Head & Neck Cancer

Introduction : “Head and neck cancer” is a broad category that includes several cancers that start in regions of your head and neck. Most start in squamous cells that make up the moist tissue lining your mouth, throat (pharynx), voice box or nasal cavity.

Head and neck cancer symptoms are often mild. They can mimic less serious conditions like a cold or sore throat. A sore throat that doesn’t get better is the most common sign of head and neck cancer.

Depending on the type of head and neck cancer, you may experience:

A persistent sore throat.
Persistent earaches or symptoms of ear infections (especially when your ear looks normal to your healthcare provider).
Frequent headaches.
Pain in your face or neck that won’t go away.
Pain in your upper teeth.
Pain when you chew or swallow.
Hoarseness or voice changes.
Trouble breathing or speaking.

You may notice:

A lump in your throat, mouth or neck.
A mouth or tongue sore that doesn’t heal.
Frequent nosebleeds, bloody saliva or phlegm.
A white or red patch on your gums, tongue or inside your mouth.
Swelling in your jaw, neck or side of your face (that may cause your dentures to fit poorly).

The most common risk factors for head and neck cancer include:

Tobacco use: Approximately 70% to 80% of head and neck cancers worldwide are linked to tobacco use. This includes smoking cigarettes or cigars and using snuff or any type of chewing tobacco. Exposure to secondhand smoke may also increase your risk.
Alcohol consumption: Consuming too much alcohol can increase your risk. This is especially the case if you also use tobacco.
Human papillomavirus (HPV): In developed nations, including the United States, HPV infection is overtaking tobacco use as the greatest risk factor associated with head and neck cancer.
Betel nut chewing: Chewing betel nuts is a common practice in Southern and Southeast Asia and Polynesia. It accounts for more than half of head and neck cancers in these regions.

Other risk factors include:

Epstein-Barr virus (EBV): An EBV infection can lead to nasopharyngeal cancer or salivary gland cancer.
Weak immune system: A weakened immune system makes it harder for your body to fight cancer. HIV infection and recent major surgeries (like organ or bone marrow transplants) have both been associated with cancer resulting from weakened immune systems.
Genetics: Your genes may increase your cancer risk. For example, people with Fanconi anemia inherit genes that increase their risk of head and neck cancers. The risk is greater if you have predisposing genes and you also use tobacco.
Long-term exposure to cancer-causing substances: Several carcinogens may cause head and neck cancers. These include asbestos, pesticides, wood dust and paint fumes.
Radiation exposure: Prior radiation therapy to the head and neck has been linked to salivary gland cancer and other head and neck cancers.
Salt-cured foods: Regularly eating salt-cured meat and fish can increase your risk of nasopharyngeal cancer.
Poor oral hygiene: Not taking care of your teeth and gums can increase your risk of oral cancer.

Diagnosis usually begins with a physical exam. During the exam, your provider will check your mouth, nasal cavities, throat and neck. They may feel your neck, lips, gums and cheeks for lumps.

Based on your provider’s findings, you’ll likely need tests, which may include:

An endoscopy: This procedure uses a thin, lighted tube that allows your provider to see inside your nasal cavity, throat or voice box. It’s usually an in-office procedure.
Imaging tests: X-rays of your head and neck, CT scans, MRIs and PET scans can show tumors inside your body.
Lab tests: Your provider may do an HPV test to check for the HPV virus as a cause of cancer if they see something concerning.
A biopsy: A biopsy is the only way to confirm that a tumor is cancerous. Your provider will remove tissue from the tumor, and a pathologist will test it for cancer cells.

The main head and neck cancer treatments are:

Surgery: Whenever possible, surgeons attempt to remove the tumor and a margin of surrounding healthy tissue. Your surgeon may also remove lymph nodes in your neck if they suspect the cancer has spread there or has a reasonably high risk of spreading there.
Radiation therapy: The most common form of radiation for head and neck tumors uses a machine that directs high-energy X-rays toward cancer cells (EBRT). You may receive radiation alone or alongside other treatments like surgery and chemotherapy.
Chemotherapy: This uses drugs to kill cancer cells, especially in advanced-stage head and neck cancer. You may receive chemo alongside radiation treatment.

Your healthcare provider may recommend other treatments, especially if your cancer is advanced or if it went away after treatment but then came back:

Targeted therapy: These drugs are most often used with other treatments for advanced head and neck cancers. The U.S. Food and Drug Administration (FDA)-approved targeted therapy drugs for head and neck cancer include Cetuximab (Erbitux^®) and Larotrectinib (Vitrakvi^®).
Immunotherapy: These drugs help your immune system identify and destroy cancer cells. Pembrolizumab (Keytruda^®) and Nivolumab (Opdivo^®) are two immunotherapy drugs that treat certain head and neck cancers that have spread or returned following treatment.
Reconstructive surgery or prosthetics may help you achieve your desired appearance following treatment.

The stage wise 5-year survival percentages

1. Oral Cavity (Mouth, Tongue, Lips, Gums)

Stage 1: ~80–90%
Stage 2: ~70–80%
Stage 3: ~50–65%
Stage 4: ~20–40%

2. Oropharynx (Tonsils, Base of Tongue, Soft Palate)

HPV-Positive (Better Prognosis):
- Stage 1: ~90%
- Stage 2: ~85%
- Stage 3: ~70–80%
- Stage 4: ~50–60%
HPV-Negative:
- Stage 1: ~60–70%
- Stage 2: ~50–60%
- Stage 3: ~30–40%
- Stage 4: ~20–30%

3. Larynx (Voice Box)

Supraglottic (Above the Vocal Cords):
- Stage 1: ~60–75%
- Stage 2: ~55–70%
- Stage 3: ~45–50%
- Stage 4: ~25–40%
Glottic (Vocal Cords):
- Stage 1: ~90%
- Stage 2: ~75–85%
- Stage 3: ~65–70%
- Stage 4: ~45–55%

4. Hypopharynx (Lower Throat)

Stage 1: ~60%
Stage 2: ~40–50%
Stage 3: ~35–40%
Stage 4: ~20–30%

5. Nasopharynx

Stage 1: ~85–90%
Stage 2: ~75–85%
Stage 3: ~60–70%
Stage 4: ~35–50%

6. Salivary Glands

Stage 1: ~90%
Stage 2: ~75–85%
Stage 3: ~60–70%
Stage 4: ~40–50%

You can take steps to help prevent most head and neck cancers. To protect yourself:

Quit tobacco. Stop using all forms of tobacco (cigarettes, cigars, pipes, snuff, dip and chewing tobacco).
Cut back on drinking. Reducing your alcohol intake or cutting it out can reduce your cancer risk.
Get the HPV vaccine. Gardasil 9^® is the HPV vaccine approved in the U.S. It protects against several strains of HPV, including those that cause throat cancer.
Use sun protection. Wearing sunscreen and protective clothing when you’re outside can reduce your risk of skin cancer. Although it’s not technically a head and neck cancer, skin cancer is the most common cancer that affects your head, neck and face.