Head and neck cancer

This section provides information about head and neck cancer. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of treatment available.

About head and neck cancer

Head and neck cancer is a general term for a group of different cancers, not just one specific type of cancer.

It's the term that doctors use to talk about cancers that start in the tissues and organs of the head and neck, and includes cancers of the eye, nose and sinuses, mouth and cheeks, throat and larynx, and the salivary glands.

Head and neck cancer facts

• Head and neck cancers are relatively rare – each year in the UK, around 13,000 new cases are diagnosed
• There are over 30 areas within the head and neck where cancer can develop, including mouth, thyroid gland, voicebox (larynx), salivary glands, nose and sinuses and the throat (pharynx)
• Oesophageal cancer isn't classified as a head and neck cancer
• Brain tumours are not classified as head and neck cancer.¹

References

¹ NHS Choices, head and neck cancer. https://www.nhs.uk/conditions/cancer-of-the-head-and-neck/Pages/Definition.aspx

Types of head and neck cancer

The different types of head and neck cancer include:

• eye cancer, also called ocular cancers, which may affect the inside of the eye (intraocular) or the outside (extraocular), and is sometimes classified as an ophthalmic tumour
• nasal and paranasal sinus cancer, which are cancers in the nasal cavity and in the sinuses around the nose
• nasopharyngeal cancer, which affects the area that connects the back of the nose to the back of the mouth
• mouth and oropharyngeal cancer, which are cancers of the tongue, tonsils, the gums, cheeks, lip and floor and roof of the mouth
• larynx or laryngeal cancer, also called cancer of the voice box, which is the organ that contains and controls the vocal cords
• salivary gland cancer, which can be cancer of one or some of the three major pairs of salivary glands, the parotid, submandibular and sublingual glands.²

References

² Cancer Research UK, Head and neck cancer. https://www.cancerresearchuk.org/about-cancer/type/head-and-neck-cancer/

Causes and risk factors

The main risk factors for head and neck cancer are smoking tobacco and drinking alcohol. In fact, it's thought that around 75% of head and neck cancers are linked to tobacco or alcohol use.³

But other risk factors include your sex, age and if you are infected with a virus called HPV 16 and HPV 18 head and neck cancer is more common in men than women. It's most common in people over 50, although younger people can be affected too.⁴

Smoking tobacco increases your risk of developing many types of head and neck cancer, including mouth cancers, throat cancers and cancer of the voice box.

Chewing tobacco or betel quid (paan) increases your risk of developing mouth cancer.

Drinking alcohol is linked to cancers of the mouth and throat.

Human papilloma virus (HPV) is an infection that's thought to spread through oral sex, and puts you at risk of cancers at the back of the tongue and in the tonsils (cancers of the oropharynx). Steve has put here there are over 20 types.

Diets high in animal fats and low in fresh fruit and vegetables may increase the risk of developing head and neck cancer.

Exposure to sunlight over a prolonged period of time increases the risk of developing cancer on the outside of the lip.

Exposure to dust and certain chemicals can increase the risk of developing cancers of the nasopharynx and sinuses.

Pre-cancerous conditions of the mouth, such as leukoplakia and erythroplakia (linked to smoking tobacco) increase the risk of mouth cancer.

Your family history can mean a slightly higher risk of developing a head and neck cancer if you have a close relative (a parent, brother, sister or child) who has had a head and neck cancer.⁵

References

³ Macmillan Cancer Support UK, Risk factors and causes of head and neck cancer. https://www.macmillan.org.uk/Cancerinformation
/Cancertypes/Headneck/Aboutheadneckcancers/Causes.aspx
⁴ Macmillan Cancer Support UK, Risk factors and causes of head and neck cancer. 
⁵ Macmillan Cancer Support UK, Risk factors and causes of head and neck cancer. https://www.macmillan.org.uk/Cancerinformation
/Cancertypes/Headneck/Aboutheadneckcancers/Causes.aspx

Head and neck cancer symptoms and diagnosis

There are many different signs and symptoms of head and neck cancer that are also indicators of other conditions. But some common symptoms include:

• a mouth ulcer that doesn't heal in a few weeks
• red or white patches in the mouth that don't go away in a few weeks
• difficulty swallowing, or pain when chewing or swallowing
• changes to your voice (for example, a hoarse voice)
• constant sore throat and earache on one side
• swelling or a lump in your face, mouth or neck.

Less common symptoms of head and neck cancer include:

• a loose tooth
• a blocked nose or nosebleeds
• pain or numbness in your face or upper jaw.

Although some of these symptoms can be caused by conditions other than a head and neck cancer, it's important to have them checked out by your GP or dentist, particularly if they continue for weeks.⁶

Diagnosing head and neck cancers
At Circle Health, our consultants will examine you and ask questions about your health. They'll also ask if you've felt or noticed any changes to your voice, swallowing, breathing, appetite or weight. They will then carefully examine your mouth, throat and neck, and talk through any tests that you might need.

