Causes of head and neck cancer
- The main risk factor of head and neck cancers (excluding skin cancer) is tobacco use.
- Alcohol is also strongly linked.
- Using both tobacco and alcohol together further increases a person’s risk.
Other risk factors include:
- age – head and neck cancer is most common in people 55+
- sex – men are about 3 times more likely to develop head and neck cancer
- race – people from some cultural backgrounds may be more likely to develop certain types of head and neck cancer
- inhalation of certain chemicals or dusts – breathing in sulphuric acid mist, asbestos fibres, dry-cleaning solvents, certain types of paint or nickel may increase the risk
- chewing areca nut (betel nut or paan)
- diet – some studies suggest a diet low in beta-carotene (found in some fruits and vegetables) may be a slight risk factor
- leukoplakia (white patches in the mouth) or erythroplakia (red patches in the mouth)
- Human Papillomavirus (HPV)
- Epstein-Barr Virus (EBV).
Symptoms of head and neck cancer
You may have a sore or swelling in your mouth, neck, throat or jaw that does not go away, or difficulty chewing or swallowing. These symptoms, along with pain in your head and neck region, are common to oral, pharyngeal, laryngeal and nasal or paranasal cancer.
Oral cancer symptoms
- mouth pain
- a white patch on your gums, tongue or lining of your mouth (leukoplakia)
- a red patch on your gums, tongue or lining of your mouth (erythroplakia)
- a change in your speech or difficulty pronouncing words
- difficulty swallowing food, or food that gets ‘stuck’
- a lump in the neck
- loose teeth or dentures that no longer fit well
Pharyngeal cancer symptoms
- throat pain
- a persistent sore throat or cough
- coughing up bloody phlegm
- difficulty swallowing
- a change in the sound of your voice, or hoarseness
- a feeling that your air supply is blocked
- dull pain around your breastbone
- a lump in the neck
- an earache
Laryngeal cancer symptoms
- swelling in the neck or throat
- a change in the sound of your voice, or hoarseness
- a lump in the neck
- difficulty swallowing
- a persistent sore throat
Nasal and paranasal cancer symptoms
- a persistent blocked nose, particularly in one nostril
- a decreased sense of smell
- nosebleeds
- mucus drainage in the back of your nose or throat
- frequent headaches or a feeling of sinus pressure
- a bulging or watery eye
- complete or partial loss of your eyesight
- double vision
- a lump on your face, or in your nose or mouth
- loose or painful teeth
- pressure or pain in your ears
Staging
Staging tells the doctor how far the cancer has spread. This helps your health care team decide what treatment is best.
Most cancers follow a general, international staging system called TNM.
- The T refers to the tumour
- The N to the lymph glands (or nodes)
- The M to metastasis, or how far the cancer has spread.
Each letter is assigned a number that indicates how advanced the cancer is.
Doctors will usually explain cancer staging in plain English.
Prognosis
Prognosis means the expected outcome of a disease.
It is not possible for any doctor to give you a 100% accurate prediction on the course of the illness. Test results, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as age, fitness and your medical history are all important factors in assessing your prognosis.
Which health professionals will I see?
You will be cared for by a range of health professionals, such as:
- audiologist – diagnoses and treats hearing problems
- cancer nurse coordinator or clinical nurse consultant – coordinates your care and supports you throughout treatment
- dentist or oral medicine specialist – evaluates and treats the mouth
- dietician – supports and educates patients about nutrition and diet, including tube feeding
- ENT specialist – diagnoses and treats disorders of the ear, nose and throat
- gastroenterologist – specialises in the digestive system and its disorders
- head and neck surgeon – operates on cancer in the head and neck region
- medical oncologist – plans and administers chemotherapy
- oral (maxillofacial) surgeon – specialises in reconstructive surgery to the face and jaws
- ophthalmic surgeon – deals with surgery affecting the eyes and visual pathways
- prosthodontist – a dentist who specialises in replacing missing teeth
- psychologists and counsellors – help people cope with changes to life as a result of cancer or treatment
- reconstructive surgeon – restores, repairs or restructures the appearance and function of the body using surgery
- radiation oncologist – plans and administers radiotherapy
- social worker – helps provide emotional support and practical assistance
- speech pathologist – rehabilitates patients with communication and swallowing disorders.
Tests to diagnose head and neck cancer
Physical examination
- May include mouth, parts of the oropharynx, neck, ears and eyes.
- Examination of some areas requires specialist equipment and/or anaesthesia.
