Frequently Asked Questions About Head And Neck Cancer

What is head and neck cancer?

Head and neck cancer (HNC) is a broad term for tumours found in various areas of the head and neck, such as the sinuses, nasal area, mouth, throat, and voice box.¹ A large subset of these cancers, formally known as head and neck squamous cell carcinoma  (HNSCC), accounts for 90% of HNCs.²

HNC has been reported as the 8th most common cancer in the UK, representing 3% of new cancer cases, and is also the 15th leading cause of cancer death, accounting for 2% of cancer-related deaths. HNC cases have been shown to be more common in males, accounting for 69% of cases, while females make up 31%. 

This disease is incredibly complex and can cause a lot of physical and psychological trauma to those who suffer from HNC. Painful tumours around the mouth and throat can lead to significant discomfort and even restrict important daily activities such as speaking, eating, and drinking. Also, in severe cases, where surgical intervention is needed, it can drastically change one’s appearance. All these factors, including having to deal with cancer in the first place, HNC patients require significant psychosocial therapy after their cancer therapy, as a result of their reduced quality of life.³

What are the risk factors of head and neck cancers?

Many associated risk factors contribute to HNC, the most notable of which are tobacco and alcohol.⁴

1. Tobacco

Tobacco is the single leading risk factor for HNC, with a UK national survey implicating tobacco in 70% of oral and pharyngeal HNSCC cases. Tobacco use includes cigarettes, cigars, or pipes; chewing tobacco, and using snuff, with even passive smoking being known to increase the risk of HNC development. Studies have also confirmed the relationship between prolonged and intensive tobacco use and the likelihood of developing HNC.⁵

2. Alcohol

Drinking alcohol contributes to 4% of HNSCC cases worldwide amongst non-smokers. This risk factor increases based on the amount and frequency of alcohol consumed, which is an even higher risk for those who like to drink spirits such as whiskey or vodka.⁶

Research indicates that people who use tobacco and drink alcohol have a significantly higher risk of developing oral cancer compared to those who only smoke or drink. Even though approximately three-quarters of HNC cases are associated with tobacco and alcohol consumption, only a small number of smokers and drinkers eventually develop HNC.²

3. Human Papillomavirus (HPV)

Human Papillomavirus (HPV) is a large group of viruses usually transmitted via oral sex, anal sex or vaginal sex. HPV infections are very common and do not cause symptoms in most people. However, if the person is immunocompromised, HPV can cause a variety of cancers.

Within developed countries, HPV accounts for 72% of all HNSCC cases. Some studies have found that oral HPV infections are closely linked to head and neck cancer, regardless of tobacco and alcohol use.⁷

4. Betel Nut

The betel nut or the areca nut is a popular, chewable, affordable and accessible stimulant and appetite suppressant. It is the fifth most commonly used psychoactive agent after alcohol, nicotine, caffeine, and cannabis.  

As the betel nut is often consumed with tobacco, there have been varying HNSCC risks with and without tobacco use. In South and Southeast Asia and Polynesia, betel nut chewing has been attributed to over half of HNSCC cases.⁸

Immunodeficiency

Immunodeficient people, such as those living with human immunodeficiency virus (HIV) and those who have received solid organ transplants, are at a higher risk for developing head and neck cancer. Individuals living with HIV are two to three times more likely to get HNSCC and also share a comorbidity with HPV. 

Similarly, organ and bone marrow transplant recipients also have an increased risk of cancer in the head and neck area, even though they may not have the usual risk factors. 

What are the common symptoms of head and neck cancer?

Whilst being an uncommon type of cancer, the symptoms develop differently depending on the type and area of HNC.

