Head and Neck Cancer: Types, Symptoms, Causes, Diagnosis and Treatment

Head and neck cancers, accounting for 4.5% of cancer diagnoses worldwide, represent a significant health concern that affects thousands of lives each year. Understanding these causes & risk factors is crucial for prevention and early detection, as the survival rate for early-stage oral and throat cancers ranges from 70% to 90%. Let's understand what head & neck cancer is, its causes and different head and neck cancer treatments.

What is Head and Neck Cancer?

Cancer affecting the head and neck region encompasses several types of malignancies that develop in various tissues and organs. These cancers primarily start in the squamous cells that form the moist lining of multiple areas in the head and neck region.

Most head and neck cancers begin as squamous cell carcinomas in the mucosal surfaces. These cells form the outermost layer of the skin and line various mucous membranes throughout the mouth, throat, nose, and tongue. These cancers can spread locally or to the lymph nodes in the neck.

Types of Head and Neck Cancers

The most common types include:

• Oral Cavity Cancer: Affects the lips, front portion of the tongue, gums, inner cheeks, floor of the mouth, and hard palate.
• Throat (Pharyngeal) Cancer: Occurs in the pharynx, a 5-inch hollow tube starting behind the nose. This category includes:
  • Nasopharyngeal cancer (upper throat)
  • Oropharyngeal cancer (middle throat, including soft palate and tonsils)
  • Hypopharyngeal cancer (lower throat)
• Laryngeal Cancer: Forms in the voice box, containing vocal cords and epiglottis, a tissue that prevents food from entering air passages.
• Paranasal and Nasal Cavity Cancer: Develops in the small hollow spaces around the nose and the nasal cavity.
• Salivary Gland Cancer: Forms in major salivary glands near the jawbone or in minor glands throughout the mouth and throat.
• Thyroid Cancer

Head and Neck Cancer Symptoms

Common symptoms affecting the mouth and throat region include:

• A persistent sore throat that doesn't improve
• Difficulty in swallowing or pain during chewing
• Changes in voice, becoming hoarse or quieter
• Problems with jaw movement or speech
• Unexplained loose teeth
• White or red patches inside the mouth (leukoplakia and erythroplakia)
• Mouth sores that don't heal within a few days

Physical changes might appear as follows:

• Lumps in the neck, jaw, or mouth area that gradually increase in size
• Swelling in the face or neck
• Facial pain or weakness that persists
• Changes in how dentures fit

Ear-related symptoms often manifest as:

• Persistent earaches
• Ringing sensation in the ears
• Hearing difficulties
• Pain that seems like recurring ear infections

Nasal cavity symptoms present as:

• Frequent nosebleeds
• Chronic nasal congestion
• Sinus infections resistant to treatment
• Blocked nose that doesn't clear

Several general symptoms warrant attention:

• Blood in saliva or phlegm
• Numbness in the tongue or facial areas
• Unexplained weight loss
• Persistent headaches
• Changes in skin moles or sores that don't heal

Head and Neck Cancer Causes & Risk Factors 

Scientific research reveals that multiple factors contribute to the development of head and neck cancer. 

• Tobacco, Betel Nut, Pan Masala and alcohol consumption stand out as the primary risk factors, accounting for approximately 80% of cases in men and 65% in women.
• Human papillomavirus (HPV) infection, especially type 16, has emerged as a significant risk factor, causing about three-quarters of all oropharyngeal cancers. 
• Occupational exposures present another significant risk category:
  • Wood dust exposure increases nasopharyngeal cancer risk
  • Industrial exposure to asbestos and synthetic fibres affects voice box cancer
  • Construction, metal, textile, ceramic, logging, and food industry workers face elevated risks
  • Exposure to nickel dust or formaldehyde raises the risk of paranasal sinus cancers
• Several other factors contribute to head and neck cancer development:
  • Radiation exposure to the head & neck region increases salivary gland cancer risk
  • Epstein-Barr virus infection raises the risk of nasopharyngeal and salivary gland cancers
  • Asian ancestry, mainly Chinese, increases nasopharyngeal cancer risk
  • Genetic disorders like Fanconi anaemia can lead to early cancer development

