Head and Neck Cancers

Head and neck cancers

Definition

The group of cancers found in the head and neck region, excluding tumors of the eyes and brain.

Description

The tumors associated with head and neck cancers are found in several regions, including the lips, tongue, mouth, nasal passages, pharynx, larynx (voice box), salivary glands, thyroid gland, and parathyroid glands. Many head and neck cancers interfere with the functions of eating and breathing. Laryngeal cancer affects speech. Loss of any of these functions is significant. Therefore, early detection and appropriate treatment is of utmost importance.

Roughly 5% of all cancers are related to the head and the neck. It is estimated that more than 59, 000 Americans will develop cancer of the head and neck in 2001, and 13, 000 will die from the disease.

The common cancers of the head and neck area are oral cancers , thyroid cancer , and laryngeal cancer. Half of all head and neck cancers occur in the oral cavity and pharynx, a third are thyroid cancer, and almost 20% are found in the larynx. The American Cancer Society estimates that in 2001 approximately 10, 000 new cases of laryngeal cancer will be diagnosed and 4, 000 people will die of this disease. New cases of thyroid cancer in 2001 will likely reach over 19, 000 and result in 1, 300 deaths. Oral cancer is the tenth most common cancer in the United States, reaching nearly 30, 000 new cases each year and causing at least 7, 800 deaths.

The survival rates for head and neck cancers varies from good to poor, depending on the specific cancer. About 54% of the patients diagnosed with oral cancer will survive five years or more after the initial diagnosis. Laryngeal cancer has a 5-year survival rate of nearly 65%. Among the different cancers, thyroid cancer has one of the better 5-year survival rates, approaching 95%. The poorer survival rates for some head and neck cancers result because the early signs of these cancers are frequently ignored. Hence, when first diagnosed, they are often in an advanced stage and not very amenable to treatment.

Tobacco is regarded as the single greatest risk factor contributing to the occurrence of oral and laryngeal cancer: 75% to 80% of these patients are smokers. Heavy alcohol use has also been included as a risk factor. A combination of tobacco and alcohol use increases the risk for oral cancer by 6 to 15 times more than for users of either substance alone. Exposure to asbestos appears to increase the risk of developing laryngeal cancer. The chance for developing certain types of thyroid cancer is linked to an exposure to radiation.

The risk for both oral cancer and laryngeal cancer seems to increase with age. Most of the cases occur in individuals over 40 years of age, and the average age at diagnosis is 60. While oral cancer strikes men twice as often as it does women, laryngeal cancer is four times more common in men than in women. Both diseases are more common in African-Americans than among whites. Thyroid cancer is three times more common in women than in men and is usually diagnosed between the ages of 30 and 50.

Types of cancers

There are many types of head and neck cancers. These are classified by where the cancer is found:

• Oral cancers occur in the mouth, or oral cavity, which includes the lips, the lining inside the lips and cheeks, the front two-thirds of the tongue, the teeth, the gums, the floor of the mouth (under the tongue), the roof of the mouth, and the small area behind the wisdom teeth. Symptoms and signs include a mouth sore that does not heal within two weeks, unusual bleeding from the teeth or gums, or a lump in the gums, mouth, or tongue.
• Lip cancers occur on the inside or outside surface of the lips. Signs of this cancer include a lump on the inside of the lip or a sore on the outside, which is usually a form of skin cancer.
• Oropharyngeal cancer is found on the back one-third of the tongue, the upper section of the pharynx, and the area around the tonsils. Symptoms include a lump in the back of the mouth or throat, ear pain, or difficulty swallowing.
• Nasopharyngeal cancer is found in the area behind the nose and the upper section of the pharynx, the area just behind the mouth. Symptoms include difficulty breathing or speaking, pain or ringing in ears, frequent headaches, or trouble hearing.
• Hypopharyngeal cancer is found only in the bottom section of the pharynx. Symptoms include a sore throat that does not subside, difficulty swallowing, a lump in the neck, or ear pain.
• Laryngeal cancer starts in the larynx, which is located in front of the neck, in the region of the Adam's apple. Symptoms include pain when swallowing, a sore throat that does not subside, a change in voice, or ear pain.
• Paranasal sinus cancer and nasal cancer develop in the small, hollow spaces in the nose called the sinuses and in the nasal cavity, which is the passageway for air moving to the throat during breathing. Symptoms include frequent sinus infections, nosebleeds, a sore inside the nose that does not heal, or pain in the sinus area.

Cancers of the head and neck
Cancer types	Cancer occurs in
Hypopharyngeal cancer	Lowest section of the pharynx (region
	behind mouth)
Laryngeal cancer	Larynx (front of neck, near Adam's apple)
Nasopharyngeal cancer	Behind nose
	Pharynx
Oral cancer	Lips
	Lining of lips and cheeks
	Front two-thirds of tongue
	Teeth
	Gums
	Under tongue
Oropharyngeal cancer	Back one-third of tongue
	Upper section of pharynx
	Area around tonsils
Parathyroid cancer	Parathyroid glands (found behind or next
	to the thyroid gland)
Thyroid cancer	Thyroid gland (found at front of neck, below the Adam's apple)

• Salivary gland tumors form in the salivary glands, which produce saliva to help prevent the mouth from drying out and aids with digestion. They are located under the jaw, in front of the ears, underneath the tongue, and in other regions of the digestive tract. Symptoms include swelling under the chin or around the jawbone, facial numbness, muscles in the face that will not move, or persistent pain in the face, chin, or neck.
• Thyroid cancer is found on the thyroid gland, which is located in the front of neck and secretes hormones that help regulate body temperature and metabolism. Symptoms include a lump on the neck, pain in the neck region, a cough with bleeding, or difficulty swallowing or breathing.
• Parathyroid cancer is found on one or on all four of the small parathyroid glands, which secrete a hormone that controls the level of calcium in the blood. They are located in neck area, with a pair on either side of the thyroid gland. Symptoms include bone pain , a lump in the neck, weak muscles, or nausea.

See Also Cigarettes; Laryngeal nerve palsy; Squamous cell carcinoma of the skin; Alcohol consumption

Resources

BOOKS

Cummings, C.W., J.M. Fredrickson, L.A. Harker, et al. Otolaryngology - Head and Neck Surgery. St. Louis: Mosby-Year Book, Inc., 1998.

Fraker, D.L., M. Skarulis, and V. Livolsi. "Thyroid Tumors." In Cancer: Principles and Practice of Oncology 5th ed. DeVita, V. Jr., et al, eds. Philadelphia: Lippincott-Raven Publishers, 1997.

PERIODICALS

Greenlee, R., M. Hill-Harmon, T. Murray, and M. Thun. "Cancer Statistics, 2001." CA: A Cancer Journal for Clinicians 51 (2001): 15-36.

OTHER

"PDQ: A Cancer Information Database." CancerNet 2 July 2001 <http://www.nci.nih.gov>

Lata Cherath, Ph.D.

Monica McGee, M.S.

KEY TERMS

Larynx

—The voice box or sound-producing organ in the body, located in the upper section of the trachea (windpipe). The movement of the muscles of this organ alters the sounds emitted by the vocal cords.

Pharynx

—The space behind the mouth that connects to the trachea and the esophagus (swallowing tube). It serves as a passageway for food and air.

Risk factor

—Anything that increases a person's chance of developing a disease.