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What is cancer?
Cancer is a group of many related diseases that begin
in cells,
the body’s basic unit of life. Normally, cells
grow and divide to form new cells in an orderly way.
They perform their functions for a while, and then
they die. Sometimes, however, cells do not die. Instead,
they continue to divide and create new cells that the
body does not need. The extra cells form a mass of tissue,
called a growth or tumor. There are two types of tumors:
benign and
malignant.
Benign tumors are not cancer. They do not invade nearby
tissue or spread to other parts of the body. Malignant
tumors are cancer. Their growth invades normal structures
near the tumor and spreads to other parts of the body.
Metastasis is
the spread of cancer beyond one location in the body.
What kinds of cancers are considered
cancers of the head and neck?
Most head and neck cancers begin in the cells that line
the mucosal surfaces in the head and neck area, e.g.,
mouth, nose, and throat. Mucosal surfaces are moist tissues
lining hollow organs and
cavities of the body open to the environment. Normal
mucosal cells look like scales (squamous) under the microscope,
so head and neck cancers are often referred to as squamous
cell carcinomas. Some head and neck cancers begin
in other types of cells. For example, cancers that begin
in glandular cells are called adenocarcinomas.
Cancers of the head and neck are further identified
by the area in which they begin:
Oral
cavity. The oral cavity includes
the lips, the front two-thirds of the tongue,
the gingiva (gums), the buccal
mucosa (lining inside the cheeks and lips),
the floor (bottom) of the mouth under the tongue,
the hard
palate (bony top of the mouth), and the small
area behind the wisdom teeth.
Salivary
glands. The salivary glands produce saliva,
the fluid that
keeps mucosal surfaces in the mouth and throat
moist. There are many salivary glands; the major
ones are in the floor of the mouth, and near
the jawbone.
Paranasal sinuses and nasal cavity. The
paranasal sinuses are small hollow spaces in the
bones of the head surrounding the nose. The nasal
cavity is the hollow space inside the nose.
Pharynx. The
pharynx is a hollow tube about 5 inches long that
starts behind the nose and leads to the esophagus (the
tube that goes to the stomach)
and the trachea (the
tube that goes to the lungs).
The pharynx has three parts:
Nasopharynx. The
nasopharynx, the upper part of the pharynx,
is behind the nose.
Oropharynx. The
oropharynx is the middle part of the pharynx.
The oropharynx includes the soft
palate (the back of the mouth), the base
of the tongue, and the tonsils.
Hypopharynx. The
hypopharynx is the lower part of the pharynx.
Larynx. The
larynx, also called the voicebox, is a short passageway
formed by cartilage just
below the pharynx in the neck. The larynx contains
the vocal
cords. It also has a small piece of tissue, called
the epiglottis,
which moves to cover the larynx to prevent food from
entering the air passages.
Lymph
nodes in the upper part of the neck. Sometimes,
squamous cancer cells are found in the lymph
nodes of the upper neck when there is no evidence
of cancer in other parts of the head and neck.
When this happens, the cancer is called metastatic squamous
neck cancer with unknown (occult) primary.
Cancers of the brain, eye, and thyroid as
well as those of the scalp, skin, muscles, and bones
of the head and neck are not usually grouped with cancers
of the head and neck.
- How common are head and neck cancers?
Head and neck cancers account for approximately 3 to
5 percent of all cancers in the United States. These
cancers are more common in men and in people over age
50. It is estimated that about 39,000 men and women in
this country will develop head and neck cancer in 2005.
- What causes head and neck cancers?
Tobacco (including smokeless tobacco, sometimes called “chewing
tobacco” or “snuff”) and alcohol
use are the most important risk factors for head and
neck cancers, particularly those of the oral cavity,
oropharynx, hypopharynx, and larynx. Eighty-five percent
of head and neck cancers are linked to tobacco use. People
who use both tobacco and alcohol are at greater risk
for developing these cancers than people who use either
tobacco or alcohol alone.
Other risk factors for cancers of the head and neck
include the following:
- Oral cavity. Sun exposure (lip);
possibly human
papillomavirus (HPV) infection.
- Salivary glands. Radiation to
the head and neck. This exposure can come from
diagnostic x-rays or
from radiation
therapy for noncancerous conditions or cancer.
- Paranasal sinuses and nasal cavity. Certain
industrial exposures, such as wood or nickel
dust inhalation.
