Head & Neck

Overview

Head and neck cancer describes a variety of malignant tumors that affect the mouth, pharynx (throat), larynx (voice box), sinuses, nose, salivary glands and thyroid (see Figure 1). Most of these cancers begin in the squamous cells, or the thin cells that line the moist tissues inside of the nose, mouth and throat. Other cancers form in the cells of the thyroid and salivary glands.

To better understand head and neck cancer, it helps to have a general understanding of cancer. Cells are the basic units of the body, and normal cells grow, divide and die in a predictable way. Cancer cells, however, are abnormal cells that grow and divide out of control quickly. When these cells continue to multiply, even when the body does not need new cells, they form a disorganized mass composed of billions of cells, called a tumor. A tumor may or may not have the ability to spread to other parts of the body. Tumors that do not spread are called benign and those that have the ability to spread are malignant. A malignant tumor is called cancer.

Diagnosis and Staging

At the first sign of a head and neck cancer, doctors usually recommend testing to define the disease and to evaluate how advanced it is. Your doctor will perform a thorough physical exam, which will likely include questions about your personal medical history, your family history of disease and any risk factors you might have. In addition, diagnostic tests or procedures will help your doctor learn more about your specific cancer.

After head and neck cancer is diagnosed, your doctor will assign it a stage. Staging is a process that takes into account the size, location and whether (and where) the cancer has spread, such as to nearby lymph nodes or tissues or to other parts of the body. These factors are used to categorize the cancer and help your doctor develop a personalized treatment plan.

Certain cancers may be staged twice, using a clinical stage and a pathologic stage. The clinical stage is based on the results of the physical exam and imaging tests. If you have surgery for your cancer, a pathologist will then determine the pathologic stage, which is based on examination of tissue specimens removed during surgery.

The TNM staging system, developed by the American Joint Committee on Cancer (AJCC), is typically used to stage head and neck cancers. This system classifies the cancer by tumor (T), node (N) and metastasis (M). The T category describes the size and location of the primary tumor. The N category describes lymph node involvement, indicating whether the lymph nodes show evidence of cancer cells. The location of these lymph nodes is important because it shows how far the disease has spread. After surgery, the pathologist determines the pathologic N stage (sometimes denoted as pN), which describes how many lymph nodes are involved and the amount of tumor found in the nodes. The M category describes metastasis (spread of cancer to another part of the body), if any. Staging for the M category is mainly clinical; however, an M subcategory may be given based on the presence of tumor cells that can only be detected using a microscope or molecular testing.

Once the cancer is classified, an overall stage is assigned. Head and neck cancers are commonly staged as Stage 0 through Stage IV. Stage 0 (also known as “in situ”) is a precursor of an invasive cancer. Stages I and II are confined to the local area where the cancer is found, and Stage III has spread to the regional lymph nodes in the neck. Stage IV can further be divided into Stages IVA, IVB and IVC. Stage IVA and Stage IVB are locally or regionally advanced disease, and Stage IVC has spread to distant sites, such as the lung or bone.

Figure 1.

Physical and Emotional Changes

The areas affected by head and neck cancer treatment control some of your most vital functions, including breathing, swallowing, chewing and speaking. As a result, treating head and neck cancer requires more than removing a tumor and killing cancer cells. It also includes repairing areas of your body to preserve those vital functions as much as possible.

The size and location of a tumor often makes reconstructive surgery a necessity. If the tumor is small, the surgeon may be able to remove it without damaging too much tissue or bone. If the tumor is large, a reconstructive surgeon may be called in to help rebuild the damaged body part. For example, treatment for cancer that has invaded the mandible, or jawbone, may require surgery to remove part of the jaw. A reconstructive surgeon may be able to remove and reshape bone from your leg or arm into a new jawbone. Along with helping to restore appearance, reconstruction of the jawbone restores function, such as chewing and swallowing, and can provide a comfortable bite for your top and bottom teeth. In addition, the new jawbone prevents that side of your face from sinking in without a bone to provide support (see Reconstructive Surgery).

