Head & Neck

• Most head and neck cancers begin in the squamous cells that line the moist surfaces inside the head and neck.
• Tobacco use, alcohol use, and human papillomavirus infection are important risk factors for head and neck cancers.
• Typical symptoms of head and neck cancers include a lump or sore (for example, in the mouth) that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice.
• Rehabilitation and regular follow-up care are important parts of treatment for patients with head and neck cancers.

Head and neck cancers account for approximately 3% of all cancers in the United States. These cancers are nearly twice as common among men as they are among women. Head and neck cancers are also diagnosed more often among people over age 50 than they are among younger people. Researchers have estimated that more than 52,000 men and women in this country would be diagnosed with head and neck cancers in 2012.

People who are at risk of head and neck cancers ― particularly those who use tobacco ― should talk with their doctor about ways that they may be able to reduce their risk. They should also discuss with their doctor how often to have check-ups. In addition, ongoing clinical trials are testing the effectiveness of various medications in preventing head and neck cancers in those who have a high risk of developing these diseases.

To find the cause of the signs or symptoms of a problem in the head and neck area, a Miami ear nose throat doctor evaluates a person’s medical history, performs a physical examination, and orders diagnostic tests. The exams and tests may vary depending on the symptoms. Examination of a sample of tissue under a microscope is always necessary to confirm a diagnosis of cancer. More information about the specific tests and procedures used to diagnose cancer is available in What You Need To Know About™ Cancer: Diagnosis. If the diagnosis is cancer, the doctor will want to learn the disease’s stage (or extent). Staging is a careful attempt to determine whether the cancer has spread and if so, to which parts of the body. Staging may involve an examination under anesthesia (in an operating room), x-rays and other imaging procedures, and laboratory tests. Knowing the stage of the disease helps the doctor plan treatment.

The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments. General information about treatment options for cancer is available in What You Need To Know About™ Cancer: Treatment.

People diagnosed with HPV-positive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are HPV-negative. Recent research has shown that patients with HPV-positive oropharyngeal tumors have a better prognosis and may do just as well on less intense treatment. An ongoing clinical trial is investigating this question.

More information about treatment for specific types of head and neck cancers is in the following PDQ® cancer treatment summaries, which are available in patient and health professional versions, as well as in Spanish (the links below go to the patient versions in English):

• Hypopharyngeal cancer
• Laryngeal cancer
• Lip and oral cavity cancer
• Metastatic squamous neck cancer with occult primary
• Nasopharyngeal cancer
• Oropharyngeal cancer
• Paranasal sinus and nasal cavity cancer
• Salivary gland cancer

The patient and the doctor should consider treatment options carefully. They should discuss each type of treatment and how it might change how the patient looks, talks, eats, or breathes.

Surgery for head and neck cancers often changes the patient’s ability to chew, swallow, or talk. The patient may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks. However, if lymph nodes are removed, the flow of lymph in the area where they were removed may be slower, and lymph could collect in the tissues, causing additional swelling; this swelling may last for a long time.

After a laryngectomy (surgery to remove the larynx) or other surgery in the neck, parts of the neck and throat may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck might become weak and stiff.

Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Other problems that may occur during treatment are loss of taste, which may decrease appetite and affect nutrition, and earaches (caused by the hardening of ear wax). Patients may also notice some swelling or drooping of the skin under the chin and changes in the texture of the skin. The jaw may feel stiff, and patients may not be able to open their mouth as wide as before treatment.

Patients should report any side effects to their doctor or nurse, and discuss how to deal with them. 

Clinical trials are research studies conducted with people who volunteer to take part. Participation in clinical trials is an option for many patients with head and neck cancer.

NCI provides information about specific clinical trials for people who have head and neck cancers. Questions about these trials can be answered by NCI’s Cancer Information Service at 1800-4-CANCER (1800-422-6237) or by chatting with a cancer information specialist online through LiveHelp.

The goal of treatment for head and neck cancers is to control the disease, but doctors are also concerned about preserving the function of the affected areas as much as they can and helping the patient return to normal activities as soon as possible after treatment. Rehabilitation is a very important part of this process. The goals of rehabilitation depend on the extent of the disease and the treatment that a patient has received.

Depending on the location of the cancer and the type of treatment, rehabilitation may include physical therapy, dietary counseling, speech therapy, and/or learning how to care for a stoma. A stoma is an opening into the windpipe through which a patient breathes after a laryngectomy, which is surgery to remove the larynx. The National Library of Medicine has more information about laryngectomy in MedlinePlus.

Sometimes, especially with cancer of the oral cavity, a patient may need reconstructive and plastic surgery to rebuild bones or tissues. However, reconstructive surgery may not always be possible because of damage to the remaining tissue from the original surgery or from radiation therapy. If reconstructive surgery is not possible, a prosthodontist may be able to make a prosthesis (an artificial dental and/or facial part) to restore satisfactory swallowing, speech, and appearance. Patients will receive special training on how to use the device.

Patients who have trouble speaking after treatment may need speech therapy. Often, a speech-language pathologist will visit the patient in the hospital to plan therapy and teach speech exercises or alternative methods of speaking. Speech therapy usually continues after the patient returns home.

Eating may be difficult after treatment for head and neck cancer. Some patients receive nutrients directly into a vein after surgery or need a feeding tube until they can eat on their own. A feeding tube is a flexible plastic tube that is passed into the stomach through the nose or an incision in the abdomen. A nurse or speech-language pathologist can help patients learn how to swallow again after surgery. The NCI booklet Eating Hints: Before, During, and After Cancer Treatment contains many useful suggestions and recipes.

Regular follow-up care is very important after treatment for head and neck cancer to make sure that cancer has not returned, or that a second primary (new) cancer has not developed. Depending on the type of cancer, medical check-ups could include exams of the stoma, if one has been created, and of the mouth, neck, and throat. Regular dental exams may also be necessary.

From time to time, the doctor may perform a complete physical exam, blood tests, x-rays, computed tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI) scans. The doctor may monitor thyroid and pituitary gland function, especially if the head or neck was treated with radiation. Also, the doctor is likely to counsel patients to stop smoking. Research has shown that continued smoking by a patient with head and neck cancer may reduce the effectiveness of treatment and increase the chance of a second primary cancer.

People who have been treated for head and neck cancers have an increased chance of developing a new cancer, usually in the head, neck, esophagus, or lungs. The chance of a second primary cancer varies depending on the site of the original cancer, but it is higher for people who use tobacco and drink alcohol.

Especially because patients who smoke have a higher risk of a second primary cancer, doctors encourage patients who use tobacco to quit. Information about tobacco cessation is available from NCI’s Cancer Information Service at 1800-4-CANCER (1800-422-6237) and in the NCI fact sheet Where To Get Help When You Decide To Quit Smoking. The federal government’s main resource to help people quit using tobacco is BeTobaccoFree.gov. The government also sponsors Smokefree Women, a website to help women quit using tobacco, and Smokefree Teen, which is designed to help teens understand the decisions they make and how those decisions fit into their lives. The toll-free number 1800-QUIT-NOW (1800-784-8669) also serves as a single point of access to state-based telephone quitlines.