What Are Head and Neck Cancers? What Are the Symptoms? How Are They Diagnosed and Treated?

Head and neck cancer is a matter of close concern for many people. Accounting for approximately 4-5 percent of all cancers, these cancers develop in the mouth, throat, nose, sinuses, larynx, and salivary glands. They are more common in men and are usually diagnosed in individuals over the age of 50. In this article, you will find everything you need to know about head and neck cancer symptoms, head and neck cancer types, head and neck cancer diagnosis, and head and neck cancer treatment. We will also focus on the causes of head and neck cancer.

What Is Head and Neck Cancer?

Cancer occurs when cells in your body multiply in an uncontrolled and abnormal way. Head and neck cancers arise when this process occurs in the tissues of the head and neck region. They usually develop as squamous cell carcinoma, and specialized areas such as the brain, eyes, and spine are not included in this group.

Which Areas Does the Head and Neck Region Cover?

The head and neck region consists of the oral cavity, nasopharynx (upper throat), oropharynx, hypopharynx (lower throat), larynx, sinuses, parts of the ear, and the neck. These regions extend along the upper respiratory and digestive tracts.

Oral cancer covers the lips, tongue, gums, cheeks, floor of the mouth, and palate. The term throat or neck cancer is also used for nasopharyngeal, laryngeal, and esophageal cancers. Salivary glands, the thyroid, and tonsils are also included in this anatomical group.

Cancers are named differently depending on the region where they are located. Therefore, distinctions are made such as oral cavity cancer, nasopharyngeal cancer, laryngeal cancer, paranasal sinus and nasal cavity cancer, and salivary gland cancer.

Prevalence of Head and Neck Cancers

Head and neck cancers account for approximately 10 percent of all cancers. However, because they account for 4 percent of cancer-related deaths, mortality rates are relatively low compared to morbidity rates.

They are seen approximately twice as often in men as in women. They are typically diagnosed in individuals over the age of 50, and the incidence of laryngeal cancer is high in Turkey. The main reason for this is attributed to tobacco consumption in men.

Among the most common head and neck cancers, laryngeal cancer ranks first, accounting for 50 percent of this type of cancer. Worldwide, the most common head and neck cancer in men is oral cavity cancer. This is followed by laryngeal cancer. In women, the most common types of head and neck cancer are oropharyngeal and hypopharyngeal cancers.

Furthermore, nasopharyngeal cancers are very rare in many countries. However, their incidence is high in China and South East Asian countries. In Chinese men living in the United States, the age-standardized annual incidence rate is as high as 10.8 per 100,000.

With early diagnosis, the chance of treatment is quite high. The appearance of symptoms in the early period facilitates early diagnosis and treatment.

What Are the Symptoms of Head and Neck Cancer?

The appearance of symptoms in the early period provides a significant advantage for the diagnosis of head and neck cancer. However, these symptoms can often be confused with simple ailments such as the flu or a sore throat. Therefore, if your complaints last longer than two weeks, you should definitely consult a specialist.

Oral and Throat Region Symptoms

Sores in the mouth that do not heal, even if they are not painful, are among the first signs of oral cancer. You should be careful if you see sores on your lips, tongue, or inside your mouth that last longer than two weeks. White or red patches in the mouth, difficulty speaking and swallowing, and a feeling of numbness are also among the symptoms of head and neck cancer.

Hoarseness and changes in voice are the primary symptoms of laryngeal cancer. Hoarseness lasting longer than two weeks is an important warning sign. Especially in individuals in the risk group who use tobacco and alcohol, prolonged voice changes require endoscopic evaluation of the vocal cords.

Difficulty swallowing makes it hard to swallow solid foods and sometimes liquids in throat and esophageal cancers. If food gives you a sensation of sticking in your throat, or if you experience nausea and regurgitation of food, it is essential to consult a physician. Conversely, difficulty swallowing may be accompanied by ear pain, bad breath, and swelling in the neck.

Neck and Ear Region Symptoms

Painless swellings in the neck that tend to grow should make you suspect head and neck cancers. Swellings that are not visible at first but can be felt by hand can grow rapidly within months, depending on the stage of the disease. It is important to evaluate swellings in the neck region that do not go away for more than two weeks as soon as possible.

Ear pain is noteworthy, especially when it lasts longer than 10 days and is accompanied by difficulty swallowing, hoarseness, or swelling in the neck. Pain in and around the ear may be due to a tumor growing in the throat. Recurrent ear infections, hearing loss, and tinnitus are also among the symptoms.

Nose and Sinus Region Symptoms

Unilateral nasal congestion is one of the most common symptoms of sinus cancer. This congestion usually persists even after cleaning the nose and worsens over time. Recurrent or persistent nosebleeds are also an important sign.

Swelling and pain in your face may become prominent, especially around the eyes and on the cheeks. Swelling around the eyes, double vision, or vision disturbances occur as a result of the tumor pressing on the eye socket. Additionally, pain, loosening, or tooth loss in the upper jaw may be seen.

Loss of smell, nasal discharge, and persistent pain in the facial region are also among the symptoms of the nose and sinus region.