Head and Neck Cancer Diagnosis

• Inspection: The initial assessment involves examining the head and neck area for sores, lumps, or swelling. Doctors use specialised tools to inspect internal structures. A laryngoscopy helps visualise the throat and voice box through two methods:
  • Direct (flexible) laryngoscopy: Uses a thin, flexible tube with a light source inserted through the mouth or nose
  • Indirect laryngoscopy: Employs small mirrors to view the larynx and surrounding areas
• Biopsy: A biopsy remains the only definitive way to confirm cancer. Three primary biopsy methods exist:
  • Direct biopsy through Forceps
  • Endoscopic biopsy: Removes tissue samples through specialised scopes
  • Fine needle aspiration (FNA): Extracts cells using a thin needle
• Imaging Tests:
  • CT Scans: Create detailed cross-sectional images of head and neck structures
  • MRI: Produces detailed pictures using magnetic fields and radio waves
  • PET scans: Detect cancer cells using modified sugar that appears as dark areas
  • Chest X-rays: Check if the cancer has spread to the lungs

Treatment for Head and Neck Cancer

Head & neck cancer treatment depends on several factors, primarily the tumour location, cancer stage, and overall health of the patient. 

• Surgery remains a cornerstone treatment whenever feasible. Surgeons remove the tumour along with a margin of healthy tissue to ensure complete cancer cell elimination. 
• For cases where cancer affects nearby structures, alternative approaches might be considered first, primarily radiation therapy or chemotherapy.
• Radiation therapy utilises powerful energy beams from various sources, commonly X-rays or protons. 
• Chemotherapy employs strong medicines to combat cancer cells. 

Modern treatment approaches incorporate targeted therapy and immunotherapy:

• Targeted Therapy: These drugs focus on specific chemicals within cancer cells. Upon blocking these substances, targeted treatments cause cancer cell death.
• Immunotherapy: This innovative approach helps the body's immune system identify and destroy cancer cells. Currently, four approved immunotherapy options exist for head and neck cancer.

When to See a Doctor

Doctors strongly advise seeking immediate care for these symptoms:

• Fever accompanied by headache and neck stiffness, which might indicate bacterial meningitis requiring prompt antibiotic treatment
• Pain radiating down one arm, particularly with weakness, numbness, or tingling sensations
• Loss of bowel or bladder control, potentially indicating pressure on the spinal cord
• The sudden ability to tilt the head forward or backward beyond the normal range
• Persistent swollen glands in the neck area
• Chest pain or pressure alongside neck discomfort

Prevention

Taking proactive steps against head and neck cancer involves multiple preventive measures. These include:

• Quitting tobacco stands as the most effective preventive measure, as smoking links to numerous types of head and neck cancers. 
• For those who drink alcohol, moderation proves crucial, as alcohol acts as a solvent that enhances mucosal exposure to carcinogens.
• HPV vaccination programs offer promising protection against certain head and neck cancers. 
• Other essential preventive measures include:
  • Sun Protection:
    • Use broad-spectrum sunscreen with SPF 30 or higher
    • Avoid extended sun exposure
    • Wear protective clothing and hats
    • Stay away from tanning beds
  • Workplace Safety:
    • Use protective face masks around toxic fumes
    • Install proper air-filtration systems
    • Minimise exposure to harmful dust
• Regular dental check-ups play an essential role in prevention, primarily for individuals who use tobacco or consume alcohol heavily. 
• A balanced diet enriched in fruits and vegetables might help reduce cancer risk. Medical experts advise minimising processed foods and refined sugars while maintaining a whole-food diet.

FAQs

1. Is head and neck cancer curable?

Head and neck cancer responds well to early treatment, primarily through single-modality therapy like surgery or radiation. The five-year survival rate stands at approximately 60%. Treatment success rates improve considerably upon early detection, as doctors can often remove tumours completely through surgery or targeted radiation therapy.

2. What are the leading causes of head and neck cancer?

Tobacco use remains the leading cause, responsible for 70-80% of head and neck cancers worldwide. The combination of tobacco and alcohol raises cancer risk by 40 times. Recently, HPV infection has emerged as a significant factor, causing about three-quarters of all oropharyngeal cancers.

3. What age does head and neck cancer start?

Nearly 60% of head & neck cancer patients are over 60 years old. Among these, roughly 70% are above 65 years, and 50% exceed 70 years. Yet, doctors note an increasing trend among younger patients, with more diagnoses occurring in people under 50 years due to alcohol, tobacco use rising HPV-related cases.

4. What is the blood test for head and neck cancer?

The HPV score test marks a breakthrough in blood-based detection. This innovative test identifies HPV-related head and neck cancer by measuring tumour DNA fragments in the bloodstream. Though blood tests cannot directly detect throat cancer, they help assess overall health and guide treatment decisions.

5. How common are head and neck cancers?

Head and neck cancers as the most common cause in india >30% cases of cancer . These cancers occur twice as frequently in males compared to females. Notably, the global burden continues rising due to population growth and ageing.