Tobacco and alcohol use may play less of a role in
this type of cancer.
- Nasopharynx. Asian, particularly
Chinese, ancestry; Epstein-Barr
virus infection; occupational exposure to wood
dust; and consumption of certain preservatives or
salted foods.
- Oropharynx. Poor oral hygiene;
HPV infection and the use of mouthwash that has a
high alcohol content are possible, but not proven,
risk factors.
- Hypopharynx. Plummer-Vinson (also
called Paterson-Kelly) syndrome,
a rare disorder that
results from iron and other nutritional
deficiencies. This syndrome is characterized
by severe anemia and
leads to difficulty swallowing due to webs of tissue
that grow across the upper part of the esophagus.
- Larynx. Exposure to airborne particles
of asbestos,
especially in the workplace.
Immigrants from Southeast Asia who use paan (betel quid)
in the mouth should be aware that this habit has been
strongly associated with an increased risk for oral cancer.
Also, consumption of mate, a tea-like beverage habitually
consumed by South Americans, has been associated with
an increased risk of cancers of the mouth, throat, esophagus,
and larynx.
People who are at risk for head and neck cancers should
talk with their doctor about ways they can reduce their
risk. They should also discuss how often to have checkups.
- What are common symptoms of head and
neck cancers?
Symptoms of several head and neck cancer sites include
a lump or sore that does not heal, a sore throat that
does not go away, difficulty swallowing, and a change
or hoarseness in the voice. Other symptoms may include
the following:
- Oral cavity. A white or red patch
on the gums, tongue, or lining of the mouth; a swelling
of the jaw that causes dentures to fit poorly or
become uncomfortable; and unusual bleeding or pain
in the mouth.
- Nasal cavity and sinuses. Sinuses
that are blocked and do not clear, chronic sinus
infections that do not respond to treatment with
antibiotics,
bleeding through the nose, frequent headaches,
swelling or other trouble with the eyes, pain
in the upper teeth, or problems with dentures.
- Salivary glands. Swelling under
the chin or around the jawbone; numbness or
paralysis of
the muscles in the face; or pain that does not go
away in the face, chin, or neck.
- Oropharynx and hypopharynx. Ear
pain.
- Nasopharynx. Trouble breathing
or speaking, frequent headaches, pain or ringing
in the ears, or trouble hearing.
- Larynx. Pain when swallowing,
or ear pain.
- Metastatic squamous neck cancer. Pain
in the neck or throat that does not go away.
These symptoms may be caused by cancer or by other,
less serious conditions. It is important to check with
a doctor or dentist about any of these symptoms.
- How are head and neck cancers diagnosed?
To find the cause of symptoms, a doctor evaluates a
person’s medical history, performs a physical
examination, and orders diagnostic tests. The exams
and tests conducted may vary depending on the symptoms.
Examination of a sample of tissue under the microscope
is always necessary to confirm a diagnosis of
cancer.
Some exams and tests that may be useful are described
below:
- Physical examination may include
visual inspection of the oral and nasal cavities,
neck, throat, and tongue using a small mirror and/or
lights. The doctor may also feel for lumps on the
neck, lips, gums, and cheeks.
- Endoscopy is
the use of a thin, lighted tube called an endoscope to
examine areas inside the body. The type of endoscope
the doctor uses depends on the area being examined.
For example, a laryngoscope is
inserted through the mouth to view the larynx; an
esophagoscope is inserted through the mouth to examine
the esophagus; and a nasopharyngoscope is inserted
through the nose so the doctor can see the nasal
cavity and nasopharynx.
- Laboratory
tests examine samples of blood,
urine,
or other substances from the body.
- X-rays create images of areas
inside the head and neck on film.
- CT (or CAT)
scan is a series of detailed pictures
of areas inside the head and neck created by a
computer linked to an x-ray machine.
- Magnetic
resonance imaging (or MRI) uses
a powerful magnet linked to a computer to create
detailed pictures of areas inside the head and
neck.
- PET
scan uses sugar that is modified
in a specific way so it is absorbed by cancer
calls and appears as dark areas on the scan.
- Biopsy is
the removal of tissue. A pathologist studies
the tissue under a microscope to make a diagnosis.
A biopsy is the only sure way to tell whether a person
has cancer.
