Head and neck cancers

What are head and neck cancers?

Just like with other areas of the body, your head and neck are made up of a complex network of tissues, organs, and systems that enable you to function. Head and neck cancer can occur when the cells in these areas start to grow abnormally and uncontrollably.

These abnormal cells can form tumors that can affect various parts of the head and neck, including the:

• Mouth
• Nose
• Sinuses
• Throat
• Larynx (voice box)
• Salivary glands
• Thyroid gland

Head and neck cancers are rare, representing about four percent of all cancers. Men and people assigned male at birth are more likely to develop head and neck cancer than women. This can be attributed to the fact that men are more likely to engage in high-risk behaviors like using tobacco products.

Learn how Mike turned “I have salivary gland cancer” into “I had cancer” on Episode 43: Hockey player ices cancer of our I Had Cancer podcast.

AHN Head and Neck Cancer Center of Excellence

At the AHN Head and Neck Cancer Center of Excellence, we only focus on treating patients with these cancers. This concentration on head and neck cancer allows for a more precise diagnosis and helps us develop an effective treatment plan for you. You also have access to our robust support services such as support groups, palliative care, and cancer genetics.

Our team has a deep understanding of the latest head and neck cancer treatments. We are committed to personalized care, finding the right treatment for you. Our compassionate team of medical oncologists, radiation oncologists, and surgeons uses the latest research to treat even the most complex cases of cancer. We use minimally invasive techniques whenever possible, so your recovery is shorter and more comfortable. At the Cancer Institute, you can find expert cancer care, close to home.

Quick guide to head and neck cancer

Head and neck cancer symptoms and signs

Head and neck cancer screening and diagnosis 

Types and stages of head and neck cancer

Head and neck cancer treatment

Head and neck cancer FAQs

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Head and neck cancer symptoms and signs

Early detection is always critical to successful cancer treatment. Symptoms of head and neck cancer can vary depending on the location and type of cancer. The following areas can exhibit the following symptoms. If you notice any of these symptoms in the mouth, nose and sinuses, throat, or jaw, contact your doctor:

• Mouth: Sores that don't heal, lumps or thickening, white or red patches, difficulty swallowing, loose teeth, numbness or tingling in the mouth.
• Nose and sinuses: Nasal congestion, nosebleeds, pain in the face or sinuses, a change in sense of smell. 
• Throat: Sore throat that doesn't go away, hoarseness, difficulty swallowing, ear pain, a lump in the neck.
• Larynx: Hoarseness, difficulty breathing, a change in voice, pain when swallowing.
• Salivary glands: Swelling in the neck, pain in the jaw, dry mouth.
• Thyroid gland: Swelling in the neck, difficulty swallowing, hoarseness, a lump in the neck.

It's important to note that these symptoms can also be caused by other conditions. If you experience any of these symptoms, it's crucial to see a doctor for a proper diagnosis.

Head and neck cancer risk factors

There are certain risk factors that can increase the chance of developing head and neck cancers. It’s important to know that not everyone who has these risk factors will develop the disease and, at the same time, stay aware of any changes or symptoms you may develop—especially if you’re more at risk. Risk factors include:

• Tobacco use: Smoking cigarettes, cigars, pipes, and chewing tobacco are the most significant risk factors. The longer and more heavily you use tobacco, the higher your risk.
• Excessive alcohol consumption: Drinking large amounts of alcohol, especially combined with tobacco use, significantly increases the risk.
• Human papillomavirus (HPV) infection: Certain types of HPV, particularly HPV16, 18, 31 and 33 are strongly linked to oropharyngeal cancer (cancer of the back of the throat). This is particularly true for people who have never smoked.
• Exposure: Working with asbestos, wood dust, nickel, and certain other chemicals can increase the risk. Excessive sun exposure can also increase the risk. Medical radiation treatments, such as for head and neck cancers, can increase the risk of developing a second cancer in the same area.
• Certain medical conditions: People with certain medical conditions, such as chronic sinusitis or gastroesophageal reflux disease (GERD), may have a slightly higher risk.

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Head and neck cancer screening and diagnosis

There is no single screening test for head and neck cancer. However, regular dental checkups and visits to your primary care physician can help detect early signs of the disease.