Nasendoscopy
- Examination of the nose, pharynx and larynx.
- Doctor uses a flexible tube called an endoscope.
- Back of the nose and throat will be numbed.
- The doctor may take small tissue samples (biopsies).
- Avoid eating and drinking for 30 minutes afterwards.
Laryngoscopy
Examination of the larynx and pharynx.
Can be performed in two ways:
1. Indirect laryngoscopy
- a mirror is inserted into the back of the pharynx
- the larynx is examined
- tissue samples (biopsies) may be taken.
2. Direct laryngoscopy
- a tube with a light is inserted into the back of the pharynx
- the larynx is examined
- tissue samples (biopsies) may be taken.
Biopsy
- Removing tissue samples for examination.
- May be done during a physical examination, nasendoscopy or laryngoscopy.
CT (computerised tomography) scan
- Special type of x-ray that takes pictures of the inside of the body.
- You may have an injection of a special dye called a contrast solution into your veins beforehand.
- You will lie still on a table while the scanner, which is large and round like a doughnut, slowly moves around you.
- Painless.
- Takes about 10-30 minutes.
MRI (magnetic resonance imaging) scan
- A scan that creates detailed cross-section pictures of the body.
- You may have an injection of a special dye called a contrast solution into your veins beforehand.
- You will lie still on a table in a metal cylinder (magnet) that is open at both ends.
- Painless.
- Usually takes about one hour.
X-rays
- Pictures of areas of the body.
- You may have a blood test beforehand.
- Quick, safe and painless procedure.
- Only takes a few minutes.
PET (positron emission tomography) scan
- Only available at some hospitals.
- May be used to see if cancer has spread (metastasised).
- You are given a radioactive glucose solution – you have to sit quietly for 30-90 minutes.
- You will have a body scan to detect cancer cells.
Ultrasound
- A scan that uses soundwaves to create pictures of the body.
- A gel is spread over the area where the doctor is scanning and a paddle-shaped device is moved over the area.
- May be used to see if cancer has spread (metastasised).
- Painless.
- Takes a few minutes.
- Some people can’t can’t eat or drink for about four hours beforehand.
Treatment
Oral cancer treatment
Surgery
Some types of oral surgery include:
- glossectomy – removal of part or all of the tongue
- mandibulectomy – removal of part or all of the lower jaw
- maxillectomy – removal of part or all of the hard palate (upper jaw)
- transoral primary tumour resection – removal of a tumour through the mouth
- mandibulotomy – cutting through the lower jaw.
Your surgeons may remove some lymph nodes in your neck. This is called a neck dissection or lymphadenectomy.
The surgeon will try to remove the smallest possible area so there are few long-term side effects. In some cases, a laser is used. You will be under general anaesthesia.
Radiotherapy
Radiotherapy is the use of high-energy x-rays or electrons to kill or damage cancer cells. It can be used alone or with another treatment.
Before your treatments begin, you will probably:
- go to a planning (simulation) session and have x-rays
- be fitted with a mask to wear during treatment
- visit a dentist or oral medicine specialist.
If you receive radiotherapy, you will usually have daily treatment sessions Monday to Friday, for about 6-7 weeks.
Chemotherapy
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs.
The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells.
It can be given during the course of radiotherapy (chemoradiation). Other times, it may be given before surgery or radiotherapy to shrink a tumour (neoadjuvant chemotherapy).
Chemotherapy is usually given by injection into a vein (intravenously). You will probably have sessions of chemotherapy over several weeks, however your medical team will determine your treatment schedule.
Pharyngeal cancer treatment
Surgery
Some types of pharyngeal surgery include:
- pharyngectomy – removal of part or all of the pharynx
- mandibulotomy – cutting through the lower jaw
- mandibulectomy – removal of part or all of the lower jaw
- maxillectomy – removal of part or all of the upper jaw
- laryngopharyngectomy – removal of part or all of the larynx and pharynx.
The surgeon will try to remove the smallest possible area so there are few long-term side effects. In some cases, a laser is used. You will be under general anaesthesia.
Radiotherapy
Radiotherapy is the use of high-energy x-rays or electrons to kill or damage cancer cells.
Before your treatments begin, you will probably:
- go to a planning (simulation) session and have x-rays
- be fitted with a mask to wear during treatment
- visit a dentist or oral medicine specialist.
If you receive radiotherapy, you will usually have daily treatment sessions Monday to Friday, for about 6-7 weeks.
