The head and neck region is an anatomically diverse area of the body that is composed of soft tissue, bones, skin, and a variety of glands and organs. Head and neck cancer encompasses a wide range of tumors that can develop in several areas of the head and neck, including the throat, larynx (voice box), nose, sinuses, and mouth. Each year, approximately 48,000 Americans are diagnosed with a head or neck cancer (not including skin cancers that occur in the head or neck). These tumors account for up to 5 percent of all cancers in the US.
Most head and neck cancers are squamous cell carcinomas — malignant (cancerous) growths that begin in the flat squamous cells that form the epithelium (inner lining) in many parts of the head and neck. A tumor limited to this layer of cells is usually called carcinoma in situ. A tumor that grows beyond the squamous cells and moves into deeper tissues is called invasive squamous cell carcinoma. Adenocarcinomas arise in glandular cells, such as those found in the salivary glands.
Below are some general symptoms and warning signs of head and neck cancer. Each type of head and neck cancer may be associated with a more specific group of symptoms. Many of these symptoms can also be caused by other health conditions. See your doctor if you notice:
- a lump or swelling in the neck
- a sore in the mouth that won't heal (the most common symptom) or that bleeds easily
- a red or white patch in the mouth that doesn't go away
- frequent nosebleeds, ongoing nasal congestion, or chronic sinus infections that do not respond to treatment
- persistent sore throat
- persistent hoarseness or a change in the voice
- persistent pain in the neck, throat, or ears
- blood in the sputum
- difficulty chewing, swallowing, or moving the jaws or tongue
- numbness in the tongue or other areas
- loosening of teeth
- dentures that no longer fit
- changes or discoloration in a mole; a skin sore that is crusting or ulcerated, or that fails to heal (these are also signs of skin cancer)
Types of Head & Neck Cancer
Cancer can develop in several different parts of the head and neck. Some of the most common include the following:
Cancer of the oral cavity (mouth) is the most common type of head and neck cancer. Nearly 30,000 new cases of oral cancer are diagnosed in the US each year. Oral cancer can begin in the lips, the gums, the area behind the molars or wisdom teeth, the inside of the lips and cheeks, the floor and roof (hard palate) of the mouth, and the front of the tongue. Most oral cancers arise in the tongue, the lip, the floor of the mouth, and the minor salivary glands. The rest are found in the gums and other sites.
Many head and neck cancers can be cured, but getting the best outcome requires close cooperation among a variety of medical specialists.
The main risk factors for oral cancer are smoking or chewing tobacco and excessive alcohol use. People who both smoke and drink heavily may be as much as 100 times more likely to develop oral cancer than those who neither smoke nor drink. Additional risk factors for oral cancer include infection with the human papillomavirus (HPV) — although this risk is not as high as it is for pharyngeal (throat) cancer — and prolonged exposure to sunlight. Sun exposure is also a risk factor for skin cancer.
Many oral cancers are found incidentally during a routine dental examination. Most of these cancers can be cured if discovered early. The most common symptoms include a sore or lump on the lip or in the mouth that does not heal; a white and/or red patch on the gums, tongue, or cheeks (these white or red areas may also be a precancerous condition called dysplasia); unusual or persistent bleeding, pain, or numbness in the mouth; and swelling that causes dentures to fit poorly or become uncomfortable.
Laryngeal cancer — cancer that arises in the larynx (voice box) — is the second most common type of head and neck cancer. An estimated 12,000 new cases of laryngeal cancer are diagnosed in the US each year. The vast majority of laryngeal cancers occur in men.
The larynx is located at the top of the trachea (windpipe) and is surrounded by the hypopharynx (the lower part of the throat where swallowing takes place). The larynx is visible on most men's throats as the Adam's apple. The larynx contains two bands of muscle called vocal cords, which vibrate as air passes through to make speech. The larynx also prevents food from entering the lungs.
Tobacco and alcohol use — especially the combination of the two — are the most common risk factors for laryngeal cancer. Additional risk factors include exposure in the workplace to wood and metal dusts, asbestos, paint fumes, and other chemical inhalants; a diet low in vitamins A and E; gastroesophageal reflux disease (GERD), which chronically exposes the throat to stomach acid; and infection with the human papillomavirus (HPV). People with aplastic anemia, a blood disorder associated with certain hereditary conditions, also have a higher risk of developing laryngeal cancer.
The most common symptoms of laryngeal cancer include hoarseness, a lump in the neck (due to an enlarged lymph node), ear pain, and difficulty swallowing.
Pharyngeal (Throat) Cancer
Pharyngeal cancer arises in the pharynx (throat), the hollow tube inside the neck that starts behind the nose and ends at the top of the esophagus. Tumors in this region include cancer of the nasopharynx (the upper part of the throat behind the nose), the oropharynx (the middle part of the pharynx), and the hypopharynx (the bottom part of the pharynx). Each year in the US, an estimated 11,800 people develop pharyngeal cancers.
