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Head and Neck Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Head and Neck Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread.

Head and neck cancer is a term used to describe a number of different malignant tumors that develop in or around the throat, larynx, nose, sinuses, and mouth (see below).

Most head and neck cancers are squamous cell carcinomas, meaning they begin in the flat, squamous cells that make up the thin surface layer of the structures in the head and neck. Directly beneath this lining, which is called the epithelium, some areas of the head and neck have a layer of moist tissue, called the mucosa. If a cancer is limited to the squamous layer of cells, it is called carcinoma in situ. If the cancer has grown beyond this cell layer and moved into the deeper tissue, then it is called invasive squamous cell carcinoma. If the cancer starts in the salivary glands, the tumor will usually be classified as an adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma.

Types of head and neck cancer

There are five main types of head and neck cancer, each named according to the part of the body where they develop. For more information about a specific type, click on one of the names below.

Laryngeal and Hypopharyngeal Cancer. The larynx is commonly called the voice box. It is a tube-shaped organ in the neck that is important for breathing, talking, and swallowing. It is located at the top of the windpipe, or trachea. The hypopharynx is also called the gullet. It is the lower part of the throat that surrounds the larynx.

Nasal Cavity and Paranasal Sinus Cancer. The nasal cavity is the space just behind the nose where air passes on the way to the throat. The paranasal sinuses are the air-filled areas that surround the nasal cavity.

Nasopharyngeal Cancer. The nasopharynx is the air passageway at the upper part of the throat behind the nose.

Oral and Oropharyngeal Cancer. The oral cavity includes the mouth and tongue. The oropharynx includes the middle of the throat from the tonsils to the tip of the voice box.

Salivary Gland Cancer. The salivary gland is tissue that produces saliva, which is the fluid that is released into the mouth to keep it moist and that contains enzymes that begin breaking down food.

Other types of cancer can also be located in this area of the body, but the diagnosis and treatment are much different. Specific information about brain tumors, esophageal cancer, eye cancer, parathyroid cancer, sarcoma, and thyroid cancer is available in separate sections on Cancer.Net.

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Head and Neck Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Head and neck cancer accounts for about 3% to 5% of all cancers in the United States. This year, an estimated 55,070 people (40,220 men and 14,850 women) will develop head and neck cancer. It is estimated that 12,000 deaths (8,600 men and 3,400 women) will occur this year.

The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. The five year survival rate of people with head and neck cancer varies and depends on several factors. Check the individual section describing a specific type of head and neck cancer for more information about survival statistics (see the Overview for a complete list).

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with head and neck cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2014.

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Head and Neck Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about what factors increase the chance of this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop the disease, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

Two risk factors greatly increase the risk of head and neck cancer:

Tobacco use. Smoking cigarettes, cigars, or pipes; chewing tobacco; and using snuff are the single largest risk factors for head and neck cancer. Eighty-five percent (85%) of head and neck cancer is linked to tobacco use, and the amount of tobacco use may affect prognosis, which is the chance of recovery. In addition, secondhand smoke may increase a person’s risk of developing head and neck cancer. Recent research suggests that people who have used marijuana may also be at higher risk for head and neck cancer.

Frequent and heavy consumption of alcohol. Alcohol use raises the risk of developing cancer in the mouth, pharynx, larynx, and esophagus. Using alcohol and tobacco together increases this risk even more.

Other factors that can raise a person’s risk of developing head and neck cancer include:

Prolonged sun exposure. This is especially linked to cancer in the lip area, as well as skin cancer of the head and neck.

Human papillomavirus (HPV). Research indicates that infection with this virus is becoming an increasingly common risk factor for some types of head and neck cancer. HPV is most often passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancer. HPV vaccines protect against certain strains of the virus. (See the Latest Research section for more information.)

Epstein-Barr virus (EBV). Exposure to EBV, which is more commonly known as the virus that causes mononucleosis or "mono," plays a role in the development of nasopharyngeal cancer.

Gender. Men are two to three times more likely than women to develop head and neck cancer. However, the rate of head and neck cancer in women has been rising for several decades.

Age. People over 40 are at higher risk for head and neck cancer.

Race. Black people are more likely than white people to develop certain types of cancer of the head and neck.

Poor oral/dental hygiene. Poor care of the mouth and teeth has been suggested as a factor that may increase the risk of head and neck cancer.

Environmental/occupational inhalants. Exposure to asbestos, wood dust, paint fumes, and certain chemicals may increase a person’s risk of head and neck cancer.

Poor nutrition. A diet low in vitamins A and B can raise a person’s risk of head and neck cancer.

Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD). Reflux of stomach acid into the upper airway and throat has been suggested as a factor associated with the development of head and neck cancer.

