Head and Neck Cancer: Questions and Answers

Overview
  • Most head and neck cancers begin in the squamous cells that line the mucosal surfaces in the head and neck. Head and neck cancers are identified by the area in which they begin.
  • Tobacco and alcohol use are the most important risk factors for head and neck cancers. People who are at risk for this disease should talk with their doctor about ways they can reduce their risk and how often to have checkups.
  • Typical symptoms of head and neck cancer include a lump or sore that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice.
  • The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health.
  • Rehabilitation and regular follow-up care are important parts of treatment for patients with head and neck cancer.
  1. What is cancer?
  2. Cancer is a group of many related diseases that begin in cells, the body’s basic unit of life. Normally, cells grow and divide to form new cells in an orderly way. They perform their functions for a while, and then they die. Sometimes, however, cells do not die. Instead, they continue to divide and create new cells that the body does not need. The extra cells form a mass of tissue, called a growth or tumor. There are two types of tumors: benign and malignant. Benign tumors are not cancer. They do not invade nearby tissue or spread to other parts of the body. Malignant tumors are cancer. Their growth invades normal structures near the tumor and spreads to other parts of the body. Metastasis is the spread of cancer beyond one location in the body.

  3. What kinds of cancers are considered cancers of the head and neck?
  4. Most head and neck cancers begin in the cells that line the mucosal surfaces in the head and neck area, e.g., mouth, nose, and throat. Mucosal surfaces are moist tissues lining hollow organs and cavities of the body open to the environment. Normal mucosal cells look like scales under the microscope, so head and neck cancers are often referred to as squamous cell carcinomas. Some head and neck cancers begin in other types of cells. For example, cancers that begin in glandular cells are called adenocarcinomas.

    Cancers of the head and neck are further identified by the area in which they begin:

    Cancers of the brain, eye, and thyroid as well as those of the scalp, skin, muscles, and bones of the head and neck are not usually grouped with cancers of the head and neck.

  5. How common are head and neck cancers?
  6. Head and neck cancers account for approximately 3 to 5 percent of all cancers in the United States. These cancers are more common in men and in people over age 50. It is estimated that about 39,000 men and women in this country will develop head and neck cancer in 2005.

  7. What causes head and neck cancers?
  8. Tobacco and alcohol use are the most important risk factors for head and neck cancers, particularly those of the oral cavity, oropharynx, hypopharynx, and larynx. Eighty-five percent of head and neck cancers are linked to tobacco use. People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone.

    Other risk factors for cancers of the head and neck include the following:

    Immigrants from Southeast Asia who use paan in the mouth should be aware that this habit has been strongly associated with an increased risk for oral cancer. Also, consumption of mate, a tea-like beverage habitually consumed by South Americans, has been associated with an increased risk of cancers of the mouth, throat, esophagus, and larynx.

    People who are at risk for head and neck cancers should talk with their doctor about ways they can reduce their risk. They should also discuss how often to have checkups.

  9. What are common symptoms of head and neck cancers?
  10. Symptoms of several head and neck cancer sites include a lump or sore that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice. Other symptoms may include the following:

    These symptoms may be caused by cancer or by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms.

  11. How are head and neck cancers diagnosed?
  12. To find the cause of symptoms, a doctor evaluates a person’s medical history, performs a physical examination, and orders diagnostic tests. The exams and tests conducted may vary depending on the symptoms. Examination of a sample of tissue under the microscope is always necessary to confirm a diagnosis of cancer.

    Some exams and tests that may be useful are described below:

    If the diagnosis is cancer, the doctor will want to learn the stage of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia, x-rays and other imaging procedures, and laboratory tests. Knowing the stage of the disease helps the doctor plan treatment.

  13. What health professionals treat patients with head and neck cancers?
  14. Patients with head and neck cancers are best treated by a team of specialists. The specialists vary, depending on the location and extent of the cancer. The medical team may include oral surgeons; ear, nose, and throat surgeons; pathologists; medical oncologists; radiation oncologists; prosthodontists; dentists; plastic surgeons; dietitians; social workers; nurses; physical therapists; and speech-language pathologists.

  15. How are head and neck cancers treated?
  16. The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health. The patient and the doctor should consider treatment options carefully. They should discuss each type of treatment and how it might change the way the patient looks, talks, eats, or breathes.

