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Head & Neck Cancer

Reviewed Sep 2016

  • Guidelines for treating these cancers were developed by the Head & Neck Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines.
  • Head and neck tumours are found in the mouth, nose or throat. Other names for these cancers include: oral cancer, cancer of the oral cavity, mouth cancer, cancer of the nasal cavity, nasopharyngeal cancer, cancer of the sinuses, throat cancer, pharyngeal cancer, cancer of the pharynx, cancer of the larynx, laryngeal cancer, nasopharyngeal cancer, cancer of the salivary gland, cancer of the tonsils.
  • Head and neck cancers can affect talking, eating, chewing, swallowing, and also the senses of smell and taste.
  • Specific information pages have also been created for many of the head and neck cancers:
  • Head and neck cancers do not usually include thyroid cancer. However, in B.C. thyroid cancers are treated by our Head & Neck Tumour Group, so it has been included in this category.
  • Head and neck cancers discussed on this page do not include brain cancer or eye (or orbital) cancer. Please see the specific information pages for these other cancers.
What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

  • Men are at greater risk than women to develop head and neck cancers.
  • Risk for getting a head and neck cancer increases with age – cancers primarily occur in people over the age of 40.
  • Tobacco use (including chewing tobacco and snuff) is the most important risk factor for developing some head and neck cancers. The longer tobacco has been used, the greater the risk.
  • Heavy drinking of alcohol increases the risk for some head and neck cancers.
  • People who use both tobacco and alcohol have a greater risk of developing head and neck cancer than people who use only one of the toxins.
  • Human papilloma virus (HPV) infection is a risk factor.
  • Occupational exposure to inhaled wood dust, paint fumes and certain chemicals may increase the risk of developing head and neck cancers.
  • Other risk factors exist for specific types of head and neck cancer – see related pages.
  • Statistics:
Can I help to prevent it?
  • Tobacco and alcohol use are major risk factors for developing this type of cancer. Don’t start smoking or chewing tobacco products.
  • If you smoke, quit. If you chew tobacco, stop. This will reduce your risk, even after years of use.
  • If you drink alcohol, stop or limit your intake. The recommended upper limits for alcohol are 1 drink or less per day for women and 2 drinks or less per day for men.
  • Patients who are cured of head and neck cancer are more likely to develop a second cancer if they continue to use tobacco and alcohol. Even after diagnosis with a head and neck cancer, quitting tobacco and alcohol can reduce the possibility of the cancer happening again.
Screening for this cancer
  • If found early, the majority of head and neck cancers are curable. Regular physical and dental checkups, including a full-mouth examination, offer the best method of early detection for many head and neck cancers.
Signs and Symptoms

Many of the following are also symptoms of non-cancerous conditions. However, any of these symptoms lasting for more than a few weeks should be evaluated by a physician.

  • A sore, swelling or ulcer in the mouth that doesn’t go away
  • A lump in the neck that lasts more than two weeks
  • A white or red patch in the mouth
  • Persistent earache or sore throat or nasal congestion
  • Pain in the mouth, jaw or ear without obvious cause
  • Voice changes or hoarseness lasting longer than two weeks
  • Difficulties with swallowing
  • Blood appearing in the saliva or phlegm for more than a few days
Diagnosis

These are tests that may be used to diagnose this type of cancer.

  • Physical examination with blood and/or urine tests.
  • Biopsy of the tissue is essential for diagnosis.
  • Imaging of the tumours using one or more of:
    • Computed tomography (CT)
    • X-rays
    • Magnetic Resonance Imaging (MRI)
    • Positron Emission Tomography (PET)

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnosis section.

Types and Stages

Types

  • Most head and neck cancers are squamous cell carcinomas, which start in the moist linings of the oral and nasal cavities. These are the cancers most typically found in smokers and alcohol drinkers.
  • Adenocarcinomas also occur, particularly in the salivary glands.
  • See the staging information for specific types of head and neck cancers for further details.

Staging

Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

T describes the site and size of the main tumour (primary)
N describes involvement of lymph nodes
M relates to whether the cancer has spread (presence or absence of distant metastases)

Treatment  

Cancer therapies can be highly individualized – your treatment may differ from what is described below. 

  • The treatment of head and neck cancers are handled by a multidisciplinary team of surgeons, radiation oncologists, medical oncologists and dentists.
  • Surgery is the preferred option for early stage cancers of the mouth and salivary glands.
  • Radiation therapy (RT) is the preferred treatment for early stage cancers at other head and neck sites. There are different methods for delivering radiation therapy. Types of RT used for head and neck cancers include:
    • External beam radiotherapy
    • Brachytherapy
    • 3-D conformal and stereotactic radiotherapy
    • Intensity modulated radiotherapy (IMRT)
  • Before beginning treatment, especially radiation therapy, patients should have a thorough dental evaluation. A detailed dental evaluation and treatment plan will be developed for you, depending on the type of treatment chosen for your type of head and neck cancer. 
  • Treatment planning for radiation therapy is complex and requires construction of a custom made mask to keep the head and neck from moving during therapy. The treatment planning phase may take 7 to 10 days before treatment can start.
  • Radiation therapy in the head and neck region is likely to cause some of the following side effects:
    • Dry mouth
    • Dental problems
    • Mouth sores
    • Difficulty swallowing
    • Hearing loss
  • Chemotherapy may be used with radiation therapy to increase control of the disease.
  • Treatment for more advanced stage head and neck cancer usually involves a combination of the available therapies. Patients should be referred to one of the BCCA regional cancer centres for multidisciplinary assessment.
  • See the treatment information on the specific types of head and neck cancers for further details.
Follow-up after Treatment
  • Guidelines for follow-up after treatment are covered on our website.
  • It is essential that patients be followed carefully for at least two years after initial treatment, by a cancer specialist and/or otolaryngologist. A large majority of recurrences are found in the first two years after treatment.
  • You will be returned to the care of your family physician or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
  • Following the active treatment phase many patients also require the services of dietitians, physiotherapists and speech therapists.
  • Excellent oral hygiene must be maintained. Detailed information about the effects of radiation on teeth is available in the Head and Neck Cancer Management Guidelines.
  • Life after Cancer focuses on the issues that cancer survivors can face.​

SOURCE: Head & Neck Cancer ( )
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