To begin the diagnosis, we will ask you about your symptoms and perform a physical examination. We may perform other tests and diagnostic procedures to confirm the diagnosis and determine if the cancer has spread. Imaging scans are also used to help physicians see cancers that are invisible to the naked eye or are hidden under tissue.

Diagnostic procedures include:

• Computed tomography (CT) scan: This test uses a combination of X-rays and computer technology. A CT produces horizontal and vertical cross-sectional images of your body, including bones, muscles, fat, and organs.
• Magnetic resonance imaging (MRI): This imaging technique uses powerful magnets and radio waves to produce detailed images of your organs.
• Positron emission tomography (PET) scan: We inject a safe amount of radioactive-tagged glucose (sugar) into your bloodstream. Then, a scanner takes images of your body. The scanning machine detects the tumors because they absorb the glucose more than normal tissues do.
• Ultrasonography: This diagnostic imaging technique uses high-frequency sound waves to create an image of internal organs.
• Endoscopy: We use a small, thin scope called an endoscope to examine your oropharynx, larynx (voice box), and upper airway.
• Biopsy: For this minor surgical procedure, we take a small portion of the suspicious tissue for a pathologist to examine under a microscope. A biopsy can confirm a diagnosis. We give you anesthesia before the procedure, so you are comfortable. For some biopsies, when the tumor is small and easy to access, you can even undergo the procedure in the office under local anesthesia. 

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Types and stages of head and neck cancer

If a biopsy and one or more imaging studies indicate the presence of cancer, physicians will then determine its stage. Cancer staging helps your care team to know the extent of the disease and if it has spread to other areas of your body. Staging is important for creating your personalized treatment plan.

Head and neck cancer is classified based on the type of cells involved and the location of the tumor.

Some common types include:

• Squamous cell carcinoma: The most common type, originating from the squamous cells that line the head and neck.
• Adenocarcinoma: Arises from glandular cells, often found in the salivary glands.
• Lymphoma: Cancer of the lymphatic system, which can affect the head and neck.

The stage of head and neck cancer refers to the extent of the disease and is determined by factors like tumor size, spread to lymph nodes, and involvement of distant organs. Stages range from I (early) to IV (advanced).

Commonly head and neck cancer falls into one of four different categories for staging:

• Oral cavity cancer: includes lip, tongue, floor of mouth, buccal mucosa, hard palate, and gingiva cancer. Learn more about oral cancer. 
• Pharyngeal cancer: includes nasopharynx, oropharynx, and hypopharynx cancer. Learn more about oropharyngeal cancer.
• Laryngeal cancer: includes supraglottis, glottis, and subglottis cancer.
• Nasal cavity and paranasal sinus cancer.

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Head and neck cancer treatment

After your diagnosis, physicians work with you to determine your personalized treatment plan. If we diagnose head and neck cancer early, we may be able to cure the cancer entirely. If we detect the cancer at a later stage, we’ll discuss care options with you to control the cancer, slow down its spread, and enhance your quality of life.

Our compassionate, experienced team of nurses, social workers, physician extenders (nurse practitioner or physician assistant), therapists, and medical oncologists support you throughout every phase of your treatment.

Treatment may involve a combination of multiple methods. The goal of treatment is to cure the cancer, control its growth, or relieve symptoms.

Surgery

We use surgery to diagnose and stage head and neck cancer. Depending on the stage of the cancer, we can also perform surgery to treat the cancer and remove the tumor. Surgery often offers a chance for a cure, especially when the cancer hasn’t spread to other tissues. We may use it alone or in combination with radiation therapy and chemotherapy.

Our experienced surgeons use the latest techniques and technologies. Their expertise ensures that you receive the highest quality of care with the best possible results. Our extensive surgical treatment options include:

• Primary tumor resection: Removes the entire tumor including, when possible, an area of surrounding normal tissue to ensure complete removal of cancerous tissue.
• Maxillectomy: Removes the tumor, and if bone is involved, part or all of the hard palate (roof of your mouth). 
• Glossectomy: Removes all or part of the tongue.
• Mandibulectomy: Removes tumors that are on the floor of your mouth that may involve your jawbone.
• Laryngectomy: Removes tumors that involve the larynx. 
• Neck dissection: Removes lymph nodes in the neck area (if the cancer has spread to the lymph nodes).
• Thyroidectomy: Removes the thyroid and sometimes nearby lymph nodes.
• Reconstruction after surgery: If the tumor is large, then you may need reconstructive surgery after the tumor removal surgery. Many of our AHN surgeons have advanced training in this specialty in order to provide expert reconstruction of the oral cavity or face.