Weakened immune system. A weakened immune system can raise a person’s risk of head and neck cancer.

Prevention

Research continues to look into what factors cause this type of cancer and what people can do to lower their personal risk. Although there is no proven way to completely prevent this disease, and some risk factors of head and neck cancer cannot be changed, such as age, there may be steps you can take to lower your cancer risk. Talk with your doctor if you have concerns about your personal risk of developing this type of cancer.

Stopping the use of all tobacco products is the most important thing a person can do to reduce their risk, even for people who have been smoking for many years. Other steps that can reduce the risk of head and neck cancer include:

  • Avoiding alcohol
  • Discussing marijuana as a risk factor with your doctor and avoiding marijuana use
  • Using sunscreen regularly, including lip balm with an adequate sun protection factor (SPF)
  • Reducing your risk of HPV infection by limiting the number of sexual partners, since having many partners increases the risk of HPV infection. Using a condom cannot fully protect you from HPV during sex.
  • Maintaining proper care of dentures. Poorly fitting dentures can trap tobacco and alcohol’s cancer-causing substances. Denture wearers should have their dentures evaluated by a dentist at least every five years to ensure a good fit. Dentures should be removed every night and cleaned and rinsed thoroughly every day.

To continue reading this guide, use the menu on the side of your screen to select another section. 

Head and Neck Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with head and neck cancer often experience the following symptoms or signs. Sometimes, people with head and neck cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • Swelling or sore that does not heal, the most common symptom
  • Red or white patch in the mouth
  • Lump, bump, or mass in the head or neck area, with or without pain
  • Persistent sore throat
  • Foul mouth odor not explained by hygiene
  • Hoarseness or change in voice
  • Nasal obstruction or persistent nasal congestion
  • Frequent nose bleeds and/or unusual nasal discharge
  • Difficulty breathing
  • Double vision
  • Numbness or weakness of a body part in the head and neck region
  • Pain or difficulty chewing, swallowing, or moving the jaws or tongue
  • Ear and/or jaw pain
  • Blood in the saliva or phlegm, which is mucus discharged in mouth from respiratory passages
  • Loosening of teeth
  • Dentures that no longer fit
  • Unexplained weight loss
  • Fatigue

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

Because many of these symptoms can be caused by other, noncancerous health conditions, as well, it is important to receive regular health and dental screenings. This is particularly important for people who routinely drink alcohol or currently use tobacco products or have used them in the past.

In fact, people who use alcohol or tobacco should receive a general screening examination at least once a year. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination using one or more of the procedures mentioned in the Diagnosis section.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

Head and Neck Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy (see description below) is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

If a person has symptoms and signs of head and neck cancer, the doctor will take a complete medical history, noting all symptoms and risk factors. In addition, the following tests may be used to diagnose head and neck cancer:

Physical examination/blood and urine tests. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. Also, the doctor will inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and a mirror for a clearer view. Blood and urine tests may be performed to help diagnose cancer. Testing for viral infections, including HPV (see the Risk Factors section), may also be done.

Endoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is gently inserted through the nose into the throat and down the esophagus to examine the head and neck areas. Sedation is giving medication to become more relaxed, calm, or sleepy. The examination has different names depending on the area of the body that is examined, such as laryngoscopy to view the larynx, pharyngoscopy to view the pharynx, or nasopharyngoscopy to view the nasopharynx. When these procedures are combined, they are sometimes referred to as a panendoscopy.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. One common type of biopsy is called a fine needle aspiration. During this procedure, cells are withdrawn using a thin needle inserted directly into the tumor or lymph node. The cells are examined under a microscope for cancer cells, which is called a cytologic examination.

Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy. See the Treatment Options section for more information.

X-ray/barium swallow. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A barium swallow may be required to identify abnormalities along the swallowing passage. During a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray. A special type of barium swallow called a modified barium swallow may be needed to evaluate specific swallowing difficulties. If there are signs of cancer, the doctor may recommend a computed tomography (CT) scan (see below).

Panorex. This is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect cancer or to evaluate teeth before radiation therapy or chemotherapy.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. This test may be done to see if cancer has spread to the bones.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. 

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.

Head and Neck Cancer - Staging

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There is a different staging system for each type of head and neck cancer, and detailed information about these stages can be found in the specific cancer type section (see the Overview for a complete list).

Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system for that type of head and neck cancer.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan. The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Head and Neck Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this group of cancers. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

Many cancers of the head and neck can be cured, especially if they are found early. Although eliminating the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When planning treatment, doctors consider how treatment might affect a person’s quality of life, such as how a person feels, looks, talks, eats, and breathes.

