Frequently asked questions about head and neck cancer

What is head and neck cancer?

In head and neck cancer, certain cells in the mouth, nose, sinuses, salivary glands, throat, or the lymph nodes in the neck grow uncontrollably, forming a solid mass called a tumor.

Where are some of the places in the head and neck that cancer can develop?

When cancer occurs in the neck, it may start in the throat (the pharynx), on the voice box (larynx), or on the piece of cartilage (epiglottis) that acts as the lid of the windpipe to prevent food from going into it. Cancer can start in the nose or the hollow areas behind the nose (the paranasal sinuses). And, in the mouth, cancer can affect the tongue or gums, as well as the salivary glands. The lymphatic system, which stores and moves immune system cells, is also sometimes a cancer site.

What are some of the symptoms of head and neck cancer?

The symptoms of head and neck cancer vary. Many of the cancers found in the head and neck produce a lump or a sore that doesn’t heal, a persistent sore throat, problems with swallowing, or a change in the voice. But besides these, symptoms depend on where the cancer is found. Common head and neck cancer symptoms include:

• Mouth: A white or a red patch on the gums, tongue, or the lining of the mouth; a swollen jaw, bleeding or pain in the mouth
• Nose and sinuses: Clogged sinuses that won’t clear up, chronic sinus infections that don’t respond to antibiotics, nose bleeds, headaches, swollen eyes, pain in the upper teeth
• Salivary glands: Swollen jaw or chin, numbness or paralysis of the face, pain that won’t go away in the face, chin, or neck
• Throat (pharynx): Ear pain, problems breathing or speaking, frequent headaches, pain or ringing in the ears, trouble hearing
• Voice box (larynx): Pain when swallowing, ear pain
• Metastatic squamous neck cancer: Pain in the neck or throat that does not go away

How is head and neck cancer staged?

Staging is different for each type of head and neck cancer and for each patient. In general, the following are the stages of head and neck cancer and what they mean in most cases:

• Stage 0: The tumor is “in situ." It’s stayed in the part of the head and neck where it started, and it’s not invasive, meaning it has not spread. Still, carcinomas in situ can become malignant (dangerous), and doctors may recommend removing them
• Stage I: The tumor hasn’t spread to the lymph nodes or to distant areas of the body
• Stage II: The tumor is larger, but may not have spread to the lymph nodes or to distant areas of the body
• Stage III: The tumor is either much larger, or it has begun to spread to the lymph nodes or to distant areas of the body
• Stage IV: The tumor is much larger and has spread to the lymph nodes. It may have also spread to other areas of the body

Head and neck cancer staging is complex, so be sure to ask your doctors and nurses any questions you have about it.

How is head and neck cancer diagnosed?

Diagnostic tests include physical examinations, imaging tests (to make pictures of the body and any tumors in it), and biopsies (in which samples are cut out of suspicious parts of the body and tested in a lab). Here are the main tests that are used to diagnose head and neck cancer:

• Physical examination: Doctors may inspect the mouth and nose, the neck and throat, and the tongue using a small mirror and/or lights. They may also feel for lumps on the neck, cheeks, lips, and gums
• Endoscopy: Using a thin, lighted tube called an endoscope, a doctor can examine the throat and the voice box (the pharynx and larynx). The endoscope can also be inserted through the nose to examine the sinuses
• Laboratory tests: These tests examine blood, urine, and other substances from the body for cancerous cells
• X-rays: X-rays help doctors see areas inside the head and neck
• CT or CAT scan: This type of scan uses X-rays to make a series of images of areas inside the head and neck
• Magnetic resonance imaging (MRI): An MRI is a scan using radio waves and strong magnets in place of X-rays. The body absorbs the radio waves, and this can reveal certain diseases when a computer translates the pattern of absorbed waves back into a detailed picture of the body’s tissues
• PET scan: This scan uses a special type of sugar—which is absorbed by cancer cells and shows up as dark when scanned—to look for the disease
• Biopsy: In this exam, tissue is removed from the body, then studied under a microscope by a doctor called a pathologist. In the end, a biopsy is the only sure way to tell whether or not someone has cancer

How is head and neck cancer treated?

There are two main types of cancer treatments. Local treatments include surgery and radiation. These treat specific tumors without affecting other parts of the body. With surgery, the tumor and lymph nodes may be removed. Radiation therapy may be recommended after surgery.

Systemic or advanced treatments such as chemotherapy circulate throughout the body to treat cancer cells that may have spread from the site where they first developed. In some cases, combinations of different treatment types are used.

Sometimes another treatment may be given before or after surgery. When given before surgery, this is called neoadjuvant therapy (usually systemic chemotherapy). When given after surgery, this is called adjuvant therapy. Adjuvant therapy targets cancer cells that may have spread in the early stages of the disease.

What are some of the possible side effects of surgery?

Head and neck surgery often changes how someone chews, swallows, and talks. They make look different after surgery, as the face and neck may be swollen. This usually goes away after a few weeks. But if lymph nodes were removed, the body has less of what it needs to heal, and the swelling may last for a long time. Specific side effects depend on the surgery. If the surgery removed the voice box (larynx), the neck might be numb. If lymph nodes were removed, the shoulders and neck might be weak or stiff.

Discuss what to expect after surgery with your healthcare team. And bring up any side effects you’re experiencing with your team—they may have ideas about how to manage them.

What are some of the possible side effects of chemotherapy?

Anti-cancer drugs harm cells that grow quickly, including the blood cells that fight infections, the cells that line the mouth and digestive tract, and the hair follicles. Chemo can cause:

• Anemia
• A low white blood cell count (leukopenia)
• Infection
• Fatigue
• Nausea
• Vomiting
• Hair loss
• Loss of appetite
• Mouth sores
• Numbness or tingling of the skin (paresthesia)

People being treated with chemotherapy should talk with their doctors and nurses about the side effects they are experiencing, and how best to manage them.

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