Head and Neck Cancer 101

Breast cancer, prostate cancer, skin cancer—you’ve heard of all of those. But if you or a loved one has been diagnosed with a cancer of the head or neck, you may not know anything about these types of cancers and you may have a lot of questions.

We talked to UNC Medical Center head and neck cancer specialists Wendell G. Yarbrough, MD, Trevor G. Hackman, MD and Samip N. Patel, MD to learn what newly diagnosed patients and their loved ones should know about these types of cancers.

Cancer of the head and neck is defined as cancer that arises in the head or neck region (nasal cavity, sinuses, lips, mouth, salivary glands, throat or voice box). They account for about 4 percent of all cancers in the United States.

Types of Cancers of the Head and Neck

There are five main types of head and neck cancer, each named according to the part of the body where they originate:

  • Laryngeal and hypopharyngeal cancer: The larynx, or voice box, is important for breathing, talking and swallowing. It’s located at the top of your windpipe. The hypopharynx is the lower part of the throat that surrounds the larynx.
  • Nasal cavity and paranasal sinus cancer: The nasal cavity is inside your nose. It’s the area where air passes as it moves down the throat. The paranasal sinuses surround the nasal cavity.
  • Nasopharyngeal cancer: The nasopharynx is located at the upper part of the throat. It is the area above your soft palate at the back of your nose. It connects your nose to your mouth and is what allows you to breathe through your nose.
  • Oral and oropharyngeal cancer: Your mouth and tongue make up your oral cavity. The middle of the throat, from the tonsils to the tip of the larynx is your oropharynx.
  • Salivary gland cancer: Your salivary glands are located on either side of your face and produce saliva.

Causes of Head and Neck Cancers

There are two major causes of head and neck cancers. First is tobacco use, which includes smoking, chewing tobacco and dipping. Drinking alcohol in addition to using tobacco further increases your risk.

In the past 20 years, the human papillomavirus (HPV) has arisen as the second major cause of cancers of the head and neck, specifically tonsil and tongue-base cancers.

“Almost 60 to 70 percent of tonsil and tongue-base cancers are driven by the HPV virus, which is the same virus that causes cervical cancer in women,” Dr. Patel says. “It affects the tongue and tonsils because the virus infects the surface cells that are integrated with lymphoid tissue that lives in the back of the throat.”

While tobacco-related cancers in the head and neck are decreasing, HPV-associated head and neck cancers have markedly increased. “We think it’s increased based on changes in sexual practices over the last 50 to 60 years,” Dr. Patel says.

Dr. Hackman says HPV-associated head and neck cancers also affect a younger demographic.

“These patients are usually younger and on average healthier,” he says. “We are now seeing a nonsmoking population of 30- to 50-year-olds with oropharyngeal cancer.”

Another, less common virus associated with head and neck cancers is the Epstein-Barr virus (EBV), a common viral infection that can cause mononucleosis. EBV infection is associated with nasopharyngeal carcinoma (NPC), which is common in Asian countries and in people of Asian descent, Dr. Patel says.

Signs and Symptoms of Head and Neck Cancers

Signs of head and neck cancers include:

  • A sore or ulcer in the mouth or throat that does not heal
  • Bleeding when you brush your teeth that does not improve or spontaneous bleeding
  • Loose teeth
  • A mass or white spot in your mouth
  • Difficulty swallowing
  • Problems with speech caused by the tongue not moving well
  • A hoarse voice
  • Bleeding or coughing up blood
  • Nosebleeds or a stuffy nose
  • Unexplained ear pain without fevers, chills or an ear infection
  • A lump in the neck that is not painful

If any of these symptoms last more than two weeks, see a doctor, preferably an ear, nose and throat specialist, Dr. Yarbrough says.

“Of course, during a cold, we all expect to have a sore throat, and we all expect to have some of these symptoms after tonsillitis, such as a lump in the neck from the infection,” Dr. Yarbrough says. “But if that lump remains more than two weeks after you’re better from your cold or tonsillitis, then it should be checked out.”

Diagnosis of Head and Neck Cancers

To determine if you have cancer, your physician will perform an examination using a special instrument called a flexible fiber-optic laryngoscope to look down your throat and a flexible scope or a rigid scope to look into your nose.

“We look in the mouth, and we feel the neck to feel for lumps and bumps,” Dr. Yarbrough says. “We look at all the surfaces on the inside of your mouth, throat and nose. We’re looking for anything abnormal.”

If your ear, nose and throat specialist finds something concerning, he or she will biopsy it either in the office or schedule a time to do it in the operating room. A pathologist will then review the sample.

“If there’s a lump in the neck, we don’t usually want to take that out just to make the diagnosis, but what we can do is perform a procedure called a fine-needle aspiration to get a few cells out. And the cytologist looks at those cells to see if there is a tumor,” Dr. Yarbrough says. “The fine-needle aspirates, as well as any biopsies we do, can also be tested for markers of HPV or EBV, which can help us to determine if one of the viruses has caused the tumor.”

Treatment for Head and Neck Cancers

The two primary forms of treatment for cancers of the head and neck are surgery and radiation therapy. For advanced cancers, you may receive both. Sometimes doctors also will recommend chemotherapy to help the radiation work better.

“The treatment is very complex for head and neck cancer, so I think you really need a team because there’s so many variables such as histology (how the cells are working), the type of cancer we’re dealing with, cause and location,” Dr. Patel says.

This is why UNC Medical Center has a head and neck cancer tumor board, a group of doctors who “meet every Friday to discuss all the potential treatment options for our patients as a team,” Dr. Hackman says. “We also discuss any clinical trials that may benefit a patient.”

It’s important to ask your doctor about all your treatment options, he adds. “A patient should know that there are more treatment options now than there used to be. Ask your doctor about the options of immunotherapy and the options of surgery versus radiation therapy.”

Preventing Cancers of the Head and Neck

To help prevent cancers of the head and neck, don’t smoke or use other tobacco products, drink alcohol in moderation and practice safe sex to reduce your risk of getting HPV.

“The other thing that is great for prevention of HPV, is there’s a vaccine for it,” Dr. Yarbrough says. “There’s really only one major type of HPV that causes head neck cancer. That’s type 16, and it’s covered by the vaccine.”

The vaccine is ideal to receive as a preteen or early teenager, but up to age 45, it is not too late to get the HPV vaccine. Talk to your health care provider to learn more.

If you’re experiencing any symptoms of head or neck cancer, talk to your primary care provider or find an ENT doctor near you.