Head and neck cancer specialists usually form a multidisciplinary team to care for each patient, and an evaluation should be done by each doctor before any treatment begins. The team often includes medical and radiation oncologists; surgeons; otolaryngologists, which are doctors that specialize in the ear, nose, and throat; plastic (reconstruction) surgeons; maxillofacial prosthodontists, which are specialists that perform restorative surgery in the head and neck areas; dentists; physical therapists; speech pathologists; hearing experts called audiologists; psychologists; psychiatrists; nurses; dietitians; and social workers. It is extremely important to create a comprehensive treatment plan before treatment begins, and people may need to be seen by several specialists before a treatment plan is fully developed. 

In addition, evaluation may include testing for HPV infection. As outlined in the Risk Factors section, HPV has been linked to a higher risk of some head and neck cancers. In some cases, whether a person has HPV can also be a factor in determining which treatments are likely to be most effective.

Descriptions of the most common treatment options for head and neck cancer are listed below.

Overall, the main treatment options are surgery, radiation therapy, chemotherapy, and targeted therapy. Surgery or radiation therapy by themselves or a combination of these therapies may be part of a person’s treatment plan. More details can be found in each specific cancer type’s section.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

During surgery, the goal is to remove the cancerous tumor and some of the healthy tissue around it, called a margin. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Types of surgery for head and neck cancer include:

Laser technology. This may be used to treat an early-stage tumor, especially in larynx cancer.

Excision. This is an operation to remove the cancerous tumor and a margin of healthy tissue around it.

Lymph node dissection. If the doctor suspects the cancer has spread, the doctor may remove lymph nodes in the neck, possibly causing stiffness in the shoulders afterward. This may be done at the same time as an excision.

Reconstructive (plastic) surgery. This type of operation is aimed at restoring a person’s appearance and the function of the affected area. If the surgery requires major tissue removal, such as removing the jaw, skin, pharynx, or tongue, reconstructive or plastic surgery may be done to replace the missing tissue. A prosthodontist may be able to make an artificial dental or facial part to help restore the ability to swallow and speak. A speech pathologist may then be needed to help the patient relearn how to swallow and communicate using new techniques or special equipment. Learn more about rehabilitation.

In general, depending on the location, stage, and type of the cancer, some people may need more than one operation. Sometimes, it is not possible to completely remove the cancer, and additional treatments may be necessary. For example, surgery may be followed by radiation therapy and/or chemotherapy to destroy cancer cells that cannot be removed during surgery.

Side effects of surgery depend on the type and location of the surgery, and each patient is encouraged to talk with their doctor about side effects expected from the specific surgery and how long the side effects are likely to last. Common side effects from head and neck surgery include temporary or permanent loss of normal voice or impaired speech; difficulty chewing or swallowing, which may require a tube inserted in the stomach for feeding purposes; hearing loss; or decreased functioning of the thyroid gland, especially after a total laryngectomy, which is the removal of the larynx.

Another potential side effect is swelling of the mouth and throat area, making it difficult to breathe. In such cases, patients may receive a temporary tracheostomy, which creates a hole in the windpipe to make breathing easier.

Some people experience facial disfigurement from surgery. Reconstructive surgery (see above) may be recommended to help appearance or maintain important functions, such as chewing, swallowing, and breathing. Patients should meet with the members of the health care team to help them make decisions about their treatment. Programs that help patients adjust to changes in body image may be useful both before and after the surgery. Talking with your doctor about what to expect and how recovery will be handled can help you cope with side effects.

Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. It can be the main treatment for head and neck cancer, or it can be used after surgery to destroy small pockets of cancer that cannot be removed surgically. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation therapy is called external-beam radiation therapy, which is radiation given from a machine outside the body.

Specific types of external-beam radiation therapy include intensity-modulated radiation therapy (IMRT). IMRT uses advanced technology to more accurately direct the beams of radiation to the tumor, helping reduce damage to nearby healthy cells and potentially causing fewer side effects. Proton therapy is another type of external-beam radiation therapy, using protons rather than x-rays. At this time, however, proton therapy is not a standard treatment option for most types of head and neck cancer.

When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy.

Before beginning radiation therapy for any head and neck cancer, patients should be examined by an oncologic dentist or oral oncologist, which are dentists experienced in treating people with head and neck cancer. Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning treatment. Learn more about dental and oral side effects. People should also receive an evaluation from a speech pathologist who has experience treating people with head and neck cancer.

Patients may experience short- and long-term pain or difficulty swallowing, changes in voice because of swelling and scarring, and loss of appetite, due to a change in sense of taste.  It is important that patients begin speech and swallowing therapy early, before radiation therapy begins, to prevent long-term problems with speaking or eating.

In addition, radiation therapy to the head and neck may cause redness or skin irritation in the treated area, swelling, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, and/or sore throat. Other side effects may include hearing loss, due to buildup of fluid in the middle ear; buildup of earwax that dries out because of the radiation therapy’s effect on the ear canal, and fibrosis (scarring).