The nasopharynx, located behind the nose, includes two openings that lead to the ears. Nasopharyngeal cancer is much more common in Asia, especially southeast China, the Mediterranean area, and Africa than in the US, and is less commonly associated with tobacco and alcohol use than other head and neck cancers. Risk factors for this type of cancer include a diet high in salt-cured fish and infection with Epstein-Barr virus, a member of the herpesvirus family and one of the most common human viruses. The most common sign of nasopharyngeal cancer is a lump in the neck, caused by the spread of cancer to the lymph nodes. Other symptoms may include nasal congestion, pain or ringing in the ears, a persistent sore throat, or frequent nosebleeds.
The oropharynx is located behind the mouth and includes the base of the tongue, the soft palate (the soft area just beyond the roof of the mouth), and the area around the tonsils. Smoking and chewing tobacco and heavy alcohol use are the most common risk factors for oropharyngeal cancer, but there is evidence that a diet low in fruits and vegetables is clearly linked to this form of head and neck cancer. Prior infection with human papillomavirus (HPV) is also a particularly strong risk factor for this cancer site1. Symptoms of oropharyngeal cancer may include a lump in the neck or throat, persistent sore throat, hoarseness, difficulty swallowing, and ear and/or jaw pain.
The hypopharynx is the uppermost portion of the esophagus (the tube through which food travels to the stomach) and surrounds the larynx (voice box). As with most other head and neck cancers, tobacco use and heavy alcohol consumption are the most common risk factors. Other risk factors for hypopharyngeal cancer may include a diet low in vitamins A and E; exposure in the work place to asbestos, wood dust, paint fumes, and other inhalants; and Plummer-Vinson syndrome (a rare condition that causes difficulty swallowing). Symptoms of hypopharyngeal cancer may include a lump in the neck, hoarseness, difficulty swallowing, and ear pain.
Nasal Cavity & Paranasal Sinus Cancers
Each year, approximately 2,000 people in the US are diagnosed with cancer in the mucus-producing tissues that line the nasal cavity (the space behind the nose through which air passes to the throat) and the paranasal sinuses (hollow areas in the facial bones near the nose). More than half of nasal cavity and paranasal sinus cancers occur in the maxillary sinuses (hollow spaces on either side of the nose and below the eyes); fewer cancers develop in the nasal cavity and in the ethmoid sinuses (sieve-like spaces made of thin bone and mucous tissues behind the bridge of the nose).
These cancers arise more frequently in people who are exposed to wood and metal dusts, asbestos, paint fumes, and air pollution. Symptoms of these head and neck cancers may include persistent nasal congestion, chronic sinus infections that do not respond to antibiotic treatment, frequent headaches or sinus pain, swelling of the eyes, and reduced sense of smell.
The thyroid is a small, butterfly-shaped gland located in the front of the neck below the larynx (voice box). The thyroid is part of the endocrine system, which makes hormones that help regulate metabolism (the body's transformation of food into energy), blood pressure, heart rate, temperature, and other functions.
An estimated 37,000 people are diagnosed with thyroid cancer each year in the US. Women are nearly three times more likely to develop a thyroid tumor than men. Unlike many other types of cancer, which are more common in older people, thyroid cancer occurs mainly in adults between the ages of 20 and 55. It is also one of the most curable types of cancer — approximately 97 percent of people with a thyroid tumor survive at least five years beyond their diagnosis.
The biggest known risk factor of thyroid cancer is exposure to moderate levels of external radiation at a young age. This type of radiation exposure may come from radiation in the environment or from prior radiation treatment in the head and neck area. Thyroid cancer usually first appears as a small lump or swelling, called a nodule, which can be felt on the front of the neck. Thyroid nodules are common, and the vast majority of them are benign. Other symptoms may include hoarseness, difficulty swallowing, swollen glands, difficulty breathing, pain in the throat or neck, or a cough that is not due to a cold.
Learn more about thyroid cancer.
The parathyroid is a small gland located at the base of the front of the neck, near the thyroid. This gland produces parathyroid hormone (PTH), which controls levels of calcium and phosphorous in the blood.
Most parathyroid tumors are benign. Only about 100 cases of parathyroid cancer are diagnosed each year in the US. Parathyroid cancer causes the parathyroid to make too much PTH, increasing the amount of calcium in the blood. People with a family history of parathyroid tumors or a hereditary condition called multiple endocrine neoplasia (MEN) type 1 or 2 have a greater risk of developing this type of cancer. Symptoms include a lump in the neck, bone pain, kidney problems, and other disorders related to having too much calcium in the blood.
D. I. Kutler, V. B. Wreesman, A. Goberdhan, et al., Human papillomavirus DNA and p53 polymorphisms in squamous cell carcinomas from Fanconi anemia patients, Journal of the National Cancer Institute 95(22), 2003: 1718-21.