- What is cancer?
Cancer is a group of many related diseases that begin in cells,
the body's basic unit of life. Normally, cells grow and divide to form new
cells in an orderly way. They perform their functions for a while, and then
they die. Sometimes, however, cells do not die. Instead, they continue to
divide and create new cells that the body does not need. The extra cells form
a mass of tissue,
called a growth or tumor. There are two types of tumors: benign
and malignant.
Benign tumors are not cancer. They do not invade nearby tissue or spread to
other parts of the body. Malignant tumors are cancer. Their growth invades
normal structures near the tumor and spreads to other parts of the body. Metastasis
is the spread of cancer beyond one location in the body.
- What kinds of cancers are considered cancers of the head
and neck?
Most head and neck cancers begin in the cells that line the mucosal surfaces
in the head and neck area, e.g., mouth, nose, and throat. Mucosal surfaces
are moist tissues lining hollow organs
and cavities of the body open to the environment. Normal mucosal cells look
like scales (squamous) under the microscope, so head and neck cancers are
often referred to as squamous
cell carcinomas. Some head and neck cancers begin in other types of cells.
For example, cancers that begin in glandular cells are called adenocarcinomas.
Cancers of the head and neck are further identified by the area in which
they begin:
- Oral
cavity. The oral cavity includes the lips, the front two-thirds
of the tongue, the gingiva (gums), the buccal
mucosa (lining inside the cheeks and lips), the floor (bottom) of the
mouth under the tongue, the hard
palate (bony top of the mouth), and the small area behind the wisdom
teeth.
- Salivary
glands. The salivary glands
produce saliva,
the fluid
that keeps mucosal surfaces in the mouth and throat moist. There are many
salivary glands; the major ones are in the floor of the mouth, and near
the jawbone.
- Paranasal sinuses and nasal
cavity. The paranasal sinuses are small hollow spaces in the bones
of the head surrounding the nose. The nasal cavity is the hollow space inside
the nose.
- Pharynx.
The pharynx is a hollow tube about 5 inches long that starts behind
the nose and leads to the esophagus
(the tube that goes to the stomach)
and the trachea
(the tube that goes to the lungs).
The pharynx has three parts:
- Nasopharynx.
The nasopharynx, the upper part of the pharynx, is behind the
nose.
- Oropharynx.
The oropharynx is the middle part of the pharynx. The oropharynx
includes the soft
palate (the back of the mouth), the base of the tongue, and the
tonsils.
- Hypopharynx.
The hypopharynx is the lower part of the pharynx.
- Larynx.
The larynx, also called the voicebox, is a short passageway formed
by cartilage
just below the pharynx in the neck. The larynx contains the vocal
cords. It also has a small piece of tissue, called the epiglottis,
which moves to cover the larynx to prevent food from entering the air passages.
- Lymph
nodes in the upper part of the neck. Sometimes, squamous cancer
cells are found in the lymph nodes of the upper neck when there is no evidence
of cancer in other parts of the head and neck. When this happens, the cancer
is called metastatic
squamous neck cancer with unknown (occult) primary.
Cancers of the brain, eye, and thyroid
as well as those of the scalp, skin, muscles, and bones of the head and neck
are not usually grouped with cancers of the head and neck.
- How common are head and neck cancers?
Head and neck cancers account for approximately 3 to 5 percent of all cancers
in the United States. These cancers are more common in men and in people over
age 50. It is estimated that about 39,000 men and women in this country will
develop head and neck cancer in 2005.
- What causes head and neck cancers?
Tobacco (including smokeless tobacco, sometimes called “chewing tobacco”
or “snuff”) and alcohol use are the most important risk factors
for head and neck cancers, particularly those of the oral cavity, oropharynx,
hypopharynx, and larynx. Eighty-five percent of head and neck cancers are
linked to tobacco use. People who use both tobacco and alcohol are at greater
risk for developing these cancers than people who use either tobacco or alcohol
alone.
Other risk factors for cancers of the head and neck include the following:
- Oral cavity. Sun exposure (lip); possibly human
papillomavirus (HPV)
infection.
- Salivary glands. Radiation
to the head and neck. This exposure can come from diagnostic x-rays
or from radiation
therapy for noncancerous conditions or cancer.
- Paranasal sinuses and nasal cavity. Certain industrial
exposures, such as wood or nickel dust inhalation.
Tobacco and alcohol use may play less of a role in this type of cancer.
- Nasopharynx. Asian, particularly Chinese, ancestry;
Epstein-Barr
virus infection; occupational exposure to wood dust; and consumption
of certain preservatives or salted foods.
