Description
Most head and neck cancers are called squamous cell carcinomas because they begin in the thin squamous lining that covers the surface of head and neck structures. Cancers of the oral cavity and larynx are most common. Head and neck cancers principally affect any of five different organ sites:
- Oral cavity (mouth, gums, lips, cheek lining, hard palate, tongue)
- Larynx (voice box)
- Pharynx (area behind the mouth, including the tonsils, that leads to the esophagus and trachea)
- Nasopharynx (area behind the nose that includes the adenoid region)
Also considered head and neck cancers are those afflicting the throat, salivary glands, nasal cavity and trachea.
Once any of these becomes cancerous, the ability to chew, swallow, talk, breathe, smell, hear or see can be compromised, depending on where the cancer strikes and the severity or progression of disease. Head and neck cancers can be physically disfiguring. After experiencing noticeable changes in appearance from cancer or treatment, head and neck cancer patients can suffer from severe depression, social trauma and a tendency to withdraw.
Statistics
Collectively, head and neck cancers comprise about three percent of all cancer cases in the United States. An estimated 35,000 men and women in the U.S. will be diagnosed with head and neck cancers in 2008.
Eighty-five percent of all head and neck cancers can be traced to the use of tobacco products. Excessive consumption of alcohol also causes changes in the squamous cells of the head and neck.
Head and neck cancer patients on average are in their 50s and 60s. Significantly more men than women are afflicted - particularly with oral cavity cancer - although the gap in male and female head and neck cancer rates is narrowing. There has been an overall decline in the United States in recent years due to a decrease in smoking. However, in developing countries the incidence is increasing, most likely due to increased smoking habits.
Black men have a higher mortality rate than their white counterparts, with the greatest disparity between black and white men occurring in oral cavity cancers. Researchers believe this may be related to differing access to preventive health, health insurance and dental care.
In recent years, there has been an increase in the number of non-smokers and non-drinkers diagnosed with head and neck cancers. Scientists suggest that exposure to the human papillomavirus through sexual activity may play a role in the development of head and neck cancers in this group, but more research is needed to understand that possible link. Certain types of HPV cause genital warts; others are associated with cervical cancer.
Early diagnosis greatly improves survival. When head and neck cancers are caught early, the average survival rate is more than 90 percent. The overall average survival rate for men and women is about 50 percent.
Symptoms and Diagnosis
Head and neck cancers may initially be detected by dentists, general practitioners and otolaryngologists. By virtue of their visible, superficial nature, oral cavity cancers are the easiest to detect. Cancers in the lowest part of the pharynx are the most difficult to discern. As with other cancers, fatigue or unexplained weight loss also may be indicators.
- Hoarseness
- Red or white patches in the mouth
- Nagging sore throat
- Feeling of a lump in the throat
- Mouth sore that will not heal
- Changes in voice
- Difficulty breathing
- Pain in jaws or ears
- Pain when chewing or swallowing
- Chronic bad breath
- Persistent nasal congestion
A routine physical exam to check the mouth, ears, nose, throat and salivary glands is the initial step in the diagnosis of head and neck cancers. More technologically advanced diagnostics include tissue biopsy, X-rays, CT scans, laryngoscopy and stroboscopy.
Laryngoscopy involves inserting a lighted tube through the mouth or nose to view the larynx. Stroboscopy is a related examination technique in which flashes of light allow doctors to view, and even record, vocal fold vibrations.
Minimizing Risk/Prevention
Smokers and heavy drinkers are at significantly greater risk for developing head and neck cancers. The combination of tobacco use and excessive alcohol consumption increases risk even more. Exposure to secondhand smoke and some inhalants such as wood dust also can increase risk.
In addition to not smoking or drinking in excess, practicing good nutrition, attention to dental care and use of sunblock to protect the lips from sun exposure are among several practical measures that can diminish head and neck cancer risk.
Latest Research
Head and neck cancers are largely preventable by reducing tobacco and alcohol use, and the research and treatment community are strong advocates for smoking cessation education and intervention efforts.
However, not everyone responds to tobacco and alcohol in the same way, so researchers are working to understand what individual characteristics make a patient more or less susceptible to risk. Recent research has suggested that the human papillomavirus, particularly the protein E7, plays a major role in head and neck cancer risk. Other studies have noted that patients with head and neck squamous cell carcinoma have elevated levels of many growth factors and their receptors including the epidermal growth factor receptor interleukin-6, interleukin-8, and hepatocyte growth factor.
Current Treatment
Early-stage head and neck cancers often are treated by surgery or radiation alone and have a high cure rate. By mid-stage, doctors may use a combination of surgery and radiation, chemotherapy and radiation, or all three approaches combined as their treatment regimen.
Surgery for head and neck cancers can be quite complex, and may require removal of the vocal cords, voice box, tongue or part of the jaw. After surgery, specialized follow-up such as speech pathology and nutritional consultations may be necessary.
In March 2006, the Food and Drug Administration approved cetuximab, also known as Erbitux, for use in combination with radiation therapy to treat patients with squamous cell cancer of the head and neck. Approval was based on a randomized clinical trial of 424 patients who used cetuximab in combination with radiation therapy and showed a survival time of 49 months compared with 29.3 months on radiation therapy alone. Tumor shrinkage was also noted in 13 percent of patients lasting an average of six months.
Researchers are also pursuing a promising avenue of study that would segregate patients based on different genotypes to tailor therapy for the individual. These gene markers would help doctors determine which patients are more likely to respond to a certain type of treatment, or which particular combination of treatments might work more effectively based on an individual's genetic makeup.
Resources
National Cancer Institute
1-800-4-CANCER
www.cancer.gov
American Cancer Society. Cancer Facts & Figures. Atlanta, American Cancer Society, 2008
1-800-ACS-2345
www.cancer.org
Support for People with Head and Neck Cancers (SPOHNC)
1-800-377-0928
www.spohnc.org
FDA Approves First Head & Neck Cancer Treatment in 45 Years Data Shows Treatment with Erbitux Extends Survival
Last reviewed: August 8, 2008