Head, neck, and oral cancers happen when abnormal cells begin to form in the mouth, nasal cavity, sinuses, lips, salivary glands, pharynx (the cavity behind the nose and mouth connecting to the esophagus), or larynx (voice box).
Tumors can be primary—meaning they originated in your head or neck and may spread to lymph nodes in your neck—or secondary— meaning they started elsewhere in your body and spread to your head or neck.
There are two types of head, neck, and oral tumors, they can all originate in different parts of these areas.
Most of these cancers are squamous cell carcinomas. These tumors develop in the flat squamous cells in the lining of your mouth, nose, and throat. If a tumor is found only in this layer of cells, it’s called carcinoma in situ. If it has grown into deeper tissues it’s called invasive squamous cell carcinoma.
The other type, adenocarcinoma, typically starts in the cells of your salivary glands.
Cancers of the brain, the eye, the esophagus, the thyroid gland, and the skin of the head and neck are not usually classified as head and neck cancers.
If a squamous cell carcinoma of the head and neck is going to spread, it almost always does so locally and/or to the lymph nodes in the neck. Sometimes, cancerous squamous cells can be found in the lymph nodes of the upper neck when there is no evidence of cancer in other parts of the head and neck, possibly because the original primary tumor is too small.
Roughly 100,000 Americans are diagnosed with cancer in their head, neck, or mouth each year.
The most common types are oral and oropharyngeal cancer. About 54,000 Americans are diagnosed each year—more than half being men.
Most head, neck, and oral cancers are quite rare. Only about 2,000 people in the US are diagnosed with sinus cancer each year, and fewer than 13,000 people in the US will be diagnosed with laryngeal cancer each year. The incidence of most head, neck, and oral cancers is dropping, likely because fewer people are using tobacco.
What are the Risk Factors
Smoking and using tobacco (including chew, dip, ping, and vaping) are the leading cause of head, neck, and oral cancers. You can help prevent them by stopping these activities.
Other risk factors include:
- Excessive alcohol use. Drinking alcohol is a risk factor for several cancers, including head and neck cancer. Limiting your alcohol consumption can reduce your risk for head and neck cancer.
- Immunosuppressive drugs. A lowered immune system, which occurs when a patient takes immunosuppressive drugs, like after a transplant, is associated with a higher risk of head and neck cancers.
- HPV and EBV exposure. Human papillomavirus and Epstein-Barr virus both can cause cancerous changes in the cells of your mouth and throat. The HPV vaccine can significantly reduce your risk for several cancers, including head and neck.
- Several genetic diseases such as Fanconi anemia and dyskeratosis congenita.
- Plummer-Vinson syndrome. This disorder is caused by nutritional deficiencies.
Signs of Head, Neck, and Oral Cancers
Most people with head, neck, and oral cancers have no symptoms until cancer has grown. If you are experiencing any of the signs below, it is important to have them checked by a physician. Earlier detection of head and neck cancer can give you the best chance for a successful treatment.
In general, signs of head and neck cancer may include:
- A lump or sore in your mouth or neck that doesn’t heal
- Sore throat that doesn’t get better
- Difficulty or pain with swallowing
- Change in your voice or general hoarseness
- Blood in your saliva or nosebleeds
- Ear pain or hearing loss
- Nasal stuffiness that doesn’t clear up
Different cancers may have additional symptoms.
Your nasal cavity is the main airway just behind your nose. Symptoms of this cancer include:
- Nasal obstruction
- Persistent nasal congestion and stuffiness
- Chronic sinus infections that fail to respond to antibiotic treatment
- Frequent headaches or sinus pain
- Pain or swelling in your face, eyes, or ears
- Persistent tearing
- Bulging eyes or vision loss
- Altered sense of smell
- Tooth pain or numbness
- Loosening of teeth
- A lump on the face, nose, or inside the mouth
- Constant runny nose
- Frequent nosebleeds
- Difficulty opening your mouth
- A lump or sore inside your nose that fails to heal
- Unexplained weight loss
- A lump in your neck
Most oral or mouth cancers begin in the tongue or in the floor of your mouth, yet other areas can be involved. Symptoms of this type of cancer include:
- White or red patches in your mouth
- A sore in your mouth that doesn’t heal
- Problems or pain with swallowing
- A lump in your neck
The salivary glands create saliva that moistens food and aids in chewing and digestion. Saliva also cleans the mouth and contains antibodies that destroy germs. Symptoms of salivary cancer include:
- A lump in your ear, cheek, jaw, lip, or inside your mouth
- Fluid in your ear
- Trouble swallowing or opening your mouth
- Numbness, weakness, or pain in your face
Throat cancer starts in your pharynx, the area that connects your mouth and nasal cavities to your voice box (larynx) and your esophagus.
- Trouble breathing or speaking
- Frequent headaches
- Pain or ringing in your ears
- Trouble swallowing
- Ear pain
Screening and Diagnosis
If you regularly drink alcohol, or if you use tobacco products or have in the past, you should have yearly general health and dental exams to screen for head, neck, and oral cancer.
During that exam, your doctor or dentist will look into your nose, mouth, and throat and feel for lumps in your neck. If they find anything abnormal, they will recommend further screening by an otolaryngologist, or ear, nose, and throat doctor. The otolaryngologist will use a thin tube with a camera in it to look deeper into your nose and throat. This is called a fiberoptic nasopharyngoscopy. Depending on what they find, they might order more tests to determine if it is cancer and whether it has spread.
- CT (computed tomography) scan takes data from several X-ray images of your chest, abdomen, or pelvis and converts them into pictures on a monitor. It can show tissues and blood vessels in addition to bones.
- MRI (magnetic resonance imaging) test uses powerful magnetic fields to create 3D pictures that detect tumors in your head.
- PET (positron emission tomography) scan uses a small amount of radioactive glucose injected into your vein to show where glucose is being used in your body. A scanner rotates around your body to create an overall picture. Cancer cells use more glucose than normal cells do.
- Endoscopy uses a thin flexible lighted tube to examine the cavities in your head and neck without surgery.
- Biopsy, or a small tissue sample of any suspicious lump or mass. A pathologist will examine the cells under a microscope for changes that could be cancer. Because human papillomavirus (HPV) infection can cause head, neck, and oral cancer, they’ll screen the cells for this virus, too.
- FNA (fine needle aspiration) injects a needle into the tumor and then suctions out cells. A pathologist will examine the cells under microscopy for changes that could be cancer. You might have an FNA of your lymph nodes to assess if cancer is present.
How are head and neck cancers treated?
Head and neck cancer treatment can include surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, or a combination of treatments. The treatment plan for an individual patient depends on a number of factors, including the location of the tumor, the stage of cancer, and the person’s age and general health.
Patients and their doctors should consider treatment options carefully. They should discuss each type of treatment and how it might change the way the patient looks, talks eats or breathes and how each treatment can affect their quality of life.