- Oropharynx. Poor oral hygiene; HPV infection and the
use of mouthwash that has a high alcohol content are possible, but not proven,
risk factors.
- Hypopharynx. Plummer-Vinson (also called Paterson-Kelly)
syndrome,
a rare disorder
that results from iron and other nutritional deficiencies. This syndrome
is characterized by severe anemia
and leads to difficulty swallowing due to webs of tissue that grow across
the upper part of the esophagus.
- Larynx. Exposure to airborne particles of asbestos,
especially in the workplace.
Immigrants from Southeast Asia who use paan (betel quid) in the mouth should
be aware that this habit has been strongly associated with an increased risk
for oral cancer. Also, consumption of mate, a tea-like beverage habitually
consumed by South Americans, has been associated with an increased risk of
cancers of the mouth, throat, esophagus, and larynx.
People who are at risk for head and neck cancers should talk with their doctor
about ways they can reduce their risk. They should also discuss how often
to have checkups.
- What are common symptoms of head and neck cancers?
Symptoms of several head and neck cancer sites include a lump or sore that
does not heal, a sore throat that does not go away, difficulty swallowing,
and a change or hoarseness in the voice. Other symptoms may include the following:
- Oral cavity. A white or red patch on the gums, tongue,
or lining of the mouth; a swelling of the jaw that causes dentures to fit
poorly or become uncomfortable; and unusual bleeding or pain in the mouth.
- Nasal cavity and sinuses. Sinuses that are blocked and
do not clear, chronic
sinus infections that do not respond to treatment with antibiotics,
bleeding through the nose, frequent headaches, swelling or other trouble
with the eyes, pain in the upper teeth, or problems with dentures.
- Salivary glands. Swelling under the chin or around the
jawbone; numbness or paralysis
of the muscles in the face; or pain that does not go away in the face, chin,
or neck.
- Oropharynx and hypopharynx. Ear pain.
- Nasopharynx. Trouble breathing or speaking, frequent
headaches, pain or ringing in the ears, or trouble hearing.
- Larynx. Pain when swallowing, or ear pain.
- Metastatic squamous neck cancer. Pain in the neck or
throat that does not go away.
These symptoms may be caused by cancer or by other, less serious conditions.
It is important to check with a doctor or dentist about any of these symptoms.
- How are head and neck cancers diagnosed?
To find the cause of symptoms, a doctor evaluates a person's medical history,
performs a physical
examination, and orders diagnostic tests. The exams and tests conducted
may vary depending on the symptoms. Examination of a sample of tissue under
the microscope is always necessary to confirm a diagnosis
of cancer.
Some exams and tests that may be useful are described below:
- Physical examination may include visual inspection of
the oral and nasal cavities, neck, throat, and tongue using a small mirror
and/or lights. The doctor may also feel for lumps on the neck, lips, gums,
and cheeks.
- Endoscopy
is the use of a thin, lighted tube called an endoscope
to examine areas inside the body. The type of endoscope the doctor uses
depends on the area being examined. For example, a laryngoscope
is inserted through the mouth to view the larynx; an esophagoscope is inserted
through the mouth to examine the esophagus; and a nasopharyngoscope is inserted
through the nose so the doctor can see the nasal cavity and nasopharynx.
- Laboratory
tests examine samples of blood,
urine,
or other substances from the body.
- X-rays create images of areas inside the head and neck
on film.
- CT (or CAT)
scan is a series of detailed pictures of areas inside the head
and neck created by a computer linked to an x-ray machine.
- Magnetic
resonance imaging (or MRI)
uses a powerful magnet linked to a computer to create detailed
pictures of areas inside the head and neck.
- PET
scan uses sugar that is modified in a specific way so it is
absorbed by cancer cells and appears as dark areas on the scan.
- Biopsy
is the removal of tissue. A pathologist
studies the tissue under a microscope to make a diagnosis. A biopsy is the
only sure way to tell whether a person has cancer.
If the diagnosis is cancer, the doctor will want to learn the stage (or
extent) of disease. Staging
is a careful attempt to find out whether the cancer has spread and, if so,
to which parts of the body. Staging may involve an examination under anesthesia
(in the operating room), x-rays and other imaging
procedures, and laboratory tests. Knowing the stage of the disease helps
the doctor plan treatment.
- What health professionals treat patients with head and neck cancers?
Patients with head and neck cancers are best treated by a team of specialists.
The specialists vary, depending on the location and extent of the cancer.
