What Is Head And Neck Cancer?

Overview

Cancers of the head and neck are one of the most common types of cancer. These cancers can be classified according to their anatomic origin. They typically occur in the paranasal sinuses, the nasal cavity, the nasopharynx, the oropharynx, the oral cavity, the hypopharynx, and the larynx.¹ The most common type of head and neck cancer is squamous cell carcinoma, which accounts for more than 90% of the cases and has a mortality rate of 50%. There are many factors that can predispose a person to head and neck cancers, including Human Papilloma Virus (HPV) and Epstein-Barr virus infections as well as increased consumption of both alcohol and tobacco. The treatment for head and neck malignancies is usually dependent on the site of the tumour growth. It remains challenging to treat and may require multiple adjunctive approaches, such as surgeries combined with radiotherapy. This article will describe the signs and symptoms of common head and neck cancers, discussing the process of diagnosis and treatment along the way. 

Types of head and neck cancer

Head and neck cancers can be classified according to the region where they occur, ranging from the head to the throat but excluding the brain and the eyes. These include:²

• Oral cancer: One of the most common head and neck cancers. It affects the lips and parts of the oral cavity, including the tongue and the base of the mouth. Causes of oral cancer are mostly associated with smoking, tobacco chewing and alcohol consumption
• Oropharyngeal cancer: A cancer that is primarily caused by tobacco consumption and HPV infections
• Laryngeal cancer: This cancer affects people assigned male at birth (AMAB) more than people assigned female at birth (AFAB) (6:1 ratio). Survivors tend to suffer from respiratory and phonetic problems 
• Hypopharyngeal cancer: This is a rare cancer type that affects the hypopharynx (the lower part of the throat). It appears to be asymptomatic in most patients and progresses slowly 
• Nasopharyngeal cancer: The nasopharynx is located in the upper part of the throat. It is a very rare cancer that has 3 further sub-types: keratinising, non-keratinising and basaloid
• Sinonasal cancer: This cancer type affects the nasal cavity and accounts for 0.2% of cancers globally, making it a rare form of head and neck cancers
• Salivary glands cancer: This is a very rare cancer type that affects the salivary glands. It is mainly diagnosed once a patient experiences difficulty and pain during swallowing 

Causes and risk factors of head and neck cancer

There are different risk factors that may contribute to the development of head and neck cancers, including:³

• Tobacco use: Consumption of tobacco, in the form of cigarettes, pipes, snuff or chewable tobacco, is the most significant risk factor for head and neck cancers, with approximately 80% of cases being attributed to it. Cancer progression and chance of recovery are dependent on the patient’s tobacco use
• Alcohol consumption: Exceeding the recommended limit of alcohol intake increases your risk of developing head and neck cancer. Heavy consumption of alcohol may lead to the development of cancer in multiple areas, including the oral cavity, pharynx, larynx, and oesophagus
• Human Papilloma Virus (HPV): HPV is a very common viral infection which is sexually transmitted. It is highly prevalent in people AFAB. However, people AFAB can be treated much more easily than people AMAB. It is directly related to many types of cancers,  including oropharyngeal cancer and genital cancers
• Genetic causes: The presence of certain gene variations can increase the risk of developing cancer. For example, the GSTM1 gene can be susceptible to mutations that may predispose an individual to certain head and neck cancers
• Poor oral hygiene: This can lead to the development of oral cancers as specific types of fungal and bacterial infections are more likely to occur
• Prolonged exposure to certain substances: Exposure to asbestos may predispose individuals to sinonasal cancers. In addition, sun exposure is the main cause of lip cancer

Signs and symptoms of head and neck cancer

The signs and symptoms differ according to the anatomical region where the cancer occurs. However, general symptoms of head and neck cancers include:

• lumps or swelling in the neck or around the jaw
• Soreness in the throat and mouth
• Headaches 
• Trouble hearing
• Difficulty swallowing
• Change in voice (hoarseness)
• White or red patches on the gums or the tongue
• Mouth ulcers
• Blocked sinuses that are not resolved with antibiotics
• Numbness

