Head and neck cancer

Definition

Head and neck cancer is a term used to describe several different malignant tumors that develop in the throat, larynx, nose, sinuses, and mouth.

Most head and neck cancers are squamous cell carcinomas. This type of cancer starts in the cells of the epithelium, a thin layer of superficial tissue. Directly beneath the epithelium, some areas of the head and neck have a layer of moist tissue called the mucosa. If cancer is found only in the squamous cell layer, it is called carcinoma in situ. If the cancer has grown beyond this cell layer and into deeper tissue, it is called invasive squamous cell carcinoma.

When head and neck cancer begins in the salivary glands, the tumor is usually classified as adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma.

Types of head and neck cancer

There are 5 main types of head and neck cancer, each named after a part of the body where it occurs.

• Laryngeal cancer. The larynx is an integral part of the voice box. This tubular organ in the neck is for breathing, speaking, and swallowing. It is located at the top of the windpipe or trachea. 
• Cancer of the nasal cavity and paranasal sinuses. The nasal cavity is the space behind the nose where air enters the throat. The paranasal sinuses are the air-filled areas surrounding the nasal cavity.
• Nasopharyngeal cancer. The nasopharynx is the air cavity in the upper part of the pharynx behind the nose.
• Cancer of the oral cavity and oropharynx. The oral cavity includes the mouth and tongue. The oropharynx includes the middle of the throat, from the tonsils to the tip of the voice box.
• Salivary gland cancer. The salivary gland produces saliva, a liquid secreted in the mouth to keep it moist, and contains enzymes that break down food.

Other types of cancer can also be localized in the head and neck region, but their diagnosis and treatment are very different.

Risk factors and prevention of head cancer

A risk factor is anything that increases a person’s likelihood of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause it. Some people with several risk factors may never develop cancer, while others with no known risk factors will. Knowing and discussing your risk factors with your doctor can help you make more informed lifestyle and healthcare choices.

There are two substances that significantly increase the risk of developing head and neck cancer:

• Tobacco. Tobacco use refers to smoking cigarettes, cigars, or pipes; chewing or snuffing tobacco. It is the most significant risk factor for head and neck cancer.
• Alcohol. Abuse of alcoholic beverages increases the risk of malignant neoplasms.

The combined use of alcohol and tobacco increases this risk even more.

Factors that can increase your risk of developing head and neck cancer also include:

• Prolonged exposure to the sun. It is especially true for cancers in the lip area and cancers of the scalp and neck.
• Human papillomavirus (HPV). Sexual intercourse with a person with HPV is the most common way to get infected with HPV.
• Epstein-Barr virus (EBV). Exposure to EBV (the virus that causes mononucleosis) plays a significant role in the development of nasopharyngeal cancer.
• Gender. Men are 2 to 3 times more likely to develop head and neck cancer. However, head and neck cancer rates in women have been increasing for decades.
• Age. People aged 45 and older are more at risk for cancer.
• Poor oral and dental hygiene.
• Environmental or occupational inhalants. Inhaling various chemical compounds (paint, asbestos) can increase the risk of developing a dangerous disease.
• Improper diet. A diet low in vitamins A and B increases the risks.
• Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LERD). Reflux is associated with tumor growth in the area.
• Weakened immune system.
• Exposure to radioactive radiation. 
• A history of head and neck cancer. People who have had head and neck cancer once have a higher chance of developing another malignancy in the future.

Stages

Staging involves determining where the cancer is located, whether it has spread, and to what extent, as well as its effect on other parts of the body.

Doctors use diagnostic tests to determine the cancer stage; they may need information based on tissue samples from surgery, so staging may continue until all tests are done. Staging information helps your doctor determine the best treatment and predict the possibility of recovery.

TNM tumor classification system

One way to determine the stage of cancer is this TNM system. Doctors use the results of diagnostic tests and scans to answer the following questions:

• Tumor (T): its size and location?
• Lymph nodes (N): extent of process spread to lymph nodes?
• Metastasis (M): spread of cancer to other parts of the body?

