Head and neck cancers most commonly develop in the squamous cells that line the inside of the mouth, throat and voice box. Rarely, head and neck cancers can begin in the sinuses, salivary glands or nerves and muscles of the head and neck.
Head and neck cancer can affect the following:
- Oral cavity: This includes the small area of the gums behind the wisdom teeth, bottom (floor) of the mouth underneath the tongue, bony top of the mouth (hard palate), the gums, the lining of the inside of the lips and cheeks, the front two-thirds of the tongue and the lips.
- Throat (pharynx): The pharynx starts in the nose and continues down to the esophagus. It’s about five inches long and has three parts: the nasopharynx (the area behind the nose), oropharynx (the middle part that includes the tonsils, base of the tongue and back of the mouth) and the hypopharynx (the lower part).
- Voice box (larynx): A short passageway located below the pharynx in the neck. The voice box contains the vocal cords and the epiglottis, a small piece of tissue that blocks food from entering the airway.
- Paranasal sinuses and nasal cavity: The paranasal sinuses are hollow pockets in the bones around the nose. The nasal cavity is located inside the nose.
- Salivary glands: The salivary glands produce saliva. The major salivary glands are located near the jawbone and bottom of the mouth. The minor salivary glands are located in the mucus membranes throughout the throat and mouth.
Types of head and neck cancer include:
- 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 following cancers are not classified as head and neck cancers:
- Brain tumors
- Eye cancer
- Esophageal cancer
- Thyroid cancer
- Skin cancer on the head and neck
To understand head and neck cancer, it’s first important to understand what cancer is: basically, the production of abnormal cells.
The body is programmed to routinely replenish cells in different organs. As normal cells age or get damaged, they die off. New cells take their place. This is what’s supposed to happen.
Abnormal cell growth refers to a buildup of extra cells. This happens when:
- New cells form even though the body doesn’t need them
- Old, damaged cells don’t die off
These extra cells slowly accumulate to form a tissue mass, lump or growth called a tumor. These abnormal cells can destroy normal body tissue and spread through the bloodstream and lymphatic system.
The first thing to understand is that a growth can be either benign or malignant. You’ve probably heard these terms. Here’s exactly what they mean:
- Benign means not cancerous. A benign tumor can grow larger but does not spread to other tissues or organs. Benign tumors:
- Can be removed
- Usually don’t grow back
- Are rarely fatal
- Don’t spread to other tissues or body parts
- Malignant means cancerous. The cells of a malignant tumor can spread and invade nearby tissues and organs. They are destructive. Malignant tumors:
- Can often be removed
- Sometimes grow back
- Can invade and damage other tissues and organs
- Can spread to other body parts
- Can be fatal
Head and neck cancers account for less than 10% of cancer cases in the United States. They are more common in men and in people over age 50. Most head and neck cancer diagnoses affect the voice box, throat or mouth. Salivary gland, paranasal sinus and nasal cavity cancers are much less common.
Hypopharyngeal cancer occurs in the lower part of the throat (pharynx). Most forms of hypopharyngeal cancer develop in the squamous cells, which are flat, thin cells that line the inside of the lower part of the throat.
Risk factors for hypopharyngeal cancer include:
- Smoking or chewing tobacco
- Heavy alcohol use
- Eating a diet low in essential nutrients
- Having Plummer-Vinson syndrome, a type of anemia caused by iron deficiency that makes swallowing difficult
Laryngeal cancer occurs in the larynx, the part of the throat between the trachea and base of the tongue. The vocal cords are located inside the larynx. Most forms of laryngeal cancer develop in the squamous cells that line the inside of the larynx.
Risk factors for laryngeal cancer include:
- Smoking or chewing tobacco
- Heavy alcohol use
Lip and oral cavity cancer develops in the lips or mouth, including in the:
- Gums (gingiva)
- Lining of the inside of the cheeks (buccal mucosa)
- Front two-thirds of the tongue
- Bottom (floor) of the mouth under the tongue
- Roof of the mouth (hard palate)
- Small area behind the wisdom teeth (retromolar trigone)
Most forms of lip and oral cavity cancer develop in the squamous cells that line the inside of the oral cavity and lips. Risk factors for lip and oral cavity cancer include:
- Smoking or chewing tobacco
- Heavy alcohol use
- Exposure to UV radiation from the sun or artificial sunlight (like tanning beds) over a long period of time
- Being male
Squamous cells are found throughout the body, including on the surface of the skin and in the lining of body cavities like the mouth, esophagus, kidneys, lungs, uterus and digestive tracts. Metastatic squamous neck cancer with occult primary is cancer that has spread to the lymph nodes in the neck. However, the location where the cancer began (the primary tumor) is unknown (occult) or cannot be found.
For many people with metastatic squamous neck cancer, the primary tumor is never found.
