Dr. Kathryn Gold is a medical oncologist specializing in the treatment of head and neck cancer and lung cancer at the University of California San Diego Moores Cancer Center. She is also a clinical investigator, with research focusing on development of new ways to treat cancer.

What is head and neck cancer?

Head and neck cancers often start in the moist surfaces that line the mouth, throat, and nose. Most of these cancers are a type called squamous cell carcinoma. Squamous cell carcinoma begins in the flat squamous cells that make up the thin layer of tissue on the surface of the structures in the head and neck. Other rare cancers can develop in the salivary glands or the skin of the head and neck area. This post will mainly cover squamous cell carcinoma of the head and neck.

What causes head and neck cancers?

Drinking alcohol and using tobacco increase the risk of head and neck cancer. Any type of tobacco use—cigarettes, pipes, chewing tobacco, and cigars—can increase the risk of head and neck cancer. Also, the risk of head and neck cancer increases as people get older. Most head and neck cancers occur in people older than 45. They are more common in men than in women.

Some head and neck cancers are related to the human papillomavirus (HPV). This is the same virus that can cause cervical cancer and other types of cancer. In general, head and neck tumors caused by HPV have a better prognosis than tumors not caused by HPV. Prognosis is the chance of recovery.

The most important thing a person can do to reduce their risk of head and neck cancer is to stop using all tobacco products. Avoiding drinking lots of alcohol also reduces risk. Vaccines against HPV can prevent the strains of HPV that cause some head and neck cancers. The HPV vaccine is most effective when it is given before any exposure to HPV. Vaccination is currently recommended for many children, adolescents, and young adults. Good dental hygiene may also reduce the risk of head and neck cancers.

What are the symptoms of head and neck cancer?

Symptoms of head and neck cancer can include:

• Difficulty swallowing

• Sore throat

• Changes in voice

• A sore that does not heal

• A lump in the neck

Other, less serious conditions may also cause these symptoms. That’s why it is important to discuss any new symptoms with your doctor.

How are head and neck cancers diagnosed and staged?

If the doctor suspects you may have head and neck cancer, the first step is to have a detailed physical exam focused on the head and neck area. However, a diagnosis of head and neck cancer can only be confirmed with an examination of a tissue sample under a microscope. This tissue sample is removed during a procedure called a biopsy.

Imaging studies, such as computed tomography (CT) or positron emission tomography (PET) scans, are often used to determine the extent of disease, called the stage. Knowing the stage of the cancer helps the health care team make decisions about the treatment plan. Most head and neck cancers are staged using the TNM staging system:

• T stands for primary Tumor: Where the tumor is, whether it invades other structures, and how large it is. T stage ranges from T0 to T4, with the higher numbers representing larger, more invasive tumors.

• N stands for lymph Nodes: Whether or not there are any lymph nodes involved, how many nodes are involved and how large they are, and whether lymph nodes on 1 or both sides of the neck are involved. N stage goes from N0 to N3, with N0 meaning no lymph nodes are involved and higher numbers representing more extensive disease in the lymph nodes.

• M stands for Metastasis: Whether or not the cancer has spread anywhere outside the head and neck area. M0 means that there are no signs that cancer has spread. M1 means that cancer has spread elsewhere.

The parts of the TNM system are combined into a single stage group used to describe the cancer.

How are head and neck cancers treated?

Surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy can be used to treat head and neck cancer. Often, many types of treatments are used together, for example, surgery followed by radiation therapy or radiation therapy combined with chemotherapy. Management of head and neck cancer usually requires a team of doctors and other medical professionals, including nutritionists/dietitians and speech language pathologists.

What are the side effects of head and neck cancer treatment?

Different treatments for head and neck cancer cause different side effects. If radiation therapy is recommended, common side effects often include fatigue, weight loss, and pain with swallowing. Side effects of chemotherapy can include nausea, low blood counts, and changes in taste. Some of these side effects, like nausea, tend to go away relatively quickly when treatment ends. Other side effects, like fatigue and discomfort with swallowing, can take longer to improve. Some side effects may be permanent.

It is important to have an experienced medical team managing the treatment of head and neck cancer. Many medical professionals, including nutritionists/dietitians, speech language pathologists, dentists, and dental hygienists, play a critical role in managing short-term and long-term treatment side effects. Counselors and support groups can be helpful as well. Rehabilitation will be a key part of the recovery process.