Chemotherapy
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs.
The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells.
Chemotherapy is usually given by injection into a vein (intravenously). You will probably have sessions of chemotherapy over several weeks, however your medical team will determine your treatment schedule.
Laryngeal cancer treatment
Radiotherapy
Radiotherapy is the use of high-energy x-rays or electrons to kill or damage cancer cells. It may be used alone, with chemotherapy or before or after surgery.
Before your treatments begin, you will probably:
- go to a planning (simulation) session and have x-rays
- be fitted with a mask to wear during treatment
- visit a dentist or oral medicine specialist.
If you receive radiotherapy, you will usually have daily treatment sessions Monday to Friday, for about 6-7 weeks.
Chemotherapy
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs.
The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells.
Chemotherapy is usually used with radiotherapy (chemoradiation); after surgery, with radiotherapy; before surgery or radiotherapy.
Chemotherapy is usually given by injection into a vein (intravenously). You will probably have sessions of chemotherapy over several weeks, however your medical team will determine your treatment schedule.
Surgery
Surgery for laryngeal cancer is often avoided because it can affect the ability to speak.
There are two main types of laryngeal surgery:
Partial laryngectomy – part of the larynx is removed. Types include:
- laser surgery – a laser beam cuts out the cancer
- cordectomy – removal of one vocal cord
- supraglottic laryngectomy – removal of the upper part of the larynx above the vocal cords (supraglottis)
- supracricoid laryngectomy – surgery to remove the upper part of the larynx, including the vocal cords
- hemilaryngectomy – surgery to remove half of the larynx
Total laryngectomy – the total removal of the larynx. You will no longer be able to speak using natural voicing after this procedure. A speech pathologist will teach you ways to communicate.
If the cancer was found at an early stage, laser surgery may be suitable. The results of laser surgery depend on how big the cancer is and where it is located in the larynx.
Nasal and paranasal sinus cancer treatment
Surgery
Surgery is a common option for many types of nasal cancer. The surgeons will plan surgery carefully in order to avoid healthy tissues and damage to your appearance and abilities to breathe, speak, chew and swallow.
There are a wide variety of different operations used for cancers of the nasal cavity and paranasal sinuses:
- Surgery depends on the exact location of the tumour.
- Some cancers require major operations with a cut along the edge of the nose and through any soft tissue and bone around the cancer.
- Some cancers can be removed using keyhole surgery.
- May involve a temporary tracheostomy (breathing tube) or a neck dissection (surgery to remove lymph nodes in the neck).
Some types of nasal cavity and sinus surgery include:
- maxillectomy – removal of part or all of the upper jaw, possibly including upper teeth, part of the eye socket and/or the nasal cavity
- craniofacial resection – removal of cancer between the eyes, requiring a cut along the side of the nose
- lateral rhinotomy – a cut along the edge of the nose to get to the nasal cavity and sinuses
- orbital exenteration – removal of the eye
- rhinectomy – removal of part or all of the nose
- endoscopic sinus surgery – removal of part of the nasal cavity or sinuses through the nostrils, using an endoscope
- midface degloving – gaining access to your nasal cavity or sinuses using a cut under the upper lip.
If surgeons have to remove part or all of your nose, reconstructive surgeons will consult with you about making a cosmetic prosthesis. This prosthesis may be made of tissues from other parts of your body, or from synthetic materials.
Radiotherapy
Radiotherapy is the use of high-energy x-rays or electrons to kill or damage cancer cells.
It is often used on its own; with chemotherapy; or after surgery.
Before your treatments begin, you will probably:
- go to a planning (simulation) session and have x-rays
- be fitted with a mask to wear during treatment
- visit a dentist or oral medicine specialist.
If you receive radiotherapy, you will usually have daily treatment sessions Monday to Friday, for about 6-8 weeks.
Chemotherapy
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells.
Chemotherapy is usually given with radiotherapy, which is called chemoradiation treatment.
Chemotherapy may also be given to try to shrink a tumour before surgery. This is called neoadjuvant chemotherapy.
Your health care team will determine your treatment schedule, which will probably include staggered sessions of chemotherapy over several weeks.
Palliative treatment
Palliative treatment helps improve people’s quality of life by alleviating symptoms of cancer, without trying to cure the disease.
Often treatment is concerned with pain relief and stopping the spread of cancer
It can also involve the management of other physical and emotional symptoms.
Treatment may include radiotherapy, chemotherapy or other medication.