Radiation therapy

AHN is the only radiation oncology network accredited in western Pennsylvania by the American College of Radiology. The accreditation means that we meet specific guidelines for patient safety, quality control, and efficiency of equipment. At the Cancer Institute, you are receiving the highest-quality care available.

Radiation therapy uses high dose X-rays to target tumor cells. Sometimes, the radiation beam can damage normal cells in the process. However, these healthy cells are better able to repair themselves, and most recover from radiation treatment.

Our skilled radiologists offer several cutting-edge and targeted treatment options, including:

• Intensity modulated radiotherapy (IMRT): We direct the radiation beam from multiple angles in smaller doses. This process helps minimize the side effects while offering maximum treatment. It helps lessen the injury to surrounding tissue and the salivary glands.
• Image-guided radiotherapy (IGRT): This therapy uses frequent imaging to deliver precise radiation therapy. We image a tumor immediately before or during radiation treatment so we can shape the radiation beam to match the tumor exactly. Precisely targeting the tumor results in minimal harm to surrounding healthy tissues.
• MR-Linac: Radiation treatments are already delivered with pinpoint accuracy, but the new MR-Linac** takes precision to the next level. We are the only cancer center in the region and one of only six in the United States that will be testing this new innovative technology. The MR-Linac combines a magnetic resonance imaging (MRI) machine with the radiation delivery machine – known as a linear accelerator – into one treatment device. The MRI provides high-quality images of a tumor in real-time, and then the linear accelerator emits radiation beams to the exact location of the cancer.

Other treatment options include looking at how inhaling and exhaling cause organs, tissues, and the tumor to move. This technology—currently in research at the AHN Cancer Institute at Allegheny General Hospital—allows us to see images of a patient's body as breaths are taken, so we can directly target the tumor with radiation. If a tumor moves out of the determined radiation area as a patient inhales, the radiation automatically turns off. When the patient exhales and the tumor returns to its original position, the high-energy beams resume.

This type of delivery limits healthy tissue and organs from being radiated while providing a powerful dose of radiation to the cancer.

Medical oncology for head and neck cancer

You may need chemotherapy medications, depending on the type of cancer. Medical oncology may be the most effective treatment for metastatic cancer (when the cancer has spread to other organs) and recurrent cancer (when the cancer has come back after treatment).

We use the latest forms of chemotherapy and immunotherapy for precise and targeted treatment. Throughout your treatment, we monitor your wellness and determine the right amount of medication. This ongoing monitoring reduces side effects and maximizes the treatment’s effectiveness.

Treatment options include:

• Chemotherapy: Just as antibiotics kill bacteria, chemotherapy kills cancer cells. These powerful drugs can sometimes damage normal cells. Side effects may occur, including dry mouth, oral ulcers, altered taste, nausea, and lowered blood counts, which may lead to infection. Fortunately, your body’s normal cells repair themselves much better than cancer cells. Side effects are generally temporary.
• Targeted therapy: This therapy can be more effective than traditional chemotherapy with fewer side effects. It attacks specific genes within the surrounding blood vessels to stop cancer from growing. This method stops the tumor’s growth.
• Immunotherapy: This therapy helps activate your immune system to fight cancer better.

Rehabilitation after treatment

Head and neck cancer surgery may affect your function. You may need rehabilitation after surgery or treatment. Our rehabilitation services address any problems with speech, swallowing, or voicing, helping you regain your strength and function.

Our specially trained and compassionate speech therapists work with you during and after treatment. We help you achieve the best possible results for swallowing, eating, and speaking. Our Navigation Team guides you through the rehabilitation process, including assisting you in scheduling appointments.