Because the location of the primary tumor is unknown, the risk factors can vary.Nasopharyngeal Cancer Risk Factors
Nasopharyngeal cancer occurs in the upper part of the throat (pharynx) behind the nose.
Risk factors for nasopharyngeal cancer include:
- Exposure to the Epstein-Barr virus, which has been associated with cancers like nasopharyngeal cancer and certain lymphomas
- Heavy alcohol use
- Having Asian or Chinese ancestry
Oropharyngeal cancer occurs in the middle part of the throat (pharynx) behind the mouth.
Risk factors for oropharyngeal cancer include:
- Tobacco use, particularly a history of smoking for more than 10 pack-years (for example, smoking one pack a day for 10 years or two packs a day for five years)
- Heavy alcohol use
- Human papillomavirus (HPV) infection, particularly HPV type 16
- History of head and neck cancer
- Chewing betel quid, a type of smokeless tobacco widely used throughout Asia
Paranasal sinus and nasal cavity cancer occurs in the air-filled spaces in the bones near the nose (the para sinuses) or inside the nose (the nasal cavity). The most common paranasal and nasal cavity cancer is squamous cell carcinoma. Other types include melanomas, sarcomas, inverting papillomas and midline granulomas.
Risk factors for paranasal sinus and nasal cavity cancer include:
- Exposure to dust and certain chemicals, particularly for those whose profession involves:
- Bakery or flour mill work
- Sawmill work
- Human papillomavirus (HPV) infection
- Being male and over age 40
Salivary gland cancer is a rare disease that occurs in the salivary glands, which make and release saliva into the mouth.
Risk factors for salivary gland cancer include:
- Radiation therapy to the head and neck
- Older age
- Exposure to certain substances at work
There are three main ways that cancer spreads in the body. It can spread through:
- Tissue. Cancer invades nearby normal tissue.
- The lymph system. Cancer invades the lymph system and travels through the lymph vessels to other parts of the body.
- Blood. Cancer invades veins and capillaries and travels through the bloodstream to other parts of the body.
The original tumor is called the primary tumor. When cancer cells break away from it and travel to other places in the body, a secondary tumor can form. The name for this spreading process is metastasis.
The secondary tumor is the same kind of cancer as the primary tumor. For instance, if the cancer cells in the throat travel to the liver, it is considered metastatic throat cancer. It is not liver cancer.
As you and your doctor explore your treatment options, be sure to get answers to the following questions:
- What are my treatment choices? Which do you recommend for me and why?
- Will I have more than one kind of treatment?
- What are the expected benefits of each type of treatment?
- What are the risks and possible side effects of each treatment? What can we do to control the side effects?
- What can I do to prepare for treatment?
- Will I need to stay in the hospital? If so, for how long?
You may want to ask these questions before the doctor takes a sample of tissue:
- Which procedure do you recommend?
- How will the tissue be removed?
- Will I have to stay in the hospital? If so, for how long?
- Will I have to do anything to prepare for it?
- How long will it take?
- Will I be awake?
- Are there any risks?
- How long will it take me to recover?
- How soon will I know the results? Who will explain them to me?
- What is the treatment likely to cost? Will my insurance cover the cost?
- How will treatment affect my normal activities?
- Would a clinical trial be right for me?
- How often should I have checkups after treatment?
- What are the chances my cancer will come back after this treatment?
- What will we do if the cancer comes back or the treatment doesn’t work?
- Will I lose my hair?
- Will you have to remove lymph nodes?
- Will it be painful?
- Will there be scars?
- What are the long-term and short-term side effects of treatment and how can I manage them?
Your immune system plays a big part in your fight against cancer. It is essential to stay as healthy as possible while undergoing cancer treatment. Here are some tips:
- Practice food safety.
- Wash your hands often, and ask your family, healthcare providers and visitors to do the same.
- Bathe every day with warm water and gentle soap.
- Ask your doctor if you should get a flu vaccine or the COVID-19 vaccine.
- Wear a mask when in public and around other people.
- Brush your teeth after meals with a soft toothbrush.
- Do your best to avoid cuts. Wear gloves when cleaning or gardening.
- If you get a small cut, wash it with soap and water, apply antibiotic cream, and put a bandage over it.
- Contact your doctor immediately if you suspect you have an infection, particularly if you have a fever.
- Be physically active.
- Maintain a healthy weight.
- Don’t use tobacco products.
- Protect your skin from the sun with sunscreen, sun-protective clothing and a wide-brimmed hat.
- Eat plenty of vegetables and fruit.
- Limit or avoid drinking alcohol.
Do your best to evaluate your financial situation as soon as possible. You will not want to deal with financial stress in the middle of treatment when you may not feel well. A social worker can help with this process. If you don’t currently have a social worker, ask your doctor or nurse for a recommendation.
