Head and Neck Cancer 

Introduction
Head and neck cancers include those that occur in the structures of the neck, throat, mouth, nose, and sinuses.  The majority of head and neck cancers are caused by the use of tobacco products and alcohol.  Head and neck cancer may lead to difficulties with swallowing, breathing, talking, and eating.  Head and neck cancer may be treated with radiation therapy, chemotherapy, surgery, or a combination of treatment types.

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Anatomy
The majority of head and neck cancers originate in the cells of the mucosal surfaces that line the surfaces in the mouth, nose, and throat.  Mucosal surfaces are moist tissues that line the hollow cavities in the head and neck.  Most head and neck cancers begin in the squamous cells that make up the mucosal surfaces, but they may also develop in glandular cells.

Head and neck cancers are named by the area in which they originate, such as the oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx, and lymph nodes.  The oral cavity refers to the lips, front part of the tongue, gums, inside lining of the cheeks and lips, and the bottom and top of the mouth.  The salivary glands are located in the mouth near the jawbone.  They produce saliva to keep your mouth moist.  The paranasal sinuses and nasal cavity are small hollow spaces in the head and nose.

The pharynx is a hollow tube that extends from the nose to the esophagus and the trachea.  It is about five inches long and consists of three sections, the nasopharynx, the oropharynx, and the hypopharynx.  The larynx is your voice box.  It is located below the pharynx in your neck.  Head and neck cancer may include the lymph nodes in the upper part of the neck.  Your lymph nodes normally help your body fight infections.

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Causes
Head and neck cancer results when cells in the head and neck grow abnormally and out of control, instead of dividing in an orderly manner.  Head and neck cancer most frequently originates in the squamous cells of the mucosal surfaces.  It may also originate in glandular cells.

The majority of head and neck cancers can be linked to tobacco use.  People that use tobacco and consume alcohol have the highest risk for developing head and neck cancer.  Head and neck cancer is more common in men than in women.  The majority of cases occur in people over the age of 55. 

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Symptoms
Head and neck cancer can cause a lump or a sore that does not heal or go away.  You may have a continued sore throat.  Swallowing may be difficult.  It may hurt when you swallow.  Your voice may become hoarse and speaking may be problematic.  There may be blood in your saliva or from your nose.  Your gums may feel sore and your dentures may not fit correctly.  Your nose may be stuffy or you may have sinus congestion that does not respond to medications. 
 
Head and neck cancer can cause face, ear, and headache pain.  You may have hearing loss.  Your face or eyes may swell.  Your face may feel numb or become paralyzed.

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Diagnosis
Your doctor can begin to diagnose head and neck cancer by reviewing your medical history, conducting a physical examination, and ordering diagnostic tests.  You should tell your doctor about your risk factors.  Your blood and urine may be checked with laboratory tests.
 
Your doctor will thoroughly examine your head, neck, nose, throat, and mouth.  Your doctor will gently feel for lumps and use a small mirror or lights to visualize these small spaces.  An endoscopy may be used to examine the structures inside of the nose and throat.  Your doctor will use an endoscope that is specifically designed for the area that is being examined.  An endoscope is a thin-lighted tube with a viewing instrument.  
 
Imaging tests may be used to provide detailed pictures of your head and neck.  Common imaging tests include X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans.  If your doctor suspects that you have cancer, a biopsy may be performed in the doctor’s office or in an operating room with anesthesia, depending on the location of the suspicious tissue.  A biopsy entails obtaining a tissue or fluid sample for examination for cancer cells.
 
If you have head and neck cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests.  Staging describes the cancer and how it has metastasized.  Cancer that has spread from its original site to other parts of the body is termed metastasized cancer.  Staging is helpful for treatment planning and recovery prediction. 
 
There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one.  Generally, lower numbers in a classification system indicate a less serious cancer, and higher numbers indicate a more serious cancer.  The stages may be subdivided into classifications that use letters and numbers.

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Treatment

Treatment for head and neck cancer depends on many factors, including your overall health and the area, type, and extent of the cancer.  Radiation therapy, chemotherapy, surgery, or a combination of treatments may be used to treat head and neck cancer.  In some cases, radiation and chemotherapy may be used before surgery to shrink the tumor and preserve surrounding structures and function.

There are a few different types of radiation therapies that can be used for head and neck cancers.  Radiation therapy is a painless procedure.  Your doctor will prescribe the amount and length of treatment.  Radiation therapy is usually delivered in several doses over a period of time.