Oral Side Effects

Most people are aware of common side effects of cancer treatment, such as alopecia (hair loss) and nausea, but many don't realize how common it is for complications that affect the mouth to develop. These problems may interfere with your cancer treatment and worsen your quality of life. Treatments for head and neck cancers, such as radiation therapy, surgery and chemotherapy, can cause oral problems ranging from dry mouth to life-threatening infections. It is crucial to have a dentist as part of your treatment team who is aware of your situation and is able to monitor you closely during and after treatment. Contact your treatment team when you first notice a mouth problem, if an existing problem gets worse or if you notice any changes that concern you (see Dental & Oral Side Effects). Immunotherapy and targeted therapy, newer options to treat head and neck cancers, are associated with different types of side effects. You can learn more about these side effects here.

Your Treatment Team

A variety of specialists will work together to treat the physical and emotional aspects of your head and neck cancer. Your team may include the following:

  • An otolaryngologist, a doctor who specializes in certain diseases of the head and neck (also known as an ear, nose, and throat, or ENT, doctor)
  • A head and neck cancer surgeon and a facial plastic (reconstructive) surgeon
  • A neurosurgeon, a doctor who specializes in surgery on the brain, spine and other parts of the nervous system
  • A radiation oncologist, a doctor who specializes in treating cancer with radiation therapy
  • A medical oncologist, a doctor who specializes in treating cancer with medicines, such as chemotherapy or immunotherapy
  • An oral surgeon and a dentist to perform dental surgery and manage dental side effects
  • A speech and language pathologist to work with you to improve vital functions, such as speech and swallowing
  • A psychiatrist, psychologist or therapist

A nutritionist and a rehabilitation specialist may also be on your team.

Reducing Your Risk

Due to the increased chance of developing another primary cancer, understanding the risk factors for head and neck cancer is important. Risk factors include poor dental hygiene, smoking cigarettes, chewing tobacco and drinking excessive amounts of alcohol. Many head and neck cancers are linked to tobacco and alcohol use, and the risk of head and neck cancer is higher for people who use both tobacco and alcohol than for people who use only one or the other.

Another risk factor is human papillomavirus (HPV), which is particularly associated with cancers of the oropharynx (back of the throat), which includes the tonsils and base of tongue. In addition, prolonged exposure to the sun has been linked to cancer of the lip.

 

Some Common Head and Neck Cancer Drugs*

  • bleomycin sulfate (Blenoxane)
  • cabozantinib (Cometriq)
  • cetuximab (Erbitux)
  • cisplatin (Platinol)
  • dabrafenib (Tafinlar)
  • docetaxel (Taxotere)
  • doxorubicin hydrochloride (Adriamycin)
  • hydroxyurea (Hydrea)
  • lenvatinib (Lenvima)
  • methotrexate sodium (Methotrexate LPF)
  • nivolumab (Opdivo)
  • pembrolizumab (Keytruda)
  • sorafenib tosylate (Nexavar)
  • trametinib (Mekinist)
  • vandetanib (Caprelsa)

       *As of 8/1/18
 

Thermoplastic Mask

Certain precautions are necessary to ensure your safety during radiation treatments because the radiation must target the same spot every time. To make sure you are placed in exactly the same position for each treatment session, body molds or other immobilizing devices may be necessary. A special mesh head mask, called a thermoplastic mask, may be created from a mold of your face and head. In most cases, semi-permanent marks or permanent tattoos may be placed on your skin to indicate the exact location the radiation beams must hit to reach the tumor.

Wearing the mask and being unable to move can be traumatic, especially if you suffer from claustrophobia. Your treatment team will help make you as comfortable as possible, so tell them if you feel anxious. They will work with you to find a position you are comfortable with during every treatment. If necessary, your doctor may prescribe medication to ease anxiety and help you relax for your treatments.

In addition, ask your doctor about medications you can take before and during treatment to help minimize the long-term oral side effects of radiation therapy.

 

Additional Resources

 

Next


Register Now! Sign Up For Our Free E-Newletter!

Read Inspiring Cancer Survivor Stories

Order Your Guides Here