What is head and neck cancer

Head and neck cancer is an umbrella term covering a number of different cancers that can develop in areas of the head and neck. It’s the  eighth most common cancer in the UK with around 34 new cases every day. More men than women develop head and neck cancer, and rates are highest in people aged over 70. As it includes a number of different cancers, the symptoms, treatments and survival rates can vary greatly.

Types of head and neck cancer

Most head and neck cancers start in cells that line the mouth, nose and throat, called squamous cells. Sometimes this is referred to as squamous cell carcinoma. Head and neck cancers can affect the mouth, different parts of the throat, the voice box (larynx), the nose and sinuses, the tonsils and the salivary gland. 

Other types of cancer affecting parts of the head and neck that don’t fall under the umbrella term of head and neck cancer include brain tumours, thyroid cancer, gullet (oesophagus) cancer and windpipe (tracheal) cancer — they are usually referred to separately. 

Mouth cancer

Mouth cancer, also known as oral cancer, can affect any part of the mouth, including the lips and tongue. If the cancer affects the part of the throat behind the mouth, the soft palate at the back of the mouth, the tonsils or the base of the tongue, it is known as oropharyngeal cancer.

The most common symptom of mouth cancer is an ulcer or sore that doesn’t heal. Depending on the exact location of the cancer, there are other possible symptoms including a continuous sore throat, a lump somewhere in your mouth or in lymph glands in your neck, and red or white patches on the gums, tongue or mouth lining. 

The biggest risk factors for mouth cancer are smoking or frequently drinking a lot of alcohol. Other risk factors including chewing tobacco or other substances such as betel quid. A weak immune system and an unhealthy diet can also increase your risk. Oropharyngeal cancer is also linked to a common virus called human papillomavirus (HPV). Most people have this virus at some point in their life and in most cases, it does not cause cancer. 

Cancers of the throat

There are different names for cancers affecting the various parts of the throat. We have already mentioned the part of the throat behind the mouth, which comes under oropharyngeal cancer. If the cancer is in part of the throat that connects the back of the nose to the back of the throat it is known as nasopharyngeal cancer. Cancer in the area at the bottom of the throat or gullet is called hypopharyngeal cancer. 

A lump in the neck is a common symptom of throat cancers. Other symptoms depend on the part of the throat affected but can include hearing problems, a constant sore throat, nose bleeds and ringing in the ears. 

Similar to mouth cancer, using tobacco and drinking a lot of alcohol can increase your risk of throat cancers. Other risk factors include infection with Epstein-Barr virus (EBV), a common virus that also causes glandular fever. Most people who have EBV do not develop cancer.

Nose and sinuses

It is rare for cancer to form in the nose and sinuses. Symptoms include feeling as if there is a blockage in your nose, continuous sinus infections that won’t go away, nose bleeds and pain in the nose and sinus area. All of these symptoms are much more likely to be caused by something less serious. 

Risk factors for nose and sinus cancer include breathing in certain chemicals or dust for many years, such as wood dust, leather dust, chromium, nickel, formaldehyde and mineral oils.  

Salivary gland cancer

There are several salivary glands in different parts of the head and neck, and they produce saliva, the liquid that keeps your mouth and throat moist. Salivary gland tumours are usually non-cancerous (benign). They are more common in women than men, especially those aged over 50. 

The most common symptom of salivary gland cancer is a lump or swelling on the face or neck. This may be painless but can cause pain or numbness in the face or neck. 

It isn’t always possible to know the cause of salivary gland cancer. However, two out of three cases happen to people aged over 55. If you have had radiation therapy on the face or neck in the past this may also increase your risk. 

Laryngeal (voice box) cancer

The voice box (larynx) and vocal cords are found in your neck. They’re important not just for speaking but also for breathing and swallowing. Cancer can develop in any part of the larynx but it is not very common — in the UK, one in 188 men and one in 834 women will be diagnosed with laryngeal cancer in their lifetime. 

A change in the sound of your voice is the most common symptom of laryngeal cancer. Other symptoms include a lump in the neck, difficulty swallowing or breathing or a sore throat that won’t go away. In most cases, these symptoms are likely to be caused by something much less serious. 

Diagnosis of head and neck cancer

If you think you have any symptoms of head or neck cancer, the first step is to see your GP. They will discuss your symptoms and may do a physical examination or refer you for blood tests. If your only symptom is a lump in your neck, you may be referred to a neck lump clinic. If you have other symptoms your GP may refer you for further tests or to see a consultant. 

Some tests may be needed to find the cause of your symptoms, such as an ultrasound scan of the neck or a nasendoscopy, where a tiny camera is inserted into your nose to look at it, the back of your mouth and parts of your throat. Sometimes a biopsy is needed, where a sample of cells or tissue is taken from the affected area. 

If these tests show that there are signs of cancer, you will likely have further tests, which may include an X-ray, MRI scan or CT scan. 

Treatments

The type of treatment you have will depend on where the cancer is and how far it has progressed. A team of specialists called a multidisciplinary team will discuss the most appropriate treatment for you, which may include: 

• Chemotherapy
• Immunotherapy, which boosts the body’s natural defences to fight the cancer
• Radiotherapy
• Surgery to remove the cancer
• Targeted therapy, which uses drugs that block the growth and spread of cancer cells

Your consultant will discuss the options with you in detail before going ahead with any treatment.