. For support groups, contact the American Cancer Society or ask your healthcare team about local or online groups.

Preparing for an appointment

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

If you might have head and neck cancer, you may be referred to:

• A doctor who specializes in diseases of the face, mouth, teeth, jaws, salivary glands and neck. This doctor is called an oral and maxillofacial surgeon.
• A doctor who specializes in diseases that affect the ears, nose and throat. This doctor is called an ENT specialist. Another term for this kind of doctor is an otolaryngologist.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet before a test.
• Write down symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements you're taking and the doses.
• Take a family member or friend along. Sometimes it can be hard to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare team is limited, so prepare a list of questions to help you make the most of your time together. List the three most important questions first so you can be sure to ask them before time runs out. List the rest of your questions from most important to least important. Some basic questions to ask include:

• What kind of cancer do I have?
• What other tests do I need?
• What are my treatment options?
• What might happen if I decide that I don't want treatment?
• Is there one treatment that's best for my type and stage of cancer?
• What are the potential side effects of each treatment?
• Should I seek a second opinion? Can you give me the names of specialists you recommend?
• Am I eligible for clinical trials?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

What to expect from your doctor

Be prepared to answer questions about your symptoms and your health, such as:

• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?