Management and treatment for head and neck cancer

Due to the diversity of factors that can contribute to the development of head and neck cancer, multiple different interventions may be required for effective management and treatment.⁴ Treatment modalities may include one or more of the following:

• Surgery: Used for large invasive types of cancer to remove the affected lymph nodes and any associated regions, thus eliminating the risk of recurrence 
• Radiation therapy: This involves the use of high-energy radiation from X-rays, gamma rays, neutrons, and protons to kill cancer cells. For head and neck cancers, a linear accelerator machine is used to direct high-energy radiation to the site of the tumour 
• Chemotherapy: This treatment option is usually used when the cancer has progressed considerably. It is used to stop the growth of cancer cells. It can be administered orally or through injection. It can also be given as a single treatment or as an adjunct to other treatments
• Immunotherapy: This option is mainly used for recurrent cancers or for when cancer has begun to metastasise. It is used in patients with nasopharyngeal cancer and those who are infected with HPV
• Targeted therapy: This treatment utilises drugs that target the epidermal growth factor, in turn halting the growth and division of cancer cells. These drugs can also be used to treat cancers related to HPV infection. The most common drug used is Cetuximab⁵

Diagnosis of head and neck cancer

To diagnose head and neck cancers, a physician will perform a physical examination, examining any abnormalities present on the neck or in the oral cavity.²

If an abnormality is identified, an incisional biopsy is conducted. This is where a small piece of the abnormal tissue is cut and a sample is taken to the laboratory for investigation. Fine needle aspiration, a procedure where a thin needle is used to extract cells from a tumour, may also be done as a diagnostic technique. 

Diagnostic imaging, including CT, MRI and PET scans, is used to determine the size and progression stage of a cancerous lesion. It can also aid in determining if cancer cells have invaded the lymph nodes.

FAQs

How can I prevent head and neck cancers?

Primary prevention starts with the elimination of causative agents that are associated with head and neck cancers. Steps that can be taken include:

• Quit smoking: If you are a smoker, this should be the first step you take to prevent the development of head and neck cancers. It is advised to use different methods to help you quit smoking, such as nicotine replacement therapy (NRT), nicotine patches, gum, lozenges, nasal spray and oral inhalers, as well as non-nicotine oral medications, including bupropion and varenicline
• Reduce alcohol consumption: According to the National Cancer Institute, the maximum alcohol intake per day should be limited to one drink per day for people AFAB and up to two drinks for people AMAB
• Receive a HPV vaccination: A vaccination is available against the HPV-16 variant and can be administered after consultation with your physician to protect you from HPV infection⁶

How common is head and neck cancer?

Head and neck cancers account for more than 500,000 cases yearly. They lead to approximately 250,000 deaths. It is 2 to 4 times more prevalent in people AMAB compared to people AFAB. The risk of having head and neck cancers increases with age, with most patients being over the age of 60.⁴ 

When should I see a doctor?

Regular check-ups are always recommended to increase survival rates and allow the early detection of any disease. In addition, when patients feel any abnormality, they should not delay their visit to their doctor. Primary care physicians play an important role in the diagnosis of different types of cancers and according to the diagnostic findings, they may rapidly refer your case to an appropriate specialist physician, such as an otolaryngologist. Dentists also play an important role in diagnosing oral cancer, so it is important to also have regular dental appointments.

Summary

Head and neck cancers are challenging to diagnose and are usually associated with a poor prognosis. Therefore, early diagnosis of the disease is significant and can help in achieving a higher survival rate, as well as a better quality of life for the patient following treatment. You are at a higher risk of head and neck cancers if you are a smoker, regularly drink alcohol or have a HPV infection. Although everyone should aim to prevent cancers by avoiding risk factors, head and neck cancers can be treated with surgery, radiotherapy, chemotherapy, immunotherapy and targeted therapies. It should also be mentioned that in the case that you have recovered from cancer, you should have regular follow-up appointments which allow you to track any changes in your health.