The medical team may include oral
surgeons; ear, nose, and throat surgeons (also called otolaryngologists);
pathologists; medical
oncologists; radiation
oncologists; prosthodontists;
dentists; plastic
surgeons; dietitians;
social workers; nurses; physical
therapists; and speech-language pathologists (sometimes called speech
therapists).
- How are head and neck cancers treated?
The treatment plan for an individual patient depends on a number of factors,
including the exact location of the tumor, the stage of the cancer, and the
person's age and general health. The patient and the doctor should consider
treatment options carefully. They should discuss each type of treatment and
how it might change the way the patient looks, talks, eats, or breathes.
- Surgery.
The surgeon may remove the cancer and some of the healthy tissue
around it. Lymph nodes in the neck may also be removed (lymph
node dissection), if the doctor suspects that the cancer has spread.
Surgery may be followed by radiation treatment.
Head and neck surgery often changes the patient's ability to chew, swallow,
or talk. The patient may look different after surgery, and the face and
neck may be swollen. The swelling usually goes away within a few weeks.
However, lymph node dissection can slow the flow of lymph, which may collect
in the tissues; this swelling may last for a long time. After a laryngectomy
(surgery to remove the larynx), parts of the neck and throat may feel
numb because nerves
have been cut. If lymph nodes in the neck were removed, the shoulder and
neck may be weak and stiff. Patients should report any side
effects to their doctor or nurse, and discuss what approach to take.
Information about rehabilitation can be found in question 10.
- Radiation therapy , also called radiotherapy.
This treatment involves the use of high-energy x-rays to kill cancer cells.
Radiation may come from a machine outside the body (external
radiation therapy). It can also come from radioactive
materials placed directly into or near the area where the cancer cells are
found (internal
radiation therapy or radiation implant).
In addition to its desired effect on cancer cells, radiation therapy
often causes unwanted effects. Patients who receive radiation to the head
and neck may experience redness, irritation, and sores in the mouth; a
dry mouth or thickened saliva; difficulty in swallowing; changes in taste;
or nausea.
Other problems that may occur during treatment are loss of taste, which
may decrease appetite and affect nutrition,
and earaches (caused by hardening of the ear wax). Patients may also notice
some swelling or drooping of the skin under the chin and changes in the
texture of the skin. The jaw may feel stiff and patients may not be able
to open their mouth as wide as before treatment. Patients should report
any side effects to their doctor or nurse and ask how to manage these
effects.
More information about radiation therapy is available in the NCI booklet
Radiation Therapy and You: Support for People With Cancer. NCI
publications and materials are available by calling the Cancer Information
Service (CIS) at 1–800–4–CANCER (1–800–422–6237),
or through the NCI Publications Locator Web site at http://www.cancer.gov/publications
on the Internet.
- Chemotherapy,
also called anticancer drugs.
This treatment is used to kill cancer cells throughout the body. The side
effects of chemotherapy depend on the drugs that are given. In general,
anticancer drugs affect rapidly growing cells, including blood cells that
fight infection, cells that line the mouth and the digestive
tract, and cells in hair
follicles. As a result, patients may have side effects such as lower
resistance to infection, sores in the mouth and on the lips, loss of appetite,
nausea, vomiting, diarrhea,
and hair loss. They may also feel unusually tired and experience skin rash
and itching, joint pain, loss of balance, and swelling of the feet or lower
legs. Patients should talk with their doctor or nurse about the side effects
they are experiencing, and how to handle them. The NCI booklet Chemotherapy
and You: Support for People With Cancer has more information about
this type of treatment.
Additional information on treatment for head and neck cancers can be found
in the following PDQ®
cancer treatment summaries, available in patient and health professional versions,
at http://www.cancer.gov/cancertopics/pdq/adulttreatment
on the Internet:
- Hypopharyngeal Cancer
- Laryngeal
Cancer
- Lip and Oral Cavity Cancer
- Nasopharyngeal Cancer
- Oropharyngeal Cancer
- Paranasal Sinus and Nasal Cavity Cancer
- Salivary Gland Cancer
- Are clinical trials (research studies) available for patients with head
and neck cancers?
Clinical
trials are research studies conducted with people who volunteer to take
part. Participation in clinical trials is an option for many patients with
head and neck cancers.