General Symptoms

Unexplained weight loss, difficulty breathing, and general fatigue are among the general symptoms of head and neck cancers. Shortness of breath, difficulty speaking, and chronic cough may also be seen. Persistent bad breath despite oral hygiene may be a sign of cancer.

What Are the Types of Head and Neck Cancer?

Head and neck cancer types are named according to the region where they form. Each type has its own unique characteristics, and treatment approaches vary accordingly. There are five main common categories.

Oral Cancer

Oral cancer develops on the lips, tongue, gums, inner lining of the cheeks, floor of the mouth, and palate. Nine out of ten cases are squamous cell carcinoma. This is the type of cancer that begins in the flat cells lining the inside of the mouth.

Less common types of oral cancer also exist. Adenocarcinoma developing in the salivary glands, sarcoma growing from bone or muscle tissue, oral malignant melanoma originating from skin pigment cells, and lymphoma developing from cells in the lymph nodes are among these.

Tongue cancer can occur in the mouth or throat. Lip cancer is the most common type of oral cancer and usually appears on the lower lip. Gum cancer is associated with irritating factors such as ill-fitting dentures.

Laryngeal Cancer

Laryngeal cancer develops in the structure containing the vocal cords. 90 percent of these cancers are of the squamous cell type. The larynx is divided into three anatomical regions: supraglottic (above the vocal cords), glottic (vocal cords), and subglottic (below the vocal cords).

It most frequently occurs in the glottic region, i.e., the vocal cords. It is seen more frequently in men than in women, with a ratio of approximately 4 male patients to 1 female patient. It is typically a disease of men over the age of 40.

Pharyngeal Cancer

The pharynx is a tube-shaped organ approximately 50 cm long, located behind the nasal and oral cavities. It is divided into three parts: nasopharynx (upper throat), oropharynx (middle throat), and hypopharynx (lower throat).

Nasopharyngeal cancers are seen more frequently in Asian countries, especially China. Oropharyngeal cancers develop in the back third of the tongue, soft palate, tonsils, and side walls. 90 percent of these cancers are squamous cell carcinoma.

Hypopharyngeal cancers are rare, but they are difficult to treat because they are mostly diagnosed at advanced stages.

Nose and Sinus Cancers

Paranasal sinus cancers form in the small cavities in the bones around the nose. They originate from the mucosal epithelial cells lining the nasal and sinus cavities.

It ranks 4th among head and neck cancers. Approximately 600-700 new cases of nasal and paranasal sinus cancer are seen in Turkey each year. These mostly occur in people over 40 and more often in men.

Salivary Gland Cancer

Salivary gland cancer occurs as a result of uncontrolled cell proliferation in the salivary glands around the mouth and throat. It can occur in the parotid, submandibular, and sublingual glands.

Tumors can be benign or malignant. Malignant salivary gland tumors account for 3-4 percent of malignant tumors seen in the head and neck region. It is most frequently seen in the parotid gland at a rate of 75-80 percent, and in the submandibular salivary gland at a rate of 20 percent. It has various subtypes such as mucoepidermoid carcinoma, adenoid cystic carcinoma, and acinic cell carcinoma.

How Is Head and Neck Cancer Diagnosed?

Making an accurate diagnosis is the first step for effective treatment planning. Your physician will first evaluate your complaints, your tobacco and alcohol use, your history of HPV infection, and occupational risks. Whether there is a family history of cancer is also questioned.

Physical Examination and Endoscopic Examination

Head and neck cancer diagnosis usually begins with a physical examination. Your doctor will examine your mouth, tongue, palate, gums, tonsils, throat, and larynx in detail. The lymph nodes in the neck are checked by hand to investigate the presence of swelling or a mass.

Endoscopy uses a thin, lighted tube that allows the inside of the nasal cavity, throat, or larynx to be seen. During this procedure, your doctor can detect the cancerous area if present. The nose, throat, larynx, and esophagus are examined in detail using a flexible or rigid endoscope.

In some cases, an examination under anesthesia may be performed. This approach helps to assess the extent of the tumor and reveal other simultaneous cancers. The mobility of the vocal cords, secretions, and bleeding areas are carefully examined.

Biopsy and Laboratory Tests

A biopsy is the only way to determine whether a mass is cancerous. The sample taken from the suspicious tissue is examined in the pathology laboratory for cancer cells. A definitive diagnosis is made by biopsy.

Fine-needle aspiration biopsy involves taking a cell sample from suspicious masses in the neck with the help of a thin needle. In some cases, local or general anesthesia may be required.

HPV testing or Epstein-Barr virus tests may be applied to determine the cause of some head and neck cancers. Blood tests are performed to evaluate your general health status and organ functions.

Imaging Methods

Computed tomography scans are used to evaluate the size, location, and relationship of the tumor with surrounding tissues. It has superiority in evaluating bone destruction.

Magnetic resonance imaging is used to determine the spread of the tumor by showing soft tissue details. It is quite good for evaluating tongue cancers.

PET-CT scan plays an important role in determining the spread of cancer and in treatment planning. Ultrasonography can be used for the evaluation of lymph nodes and masses in the neck.

