What are head and neck cancers?

Head and neck cancer is a general term used for a range of cancers that start in the tissue or lymph nodes in the head and neck area. This region includes the mouth, tongue, palate, gums, salivary glands, tonsils, throat (pharynx), voice box (larynx), nose and sinuses.

Only malignant tumours are cancer. Some tumours in the head and neck are benign (not cancer).

Types of head and neck cancer

Cancers of the head and neck are categorised by the area of the head or neck where they begin.

Mouth (oral cavity)

The mouth, also called the oral cavity, includes the lips, tongue and gums.The muscles at the base of the tongue continue into the upper throat (oropharynx). Cancer that starts in the mouth is called oral cancer. Cancer can begin in any part of the mouth – the lips, gums, inside lining of the cheek and lips, front two-thirds of the tongue, floor of the mouth under the tongue, bony roof of the mouth (hard palate), and the small area behind the wisdom teeth.

Salivary gland

The salivary gland makes saliva. There are three major salivary glands; parotid (in front of the ears), sublingual (under the tongue) and submandibular gland (under the jawbone). Most salivary gland cancers affect the parotid glands.

Throat (pharynx)

The throat, also called the pharynx, is a hollow tube that starts behind the nose and leads to the food pipe (oesophagus) and the windpipe (trachea). Cancer can affect the three parts of the pharynx; nasopharynx, oropharynx and hypopharynx.

Voice box (larynx)

The voice box, also called the larynx, is a short passageway that connects the lower part of the throat (hypopharynx) with the windpipe (trachea). Cancer that starts in the larynx is called laryngeal cancer.

Nasal cavity or paranasal sinuses

The nasal cavity is the large, hollow space inside the nose. The bones around the nasal cavity have a group of small, air-filled spaces called the paranasal sinuses.

How common are head and neck cancers?

About 800 people in Queensland are diagnosed with head and neck cancer each year. Men are three times more likely than women to develop a head and neck cancer.

Risk factors

Major Risk Factors

Head and neck cancer are associated with a number of major risk factors. Two of the main risk factors are alcohol and tobacco, and the combined effect of drinking and smoking is significantly greater than the risk of just drinking or just smoking.

Known risk factors include:

• Drinking alcohol
• Smoking tobacco (including cigarettes, cigars and pipes)
• Chewing or smoking areca nut, betel nut, pan or gutka
• Infection with the human papillomavirus (HPV), especially HPV 16 or the Epstein-Barr virus (EBV).
• Being overweight or obese
• Older age (being over 40).
• Being male
• Having a first degree relative (parent, child or sibling) with some types of head and neck cancer.
• Being from southern China or South-East Asia (because of cultural practices such as chewing tobacco or eating salty fish).
• Breathing is asbestos fibres, wood dust, dry-cleaning solvents or certain types of paint or chemicals.
• Having a weakened immune system
• Sun exposure (for skin cancer on the lip)

Eating adequate amounts of fruit and vegetables may help lower the risk of getting oral and oropharyngeal cancers. Talk to your doctor if you are worried about any of these factors.

Symptoms

In the early stages, head and neck cancers may have no symptoms. There are many possible symptoms when they do occur. However, these symptoms can also occur with other illnesses, so they don’t necessarily mean you have cancer – only tests can confirm the diagnosis. If you are concerned about these symptoms, make an appointment with your general practitioner (GP) without delay.

Some general symptoms include:

• A persistent sore throat or cough
• Coughing up bloody phlegm
• Difficulty swallowing or painful swallowing
• Swelling or a lump in the neck or throat
• Frequent headaches or sinus pressure
• Pressure or pain in your ears

Diagnosis

To diagnose a head and neck cancer, your GP or dentist may do some general tests and then refer you to a specialist. Depending on your symptoms, tests will include examinations, tissue sampling (biopsy) and imaging tests. Further tests may be needed to work out whether the cancer has spread. The tests you have will depend on your situation.

• Physical examination – depending on your symptoms, the doctor will examine your mouth, throat, nose, neck, ears and eyes. They may use a thin wooden tongue depressor to see inside the mouth more clearly.
• Nasendoscopy – examination of the nose and throat area using a thin flexible tube with a light and camera on the end.
• Laryngoscopy – a procedure that allows a doctor to examine your larynx and pharynx, and take a tissue sample using a tube with a light and camera on the end.
• Biopsy – the doctor removes a sample of cells or tissue from the affected area, and the pathologist examines the sample under a microscope to see if it contains any cancer cells.
• Testing the lymph nodes – the lymph nodes are often the first place cancer cells spread to outside the primary site. If you have a lump in the neck or an imaging scan has shown a suspicious-looking lymph node, your doctor may recommend you have a biopsy.
• CT scan
• MRI scan
• PET Scan
• Ultrasound – sometimes used to look at the thyroid, salivary glands and lymph glands in the neck.
• X-ray – of your head and neck to check for tumours or damage to the bones.

Some tests may be repeated during or after treatment to check how well the treatment is working. Waiting for the test results can be a stressful time. It may help to talk to a friend or family member, a healthcare professional, or call Cancer Council on 13 11 20.

Treatment

The main treatments for head and neck cancers are surgery, radiation therapy and chemotherapy. You may have one of these treatments, or a combination.

The treatment will depend on:

• The type, size and location of the tumour
• Your age, medical history and general health
• Whether, and how far, the cancer has spread
• The types of symptoms and side effects you experience.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about the general prognosis for people with the same type and stage of cancer.

Usually – the earlier head and neck cancer is diagnosed , the better the chances of successful treatment. But people with more advanced head and neck cancer may also respond well to treatment. Oropharyngeal cancers associated with HPV status also tend to have better outcomes.

To work out your prognosis , your doctor will consider your test results; the type of head and neck cancer and the rate of growth; the tumours HPV status; the likelihood of response to treatment; and other factors such as your age, general fitness and medical history.

Discussing your prognosis and thinking about the future can be challenging and stressful. It may help to talk with family and friends. You can also call Cancer Council 13 11 20 if you need more information or emotional support.

Support for Queenslanders

Whether you have been diagnosed with a head and neck cancer, or have a family member or friend who is affected by cancer, there are times when you may need support. Our professional services and support programs are here to help you.

Find out more about:

• Phone support
• Email support
• Cancer counselling
• Practical and financial support
• Support groups
• Information sessions

You don’t have to face cancer alone – we’re here to help.

Resources

For more information on head and neck cancer please see these resources

If you are a patient, family or friend and would like to order a copy of the Understanding Head and Neck cancer booklet, please call Cancer Council 13 11 20