Treatment trials are designed to find more effective cancer treatments and
better ways to use current treatments. In some studies, all patients receive
the new treatment. In others, doctors compare different therapies by giving
the new treatment to one group of patients and standard
therapy to another group. Doctors are studying new types and schedules
for delivering radiation therapy, new anticancer drugs, new drug combinations,
and new ways of combining treatments. They are also studying ways to treat
head and neck cancers using biological
therapy (a type of treatment that stimulates the immune
system to fight cancer) by itself or in combination with anticancer drugs
or radiation therapy.
Scientists are also conducting clinical trials to find better ways to reduce
the side effects of chemotherapy and radiation therapy for head and neck cancers.
These clinical trials, called supportive
care trials, explore ways to improve the comfort and quality
of life of cancer patients and cancer survivors.
People interested in taking part in a clinical trial should talk with their
doctor. Information about clinical trials is available from the CIS (see below)
and the NCI booklet Taking Part in Cancer Treatment Research
Studies . This booklet describes how research studies are carried out
and explains their possible benefits and risks. In addition, the NCI's Web
site, http://www.cancer.gov on the Internet,
provides information about clinical trials. It also offers detailed information
about specific ongoing studies by linking to PDQ, a cancer information database
developed by NCI. The CIS also provides information from PDQ.
- What rehabilitation or support options are available for
patients with head and neck cancers?
Rehabilitation is a very important part of treatment for patients with head
and neck cancer. The goals of rehabilitation depend on the extent of the disease
and the treatment a patient has received. The health care team makes every
effort to help the patient return to normal activities as soon as possible.
Depending on the location of the cancer and the type of treatment, rehabilitation
may include physical
therapy, dietary counseling, speech therapy, and/or learning how to care
for a stoma
after a laryngectomy. A stoma is an opening into the windpipe
through which a patient breathes after a laryngectomy.
Sometimes, especially with cancer of the oral cavity, a patient may need
reconstructive and plastic
surgery to rebuild the bones or tissues of the mouth. If this is not possible,
a prosthodontist may be able to make a prosthesis
(an artificial dental and/or facial part) to restore satisfactory swallowing
and speech. Patients will receive special training to use the device.
Patients who have trouble speaking after treatment, or who have lost their
ability to speak, may need speech therapy. Often, a speech-language pathologist
will visit the patient in the hospital to plan therapy and teach speech exercises
or alternative methods of speaking. Speech therapy usually continues after
the patient returns home.
Eating may be difficult after treatment for head and neck cancer. Some patients
receive nutrients
directly into a vein (IV)
after surgery, or need a feeding tube until they can eat on their own. A feeding
tube is a flexible plastic tube that is passed into the stomach through the
nose or an incision
(cut) in the abdomen.
A nurse or speech-language pathologist can help patients learn how to swallow
again after surgery. The NCI booklet Eating Hints for Cancer Patients:
Before, During, and After Treatment contains many useful suggestions
and recipes.
- Is follow-up treatment necessary? What does it involve?
Regular follow-up care is very important after treatment for head and neck
cancer to make sure the cancer has not returned, or that a second primary
(new) cancer has not developed. Depending on the type of cancer, medical checkups
could include exams of the stoma, mouth, neck, and throat. Regular dental
exams may also be necessary. From time to time, the doctor may perform a complete
physical exam, blood tests, x-rays, and CT, PET, or MRI scans. The doctor
may continue to monitor thyroid and pituitary
gland function, especially if the head or neck was treated with radiation.
Also, the doctor is likely to counsel patients to stop smoking. Research has
shown that continued smoking may reduce the effectiveness of treatment and
increase the chance of a second
primary cancer (see question 12). The NCI fact sheet Follow-up Care
After Cancer Treatment: Questions and Answers has more information about
this topic.
- What can people who have had head and neck cancer do to reduce the risk
of developing a second primary (new) cancer?
People who have been treated for head and neck cancer have an increased
chance of developing a new cancer, usually in the head and neck, esophagus,
or lungs. The chance of a second primary cancer varies depending on the original
diagnosis, but is higher for people who smoke and drink alcohol. Patients
who do not smoke should never start. Those who smoke should do their best
to quit. Studies have shown that continuing to smoke or drink (or both) increases
the chance of a second primary cancer for up to 20 years after the original
diagnosis. Information about smoking cessation is available from the CIS (see
below) and in the NCI fact sheet Quitting Smoking: Why To Quit and How
To Get Help.
Some research has shown that isotretinoin
(13-cis-retinoic acid), a substance related to vitamin
A, may reduce the risk of the tumor recurring (coming back) in patients
who have been successfully treated for cancers of the oral cavity, oropharynx,
and larynx. However, treatment with isotretinoin has not yet been shown to
improve survival or to prevent future cancers.