How Is Head and Neck Cancer Treated?

Your treatment approach is determined according to the type of cancer, its stage, the region where it is located, and your general health status. Treatment decisions made by a multidisciplinary team increase the success rate by 15-25 percent. This team consists of an ENT surgeon, medical oncologist, radiation oncologist, pathologist, speech therapist, and dietitian.

Surgical Treatment

Surgery is the gold standard method in the treatment of early-stage head and neck cancer. It aims to completely remove the tumor and may be sufficient on its own in early stages. The 5-year survival rate in Stage I and II patients ranges between 70-90 percent.

Minimally invasive techniques such as robotic surgery and transoral laser surgery improve functional outcomes. During the surgery, not only the cancerous tissue but also the lymph nodes in the neck are removed when necessary. If cancer cells remain at the surgical margin after surgery, or if there is perineural invasion or lymphovascular invasion, treatment is continued with radiotherapy or chemotherapy.

Radiotherapy

Cancer cells are destroyed using high-energy rays. With the intensity-modulated radiotherapy technique, high-dose radiation can be delivered to the tumor while protecting healthy tissues. In early-diagnosed nasopharyngeal cancers, a 98 percent cure rate is achieved with this method.

Radiotherapy can be applied alone or after surgery. It is used in combination with chemotherapy in advanced-stage patients. Thanks to the IMRT technique, different doses of radiation can be delivered to different regions at the same time. Treatment lasts for seven weeks, five days a week.

Chemotherapy

It is aimed to kill cancer cells or stop their growth with drugs. Cisplatin is used as the gold standard drug. It is usually applied in combination with radiotherapy in advanced-stage cancers. In some cases, the tumor is first shrunk with induction chemotherapy, and then surgery or radiotherapy is performed.

Immunotherapy and Targeted Therapies

It enables you to fight cancer by strengthening your immune system. PD-1 inhibitors, pembrolizumab and nivolumab, are approved for metastatic disease. PD-1 inhibitors added to chemotherapy significantly extend survival.

Pembrolizumab increased event-free survival to 59.7 months when used before and after surgery, while this period was found to be 29.6 months in the control group. Targeted therapies such as cetuximab are effective in recurrent-metastatic cases.

Frequently Asked Questions

Is head and neck cancer dangerous? Yes, it is a serious disease because it can spread to surrounding tissues and distant organs if not diagnosed early. However, the recovery rate is quite high with early diagnosis. Depending on the type and stage of the cancer, the 5-year survival rate can range between 70-90 percent.

Which doctor should I see? An Ear, Nose, and Throat specialist is usually involved in diagnosis and treatment. When necessary, cooperation is made with medical oncology, radiation oncology, and other specialists.

What does a mass in the nape of the neck mean? It can be caused by reasons such as infection, benign growth, or swelling of the lymph nodes. It can also be a sign of cancer, so it must be evaluated. Hardness, swelling, growth over time, and persistent tenderness felt in the neck suggest the presence of a mass.

Where does metastasis occur? Head and neck cancer most frequently spreads to the lungs, liver, and bones. Therefore, regular follow-ups are important.

What should support after treatment be like? You may experience difficulties in speaking, swallowing, and breathing after surgery or treatment. Speech therapy, swallowing rehabilitation, breathing exercises, and psychological support are parts of this process.

How often are follow-ups done? Check-ups every three months are recommended in the first two years of treatment, and every six months between 2-5 years. Afterwards, follow-up once a year is sufficient. Physical examination, imaging methods, and biopsy if necessary are performed.

How can I reduce the risk of a second cancer? If you continue to smoke, the risk of both recurrence and developing a new cancer is high. Quit tobacco and alcohol completely, eat healthy, exercise regularly, and do not skip doctor check-ups.

Can cancer occur on the lips and inside the mouth? Yes, lip cancer usually manifests itself in the form of a sore. Persistent cold sore-like lesions and aphthous ulcers that do not heal require attention.

What is the symptom of laryngeal cancer? The most prominent symptom is long-term hoarseness. Difficulty swallowing, sore throat, and a mass in the neck are also important findings.

Can ear pain be cancer? Yes, especially unilateral and persistent ear pain can be a symptom of nasopharyngeal cancers. It should be evaluated carefully when seen with hearing loss.

Is it contagious? No, head and neck cancers are not contagious. However, in cancers linked to HPV infection, the virus can be transmitted through unprotected sexual contact.

How should I eat? Consume foods rich in protein, vitamins, and minerals that strengthen your immune system. Prefer soft, easy-to-chew foods and drink plenty of water.

In Summary, Head and Neck Cancers

Head and neck cancers are serious diseases; however, your chance of treatment is quite high with early diagnosis. Do not ignore symptoms such as hoarseness lasting longer than two weeks, difficulty swallowing, swelling in the neck, or sores inside the mouth.

Therefore, it is important to consult a specialist immediately when you notice these complaints. You can reduce risk factors by quitting your tobacco and alcohol use. Regular check-ups and a healthy lifestyle both increase your treatment success and reduce the risk of the disease recurring.