It’s important to plan ahead as much as possible when beginning cancer treatment. Ask your nurse navigator or social worker if they can recommend resources to help with the logistics of treatment.
With Your Healthcare Team
When going through cancer treatment, your healthcare team is very important. Your healthcare team may include your oncologists, surgeon, nurse navigator, dietitian, social worker or other medical professionals. Every member plays an important role. Use the tips below for talking with your healthcare team:
- Establish your main point of contact.
- Your main point of contact will probably be a nurse navigator, but it may be another member of your healthcare team. Find out who you should contact first with questions.
- Don’t be afraid to ask questions.
- Be open and honest with your healthcare team about your physical and emotional well-being.
- Cancer is usually not a medical emergency. There is time to ask your healthcare team any questions you may have and consider your treatment options.
- Write down your questions before your appointments. Take a pen and paper to write down the answers.
- If you develop any new problems or symptoms during treatment, tell your healthcare team immediately. You are not complaining. This is valuable information for your doctors.
- Do not change your diet, start an exercise program or take any new medications, including vitamins and supplements, during treatment without talking to your healthcare team first.
With Your Caregiver
Your primary caregiver may be with you when you receive your diagnosis. Your primary caregiver may be your spouse, partner, adult child, parent or friend. This person may come with you to appointments, take care of you after surgery or treatment and support you throughout your cancer journey. Here are some tips for communicating with your caregiver:
- Everyone reacts to the news of cancer differently. You may feel upset, shocked or angry. It may take you some time to process the information. Your caregiver may react the same way you do or your caregiver may not. Even if they don’t react the same way you do, it doesn’t mean that they don’t care deeply.
- Establish your role and your caregiver’s roles early. For example, will your caregiver be the one scheduling most of your appointments or do you prefer to take an active role? Find what works best for you and your caregiver.
- Be open with each other about how you both feel. Overly positive attitudes may hinder honest communication. It’s okay to be upset.
- Encourage your caregiver to take time to care for their own physical and emotional well-being. Being a caregiver comes with its own hardships.
- If your primary caregiver is your spouse or partner, your intimate and physical relationship may change. Cancer treatment and side effects can potentially affect your libido and sexual function. If you have questions or concerns about sexuality and intimacy during and after cancer treatment, talk to your nurse, doctor or social worker.
With Your Children
Children are very perceptive, no matter their age. While you may wish to protect your children by not telling them about your cancer diagnosis, even young children may be able to tell that something is wrong. Not knowing what is wrong may cause them more stress and anxiety.
Here are some tips to talk to your children and teens about your cancer diagnosis:
- Wait until your emotions are under control and decide what to say ahead of time.
- Tell the truth and answer questions honestly. Depending on your children’s ages, it may not be appropriate to give them all the details, but do be truthful.
- Let them know what to expect. For example, tell them that after surgery, you will need a lot of rest and may need to stay in the hospital. If your chemotherapy may cause you to lose your hair, let them know. Keep your children in the loop as much as possible.
- Explain to your children, especially younger children, that they cannot “catch” cancer.
- Let your children know that it is okay to cry or be upset. This may be especially important for your teens to hear.
- Tell teachers, babysitters and others with responsibilities with and around your kids about your diagnosis in case they see behavior changes you may need to know about.
- Maintain normal schedules as much as possible.
- Let your kids help. Allow them to help with chores and let them know that their help is important. Teens may want to take an active caregiver role. Let them do so at appropriate levels.
- Look for support groups in your area. Many places offer support groups for children and teens whose parents have a cancer diagnosis.
- Know when to seek professional help. If your child begins to demonstrate unusual behavior such as angry outbursts, nightmares or poor grades in school, ask your healthcare team for a recommendation for a counselor.
With Family and Friends
You may choose to keep your cancer journey private or you may choose to share your story with others. The choice is yours. Remember, when family, friends, coworkers or other acquaintances ask about your diagnosis, they are genuinely concerned about your well-being. You can share with them as much or as little information as you like. These suggestions may heclp you talk about your diagnosis:
- Decide how much information you want to share before you start telling people about your diagnosis.
- If you chose to keep your journey private, let people know that you appreciate their concern, but you hope they respect your privacy.
- Choose someone close to you, like your caregiver, to spread the word about updates and treatment progress. After a long day of treatment, you may not feel like calling and texting people, but your friends and family will probably want to know how you are.
- If you want to share your story, consider starting an email chain or a Facebook group. This way, you can update everyone with one message instead of answering a lot of emails and phone calls.
- You can also create your own private website at MyLifeLine.
- When people offer to help, let them. Your family and friends could cook dinner, drive you to an appointment, help clean your home, run errands or babysit.
- If you lose your hair due to treatment or have visible surgical scars, strangers may ask about your diagnosis. Have a response prepared. Again, you may share as little or as much as you like.