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Head and neck cancers FAQs

Head and neck cancers can affect various parts of the upper body, including the brain and eyes. Having an understanding of how the disease can potentially affect you can help in understanding your treatment options and prognosis. Your AHN care team is your go-to resource to help answer your specific questions, but to help get you started with reliable information, we’ve included answers to patients’ frequently asked questions that might help in your conversations with your care team.

What cancers are included in head and neck cancer?

Head and neck cancers generally refer to a group of cancers that originate in the head and neck region, excluding the brain and eyes. These typically include cancers of the:

• Oral cavity: Lips, tongue, gums, lining of the cheeks, floor of the mouth, and hard palate.
• Pharynx: The throat, which is divided into three parts:
  • Nasopharynx: Upper part of the throat behind the nose.
  • Oropharynx: Middle part of the throat behind the mouth, including the tonsils and base of the tongue.
  • Hypopharynx: Lower part of the throat near the voice box.
• Larynx: The voice box.
• Paranasal sinuses and nasal cavity: Air-filled spaces around the nose.
• Salivary glands: Glands that produce saliva.

What is the most common type of head and neck cancer?

The most common type of head and neck cancer is squamous cell carcinoma. This type of cancer originates in the squamous cells that line the moist, mucosal surfaces inside the head and neck, such as the mouth, throat, and voice box.

How are head and neck cancers diagnosed?

Diagnosing head and neck cancers typically involves a combination of methods:

• Physical examination: A doctor will examine the head and neck, looking for any lumps, sores, discolored patches, or other changes.
• Endoscopy: A thin, flexible tube with a camera (endoscope) is used to look inside the throat, larynx, and other areas.
• Biopsy: A small tissue sample is removed from any suspicious areas and examined under a microscope to confirm the presence of cancer. This is the definitive diagnostic test.
• Imaging tests: These can help determine the size and extent of the tumor and whether it has spread. Common imaging tests include:
• CT scan (Computed Tomography): A CT scan uses a series of X-ray images taken from different angles around your body to create detailed cross-sectional images of bones, blood vessels, and soft tissues in the head and neck, helping to pinpoint tumor location and size.
• MRI (Magnetic Resonance Imaging): An MRI uses strong magnetic fields and radio waves to generate highly detailed images of soft tissues, making it particularly effective for visualizing tumors in areas like the brain, spinal cord, and intricate structures of the head and neck, and for assessing tumor invasion.
• PET scan (Positron Emission Tomography): A PET scan uses a small amount of a radioactive tracer, typically sugar-based, to highlight areas of increased metabolic activity, which can indicate the presence of cancerous cells, helping to detect tumors, determine their spread, and monitor treatment response.
• Barium swallow: X-ray of the esophagus and stomach.
• HPV testing: For oropharyngeal cancers, testing for Human Papillomavirus (HPV) is often done as it can influence treatment and prognosis.

What is the most aggressive head and neck cancer?

Determining the "most aggressive" can be complex as aggressiveness can depend on various factors like stage at diagnosis, specific subtype, and response to treatment. However, generally, hypopharyngeal cancers and anaplastic thyroid cancer are often considered among the more aggressive head and neck cancers due to their tendency to be diagnosed at later stages, grow rapidly, and have a higher likelihood of regional or distant metastasis. Oropharyngeal cancers, especially those not associated with HPV, can also be quite aggressive.

Are head and neck cancers curable?

Yes, many head and neck cancers are curable, especially when detected and treated early. The cure rate depends significantly on:

• Stage of the cancer: Earlier stages generally have higher cure rates.
• Location of the tumor: Some locations are more amenable to treatment.
• Type of cancer: Specific subtypes can respond differently to therapies.
• Presence of HPV (for oropharyngeal cancers): HPV-positive oropharyngeal cancers often have a better prognosis.
• Overall health of the patient: The patient's ability to tolerate treatment plays a role. Treatment options typically include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy, often used in combination.

How common are head and neck cancers?

Head and neck cancers account for a significant portion of all cancers diagnosed annually. Globally, they are among the top ten most common cancers. In the United States, they represent about 3% to 5% of all cancers. Incidence rates can vary by geographic region, lifestyle factors (such as tobacco and alcohol use), and HPV prevalence. Men are more commonly affected than women, and the risk increases with age. 

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