Radiation therapy also may cause a condition called hypothyroidism in which the thyroid gland (located in the neck) slows down and causes the patient to feel tired and sluggish. This may be treated with thyroid hormone therapy. Every patient who receives radiation therapy to the neck area should have his or her thyroid checked regularly. Patients are encouraged to talk with their health care teams about what to expect from side effects of radiation therapy before treatment begins, including how these side effects can be prevented or managed.

Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them.

For head and neck cancers, targeted therapies against a tumor protein called epidermal growth factor receptor (EGFR) may be used. Researchers have found that drugs that block EGFR may be effective for stopping or slowing the growth of certain types of head and neck cancer.

Talk with your doctor about possible side effects for a specific medication and how they can be prevented or managed. Learn more about targeted treatments.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.   

Metastatic head and neck cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes a combination of surgery, radiation therapy, chemotherapy, and targeted therapy. Supportive care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above, such as surgery, chemotherapy, targeted therapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.

Head and Neck Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with head and neck cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments, such as new chemotherapy, before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

People decide to participate in clinical trials for many reasons. For some, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating head and neck cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with head and neck cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for head and neck cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Head and Neck Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about head and neck cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

New medications. Many studies are underway investigating new types of cancer medications to treat head and neck cancers. Immunotherapy, which is designed to boost the body's natural defenses to fight the cancer, is of particular interest currently.

Combined therapies. Most research for head and neck cancers focuses on combining different types of treatments to improve the effectiveness and the patient’s quality of life.

Radiofrequency thermal ablation (RFA). Used on a localized tumor that cannot be removed by surgery, RFA is a minimally invasive treatment option that applies heat to the tumor.

Gene therapy. Gene therapy is a targeted form of treatment that uses biologic gene manipulation to change bits of genetic code in a person’s cells. Although gene therapy is relatively new, it appears to show promising potential for treating head and neck cancer.

Photodynamic therapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor that stays longer in cancer cells than in normal cells. A laser is directed at the tumor, which destroys the cancer cells. The long-term effects of photodynamic therapy are still being investigated.

Proton therapy. Proton radiation therapy can be used as a boost (part of treatment) to reduce the damage done to healthy tissue. It can be used as part of the treatment for some skull-base tumors, including nasopharyngeal cancer; chordoma, a rare tumor that usually occurs in the spine and base of the skull; and chondrosarcoma, a cartilage-based tumor, to further limit the radiation dose to healthy structures, such as the optic (eye) nerves and brainstem.

HPV. Research continues regarding the link between HPV and head and neck cancers, evaluating both why this virus raises the risk for the disease and why it may affect treatment results in some cases. Studies are also underway to determine whether the HPV vaccine that is currently used to prevent cervical, vaginal, vulvar, and anal cancer is effective at preventing some head and neck cancers as well.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current head and neck cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding head and neck cancer, explore these related items that take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Head and Neck Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for head and neck cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or manage them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with head and neck cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called long-term side effects. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Head and Neck Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for head and neck cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. If radiation therapy was used, your doctor may recommend regular thyroid gland checkups, which are done through blood tests. 

Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may receive physical therapy to maintain movement and the range of movements, as well as speech and swallowing therapy to regain skills, such as talking and eating. Proper evaluation and treatment may often prevent long-term speech and swallowing problems. Supportive care to manage symptoms and maintain nutrition during and after treatment may be recommended. Some people may need to learn better ways to eat or different ways to prepare foods.

People may look different, feel tired, and be unable to talk or eat the way they used to. Many people experience depression. The health care team can help people adjust and connect them with support services. Support groups may help people cope with changes following treatment.

ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

People recovering from head and neck cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, limiting alcohol, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

Head and Neck Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What is the exact type of head and neck cancer that I have?
  • Where is the tumor located?
  • What stage is the cancer? What does this mean?
  • Can you explain my pathology report (laboratory test results) to me?
  • Is it important to find out whether the tumor was caused by HPV? Why or why not?
  • What are the treatment options?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • If surgery is needed, will I need to have a reconstruction done to replace lost tissue?
  • If surgery is needed, will there be a need for a neck dissection to remove lymph nodes? If so, what type of dissection will be done? What does this mean?
  • Should I get an additional consultation or second opinion?
  • Who will be part of my health care team, and what does each member do?
  • Can you recommend an oncologic dentist?
  • Should I see a speech pathologist before starting treatment?
  • Who will be coordinating my overall treatment and follow-up care?
  • What are the possible side effects of this treatment, both in the short term and the long term?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What follow-up tests will I need, and how often will I need them?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Head and Neck Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Head and Neck Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

This is the end of Cancer.Net’s Guide to Head and Neck Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.