  17. Are clinical trials available for patients with head and neck cancers?
  18. Clinical trials are research studies conducted with people who volunteer to take part. Participation in clinical trials is an option for many patients with head and neck cancers.

    Treatment trials are designed to find more effective cancer treatments and better ways to use current treatments. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and standard therapy to another group. Doctors are studying new types and schedules for delivering radiation therapy, new anticancer drugs, new drug combinations, and new ways of combining treatments. They are also studying ways to treat head and neck cancers using biological therapy by itself or in combination with anticancer drugs or radiation therapy.

    Scientists are also conducting clinical trials to find better ways to reduce the side effects of chemotherapy and radiation therapy for head and neck cancers. These clinical trials, called supportive care trials, explore ways to improve the comfort and quality of life of cancer patients and cancer survivors.

    People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the CIS and the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. This booklet describes how research studies are carried out and explains their possible benefits and risks. In addition, the NCI’s Web site, http://www.cancer.gov on the Internet, provides information about clinical trials. It also offers detailed information about specific ongoing studies by linking to PDQ, a cancer information database developed by NCI. The CIS also provides information from PDQ.

  19. What rehabilitation or support options are available for patients with head and neck cancers?
  20. Rehabilitation is a very important part of treatment for patients with head and neck cancer. The goals of rehabilitation depend on the extent of the disease and the treatment a patient has received. The health care team makes every effort to help the patient return to normal activities as soon as possible.

    Depending on the location of the cancer and the type of treatment, rehabilitation may include physical therapy, dietary counseling, speech therapy, and/or learning how to care for a stoma after a laryngectomy. A stoma is an opening into the windpipe through which a patient breathes after a laryngectomy.

    Sometimes, especially with cancer of the oral cavity, a patient may need reconstructive and plastic surgery to rebuild the bones or tissues of the mouth. If this is not possible, a prosthodontist may be able to make a prosthesis to restore satisfactory swallowing and speech. Patients will receive special training to use the device.

    Patients who have trouble speaking after treatment, or who have lost their ability to speak, may need speech therapy. Often, a speech-language pathologist will visit the patient in the hospital to plan therapy and teach speech exercises or alternative methods of speaking. Speech therapy usually continues after the patient returns home.

    Eating may be difficult after treatment for head and neck cancer. Some patients receive nutrients directly into a vein after surgery, or need a feeding tube until they can eat on their own. A feeding tube is a flexible plastic tube that is passed into the stomach through the nose or an incision in the abdomen. A nurse or speech-language pathologist can help patients learn how to swallow again after surgery. The NCI booklet Eating Hints for Cancer Patients: Before, During, and After Treatment contains many useful suggestions and recipes.

  21. Is follow-up treatment necessary? What does it involve?
  22. Regular follow-up care is very important after treatment for head and neck cancer to make sure the cancer has not returned, or that a second primary cancer has not developed. Depending on the type of cancer, medical checkups could include exams of the stoma, mouth, neck, and throat. Regular dental exams may also be necessary. From time to time, the doctor may perform a complete physical exam, blood tests, x-rays, and CT, PET, or MRI scans. The doctor may continue to monitor thyroid and pituitary gland function, especially if the head or neck was treated with radiation. Also, the doctor is likely to counsel patients to stop smoking. Research has shown that continued smoking may reduce the effectiveness of treatment and increase the chance of a second primary cancer. The NCI fact sheet Follow-up Care: Questions and Answers has more information about this topic.

  23. What can people who have had head and neck cancer do to reduce the risk of developing a second primary cancer?
  24. People who have been treated for head and neck cancer have an increased chance of developing a new cancer, usually in the head and neck, esophagus, or lungs. The chance of a second primary cancer varies depending on the original diagnosis, but is higher for people who smoke and drink alcohol. Patients who do not smoke should never start. Those who smoke should do their best to quit. Studies have shown that continuing to smoke or drink increases the chance of a second primary cancer for up to 20 years after the original diagnosis. Information about smoking cessation is available from the CIS and in the NCI fact sheet Questions and Answers About Smoking Cessation.

    Some research has shown that isotretinoin, a substance related to vitamin A, may reduce the risk of the tumor recurring in patients who have been successfully treated for cancers of the oral cavity, oropharynx, and larynx. However, treatment with isotretinoin has not yet been shown to improve survival or to prevent future cancers.

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