Mouth

Mouth cancer is the most common type of HNC. Symptoms include painful mouth ulcers and persistent, unexplained painful lumps, which may be located in or around the:

• Lips
• Tongue
• Inside the cheeks
• Floor or roof of the mouth
• Gums

Laryngeal (Voice box)

Laryngeal cancer develops in the tissue of the larynx. Symptoms can include:

• Voice change, such as ongoing hoarseness
• Difficulty or pain when swallowing
• Noisy breathing
• Shortness of breath
• A persistent cough
• A lump or swelling in the neck

Pharynx (Throat) 

The throat has many different parts. Common symptoms include a lump in the neck, a persistent sore throat and difficulty swallowing within these areas:

• Oropharynx – the throat section at the back of the mouth  
• Hypopharynx – links the oropharynx to the gullet and windpipe  
• Nasopharynx – links the back of the nose to the back of the mouth

Salivary glands

Salivary glands produce saliva, which keeps the mouth moist and helps with swallowing and digestion.

There are three main pairs of salivary glands:

• Parotid glands – between the cheeks and ears
• Sublingual glands – under the tongue
• Submandibular glands –under the jawbone

The primary symptom is a lump or swelling on or near the jaw, mouth, or neck, though most are non-cancerous. Other symptoms may include facial numbness and drooping on one side.

Nasal and sinus

Nasal and sinus cancer affects the nasal cavity (area above the roof of the mouth) and the sinuses (small air-filled cavities in the nose and cheekbones).

Symptoms are similar to viral or bacterial infections, like the common cold, which include:

• Persistent blockage of one side of the nose
• Nosebleeds
• Reduced sense of smell
• Mucus drainage from the nose or throat

What are the current methods of treatment?

As each HNC case is different, there is no single suitable method of treatment. Usually, the chosen cancer treatment is often influenced by factors such as tumour size, location, whether it has reached other parts of the body, and even the age of the patient, as a lot of treatment methods have negative life-altering side effects.⁹

Surgery

Surgery is where the tumour is essentially cut out of the body, which makes the tumour a lot smaller and can sometimes remove all the tumour. Surgery has been shown to significantly reduce patient cancer death and improve the quality of the patient’s life as a result of the smaller tumour size.¹⁰

Radiotherapy

Radiotherapy uses radiation to treat cancer. The radiation is positioned where the cancer cells are, and it targets and destroys the cancer cells in that area. However, as cancer cells are treated, the radiation also affects healthy cells, which can cause negative side effects. Fortunately, after radiotherapy, the healthy cells often repair, and the side effects improve.

Chemotherapy

Chemotherapy is where drugs are used to kill cancer cells, and many types of cancer are treated mainly this way. Similar to radiotherapy, chemotherapy also destroys healthy cells as well as cancer cells, which causes a lot of side effects such as fatigue, mouth sores, nausea, and hair loss. However, these side effects often get better or go away after chemotherapy is finished.

There is a method of treatment known as chemoradiation, which is when chemotherapy and radiotherapy are combined, as they can complement each other in more advanced forms of cancer.

Immunotherapy

Immunotherapy is an alternative method of treatment that uses the body’s immune system. Activating cancer-fighting responses or suppressing the immune system can stop cancer from growing.

There are many different types of immunotherapies, and treatment is dependent on the type of cancer and the immune system’s response, which may have been weakened by other methods of treatment, such as chemotherapy.

How can I reduce my risk of getting head and neck cancer?

There are many ways you can prevent HNC, which also benefit your overall health, is as eliminating the largest risk factors from your lifestyle, such as:

• Stop Smoking
• Decrease Alcohol Consumption
• Get HPV Vaccinations
• Practice safe sex
• Limit Betel nut chewing

Summary

Head and Neck cancer (HNC) is a complex disease that manifests around the head and neck and is the 8th most common cancer in the UK, which affects mostly men. Combined smoking, excessive alcohol consumption, HPV transmissions, betel nut chewing and immunodeficiencies are the main risk factors towards developing HNC. HNC can develop in many areas, including the mouth and lips, voice box (larynx), throat (pharynx), salivary glands, nose and sinuses and the area at the back of the nose and mouth (nasopharynx). The main methods of treatment include surgery, radiotherapy, chemotherapy and immunotherapy, which often cause negative side effects. The best way to prevent HNC is by refraining from smoking and betel nut chewing, drinking less and getting HPV vaccinations.