If the diagnosis is cancer, the doctor will want to
learn the stage (or extent) of disease. Staging is
a careful attempt to find out whether the cancer has
spread and, if so, to which parts of the body. Staging
may involve an examination under anesthesia (in
the operating room), x-rays and other imaging
procedures, and laboratory tests. Knowing the stage
of the disease helps the doctor plan treatment.
- What health professionals treat patients with head and
neck cancers?
Patients with head and neck cancers are best treated
by a team of specialists. The specialists vary, depending
on the location and extent of the cancer. The medical
team may include oral
surgeons; ear, nose, and throat surgeons (also called
otolaryngologists);
pathologists; medical
oncologists; radiation
oncologists; prosthodontists;
dentists; plastic
surgeons; dietitians;
social workers; nurses; physical
therapists; and speech-language pathologists (sometimes
called speech
therapists).
- How are head and neck cancers treated?
The treatment plan for an individual patient depends
on a number of factors, including the exact location
of the tumor, the stage of the cancer, and the person’s
age and general health. The patient and the doctor should
consider treatment options carefully. They should discuss
each type of treatment and how it might change the way
the patient looks, talks, eats, or breathes.
- Surgery. The
surgeon may remove the cancer and some of the healthy
tissue around it. Lymph nodes in the neck may also
be removed (lymph
node dissection), if the doctor suspects that
the cancer has spread. Surgery may be followed by
radiation treatment.
Head and neck surgery often changes the patient’s
ability to chew, swallow, or talk. The patient
may look different after surgery, and the face
and neck may be swollen. The swelling usually
goes away within a few weeks. However, lymph node
dissection can slow the flow of lymph, which may
collect in the tissues; this swelling may last
for a long time. After a laryngectomy (surgery
to remove the larynx), parts of the neck and
throat may feel numb because nerves have
been cut. If lymph nodes in the neck were removed,
the shoulder and neck may be weak and stiff.
Patients should report any side
effects to their doctor or nurse, and discuss
what approach to take. Information about rehabilitation
can be found in question 10.
- Radiation therapy , also called
radiotherapy.
This treatment involves the use of high-energy
x-rays to kill cancer cells. Radiation may come from
a machine outside the body (external
radiation therapy). It can also come from radioactive materials
placed directly into or near the area where the
cancer cells are found (internal
radiation therapy or radiation implant).
In addition to its desired effect on cancer cells,
radiation therapy often causes unwanted effects.
Patients who receive radiation to the head and
neck may experience redness, irritation, and
sores in the mouth; a dry mouth or thickened saliva;
difficulty in swallowing; changes in taste; or
nausea.
Other problems that may occur during treatment
are loss of taste, which may decrease appetite
and affect nutrition,
and earaches (caused by hardening of the ear wax).
Patients may also notice some swelling or drooping
of the skin under the chin and changes in the texture
of the skin. The jaw may feel stiff and patients
may not be able to open their mouth as wide as
before treatment. Patients should report any side
effects to their doctor or nurse and ask how to
manage these effects.
More information about radiation therapy is available
in the NCI booklet Radiation Therapy and You:
A Guide to Self-Help During Treatment. NCI
publications and materials are available by calling
the Cancer Information Service (CIS) at 1–800–4–CANCER
(1–800–422–6237), or through
the NCI Publications Locator Web site at http://www.cancer.gov/publications on
the Internet.
- Chemotherapy,
also called anticancer drugs.
This treatment is used to kill cancer cells throughout
the body. The side effects of chemotherapy depend
on the drugs that are given. In general, anticancer
drugs affect rapidly growing cells, including blood
cells that fight infection, cells that line the
mouth and the digestive
tract, and cells in hair
follicles. As a result, patients may have side
effects such as lower resistance to infection,
sores in the mouth and on the lips, loss of
appetite, nausea, vomiting, diarrhea,
and hair loss. They may also feel unusually tired
and experience skin rash and itching, joint pain,
loss of balance, and swelling of the feet or lower
legs. Patients should talk with their doctor or nurse
about the side effects they are experiencing, and
how to handle them. The NCI booklet Chemotherapy
and You: A Guide to Self-Help During Treatment has
more information about this type of treatment.
To read the rest of this article from the National Cancer
Institute, please click here: http://www.cancer.gov/cancertopics/factsheet/Sites-Types/head-and-neck
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