External beam radiation uses high-energy beams to disrupt the growth of cancer cells.  Radiation damages all cells, both healthy and cancerous, in the exposed area.  Radiated cancer cells are not able to repair themselves or replicate.  Your doctor may prescribe medication to prevent the side effects of radiation.

State-of-the-art technology has advanced radiation methods to help make them more effective and tolerable.  Three dimensional conformal radiation therapy (3D CRT) maps a tumor with imaging scans before treatment.  Magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, and positron emission tomography (PET) scans are used to produce images of a tumor and its surrounding tissue.  The images from the scans are combined with a computer called a multi-leaf collimator (MLC).  The MLC produces a 3D image of the cancer and formulates a treatment plan specifically for the 3D image.  This allows direct multiple beams of radiation to be targeted precisely at the tumor and spare as much healthy tissue as possible.

Intensity modulated radiation therapy (IMRT) is a refined type of 3D CRT.  IMRT allows the radiologist to sculpt the edges of a tumor, sparing healthy tissue.  With IMRT, the radiation dose can be changed during a treatment session.  In the past, radiation was delivered in one dose, from the beginning to the end of a treatment session.  IMRT allows the radiation dose to alter and conform more specifically to the shape of the tumor while minimizing the dose received by healthy tissues. 

Brachytherapy is used to destroy cancer cells from an internal source of radiation. Radiation from internally placed radioactive seeds disrupts the growth of cancer cells.  Brachytherapy spares as many healthy cells as possible because it directs radiation to only a specific area.  There are different types of brachytherapy.  Intracavity brachytherapy involves placing the radioactive seeds inside a natural body cavity, such as the throat or windpipe.  Interstitial brachytherapy involves implanting radioactive seeds into or near a cancer tumor.  Brachytherapy can be delivered in high dose rates (HDR) or low dose rates (LDR).  HDR brachytherapy is delivered for several minutes and then withdrawn.  LDR brachytherapy remains in the body longer.

Chemotherapy may be used to help treat some types of head and neck cancer and to help shrink cancer tumors before they are removed with surgery.  Chemotherapy consists of cancer fighting drugs that are given in a series of treatments over time.  There are many types of chemotherapy.  Your doctor may prescribe medication to help reduce the side effects of your treatment.  In some cases, surgery may be used to remove the cancer and some of the healthy tissue around it.

The experience of head and neck cancer and cancer treatments can be an emotional process for people with cancer and their loved ones.  It is important that you receive support from a positive source.  Some people find comfort in their family, friends, counselors, co-workers, and faith.  Cancer support groups are another good option.  They can be a source of information and support from people who understand what you are experiencing.  Ask your doctor for cancer support group locations in your area.

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Surgery
Some types of head and neck cancer may spread to other parts of the body, such as the lymph nodes.  In some cases, head and neck cancer may return following treatment.  This is termed recurrent cancer.  Head and neck cancer treatments may alter the function and appearance of the head and neck structures.  Individuals may benefit from rehabilitation to learn new ways for breathing, swallowing, talking, and eating.

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Prevention
The majority of head and neck cancers are caused by using tobacco and tobacco products.  Quitting the use of tobacco products may help decrease your risk of head and neck cancer.  There are many smoking cessation products on the market, and your doctor is happy to refer you to them.  You may also lower your risk by discontinuing the use of alcohol.  If it is difficult for you to stop drinking on your own, ask your doctor for resources that may help you.  If you work in a manufacturing setting that exposes you to cancer-causing dust, make sure that you follow the proper safety precautions for your job setting.

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Am I at Risk

Researchers have identified risk factors that may increase the likelihood of developing head and neck cancer.  People with all of the risk factors may never develop the condition; however, the chance of developing head and neck cancer increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for head and neck cancer:

_____ Using tobacco products is the greatest risk factor for developing head and neck cancer.  This includes cigarettes and smokeless tobacco, such as chew or dip.

_____ Drinking alcohol is associated with head and neck cancer. 

_____ People that use tobacco and drink alcohol together have the highest risk of all.

_____ Exposure to wood dust, nickel dust, or asbestos increases the risk for head and neck cancer.

_____ Plummer-Vision syndrome, a disorder caused by nutritional deficiencies, is associated with an increased risk for head and neck cancer.

_____ Certain viruses, such as the human papillomavirus (HPV) and the Epstein-Barr virus can contribute to the development of head and neck cancer.

_____ Leukoplakia, white patches or spots in the mouth, can become cancerous.

_____ Paan (betel quid), a substance originally used in China and Southeast Asia, can contribute to head and neck cancer.

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Advancements
Researchers are working on identifying new treatments and combination of treatments for head and neck cancer, including gene therapy methods. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.