Results are combined to determine each patient’s cancer stage. Staging provides a common way to describe the cancer so doctors can work together to plan the best treatment.

Symptoms

Patients with head and neck cancer often experience the following symptoms or signs. Sometimes, head and neck cancer patients do not experience any of the following changes. Or the symptom may be caused by a non-cancerous condition.

• Non-healing inflammation or wounds
• A red or white spot in the mouth
• A lump, bump, or mass in the head or neck area, painful or painless
• Long-lasting sore throat
• Putrid breath that is not attributable to hygiene
• Hoarseness of voice
• Frequent nosebleeds and/or unusual nasal discharge
• Difficulty breathing (including nasal breathing)
• Numbness in the neck or weakness in the occipital area
• Pain or difficulty chewing, swallowing even small pieces of food
• Jaw pain
• Bloody discharge in saliva or sputum, mucus that is secreted into the mouth from the respiratory tract
• Unexplained weight loss
• Fatigue
• Ear pain or infection

If cancer is diagnosed, symptom relief remains an important part of cancer care. It may be called palliative or supportive care. It often starts soon after diagnosis and continues throughout treatment.

Treatment

Head and neck cancer encompasses a range of malignancies that develop in various regions of the head and neck, including the mouth, throat, larynx, sinuses, and salivary glands. The main treatment options are following:

1. Surgery:

Surgical intervention is often the first line of treatment for head and neck cancers, especially if the tumor is localized and operable. The goal of surgery is to remove the cancerous tissue while preserving as much function as possible. Types of surgeries include tumor resection, neck dissection (removal of lymph nodes), and reconstructive surgery to restore appearance and function.

2. Radiation Therapy:

Radiation therapy uses high-energy rays to target and kill cancer cells. It can be used as a primary treatment or in conjunction with surgery. External beam radiation therapy and brachytherapy (internal radiation) are common methods. This treatment is particularly useful for patients who cannot undergo surgery or when the cancer has spread to surrounding tissues.

3. Chemotherapy:

Chemotherapy involves the use of drugs to destroy cancer cells or stop them from growing. It is often combined with radiation therapy (chemoradiation) to enhance effectiveness, especially in more advanced stages of head and neck cancer. Chemotherapy can also be used to shrink tumors before surgery or to treat metastatic cancer.

4. Targeted Therapy:

Targeted therapy drugs focus on specific molecules involved in cancer cell growth and survival. These therapies are designed to minimize damage to healthy cells and often have fewer side effects compared to traditional chemotherapy. Examples include monoclonal antibodies and tyrosine kinase inhibitors.

5. Immunotherapy:

Immunotherapy leverages the body’s immune system to fight cancer. Immune checkpoint inhibitors, for instance, help the immune system recognize and attack cancer cells more effectively. This treatment is becoming increasingly important for head and neck cancers, particularly those that are resistant to other treatments.

All these treatment options are available in more than 830 hospitals worldwide (https://doctor.global/results/diseases/head-and-neck-cancer). For example, Cervical lymphadenectomy can be done in these hospitals at following approximate prices:

Turkey $6.0 K in 16 clinics

China $10.8 K in 2 clinics

Israel $17.1 K in 5 clinics

Germany $17.9 K in 12 clinics

United States $27.4 K – 36.5 K in 10 clinics.

Prevention

• Tobacco cessation is a critical component of prevention.
• Abstinence from alcohol and marijuana use.
• Regular use of sunscreen, including lip balm with sufficient sun protection factor (SPF)
• Reduce the risk of HPV infection by HPV vaccination or by limiting the number of sexual partners. Using a condom during sexual intercourse cannot fully protect against HPV.
• Proper care of dentures is essential. Poorly fitting dentures can pick up carcinogenic substances from tobacco and alcohol. Dentures should be removed every night and cleaned and rinsed thoroughly every day.