If they think you need more specific tests, you're likely to see an oral and maxillofacial surgeon or an ear, nose and throat (ENT) specialist. These specialist consultants may recommend one or more of the following tests for head and neck cancers: 

Nasendoscopy
A nasoendoscope is a thin, flexible tube with a light at the end that's gently passed up your nose and down your throat to look closely at the back of your mouth, throat and larynx.

Ultrasound scan 
An ultrasound scan uses sound waves to create an image of your neck and lymph nodes, so that the doctor can see any changes in the size or appearance.

Biopsy
One of the main tests to diagnose cancer is a biopsy, which involves taking a small sample of tissue from inside your mouth or throat to be examined under a microscope for any cancer.

Incision biopsy
An incision biopsy is simply a biopsy where a thin slice of tissue is cut from the area to be tested, which is numbed with a local anaesthetic.

Fine needle aspiration (FNA) cytology
To test neck lumps, a fine needle is used to take a sample of cells, and can also be used to take tissue samples from the mouth or throat.

Examination under anaesthetic
Sometimes a biopsy is taken while you're asleep under a general anaesthetic. This allows the specialist to examine the area closely and to remove a larger area of tissue and/or take samples from any other areas that look abnormal. Usually this test can be done as day surgery and most people are able to go home the same day.

Stages of head and neck cancer

After your tests, your doctor or consultant will tell you about what stage of your head and neck cancer is at, and whether it has spread to any other parts of your body.

The stage of a cancer is simply a term to describe its size and whether it has spread beyond its original site.

The stage of your cancer describes how big your tumour is and how far it's spread, which will all influence the type of treatment you're offered.

The stages of the different types of head and neck cancers are all different, and your doctor or nurse will be able to give you more details about the stage of your cancer.

The most common method for staging cancers of the head and neck is the TNM staging system:

TNM staging

• T describes the size and extent of a primary tumour
• N describes whether the cancer has spread to the lymph nodes and which nodes are involved. For example, N0 means that no lymph nodes are affected. N1 means there are cancer cells in a single lymph node, whereas N2 refers to cells in multiple nodes
• M describes if the cancer has spread to another part of the body. For example, M0 means the cancer hasn't spread (metastasised) to other parts of the body.⁷

References

⁶ Macmillan Cancer Support UK, Symptoms - head and neck cancer.https://www.macmillan.org.uk/Cancerinformation
/Cancertypes/Headneck/Aboutheadneckcancers/Causes.aspx
⁷ Macmillan Cancer Support, Staging of head and neck cancer.https://www.macmillan.org.uk/Cancerinformation
/Cancertypes/Headneck/Symptomsdiagnosis/Staging.aspx

Treating head and neck cancer

The aim of most cancer treatment is to remove all of the tumour and abnormal cells to reduce the chances of the cancer returning.

The specific treatment you're offered will depend on a number of factors – where the cancer is in your head or neck, the stage of the cancer, the size of the tumour and your general health.

And, in considering your treatment, your consultant will also try to reduce the long-term effects. For example, they will plan any head and neck cancer treatment so that your appearance and ability to talk, eat and drink are affected as little as possible.

But, before you decide on the best treatment, it's important to discuss with your Circle Health consultant or nurse specialist how different treatment options may affect you.

Early stage cancer treatment
If the tumour is small and hasn't spread to lymph nodes or other organs in the body, the cancer can usually be treated with either surgery or radiotherapy.

Small mouth cancers can often be removed with surgery, which can lead to small changes to speech, chewing or swallowing which can be adapted to quite quickly.

Radiotherapy may be used for cancers in areas of the head and neck that are difficult to reach, or where removing tissue can cause major changes in speech or swallowing.

Locally advanced cancer treatment
If a head and neck cancer is larger, or has spread to lymph nodes in the neck, a combination of treatments is usually needed. This may be either:

• a combination of chemotherapy and radiotherapy, called chemoradiation
• or a surgery followed by radiotherapy on its own, chemotherapy on its own or chemoradiation.

After treatment
You'll have regular check-ups following your treatment. How often and for how long you'll have these check-ups depends on the kind of treatment that you had.

At your check-ups, your doctor will ask how you're feeling and examine you, and you may need further tests to see how the treatment has worked, such as an ultrasound or nasendoscopy. 

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.

Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.

If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and make sure that this includes the consultant fees and hospital charge for your procedure.

Want to know more?
If you'd like to read more about head and neck cancer, treatment or living with head and neck cancer, please visit cancerresearchuk.org.uk or macmillan.org.uk.