Head and Neck Cancer: Symptoms, Causes & Treatment

Head and neck cancer is a disease that can cause symptoms such as sores in the mouth or on the lips that do not heal, hoarseness, weight loss, and difficulty swallowing or speaking. It can also cause ear pain or ringing in the ears, lumps in the neck, and persistent pain in the mouth or throat.

Head and neck cancer can develop in several different areas. These include cancers of the oral cavity, larynx, pharynx, salivary glands, thyroid, and the nasal cavity and paranasal sinuses.

If you have symptoms that may indicate head and neck cancer, you should see a primary care provider, dentist, or an ear, nose, and throat (ENT) specialist. Early diagnosis can help guide the most appropriate treatment, which may include chemotherapy, radiation therapy, surgery, or immunotherapy. Regular dental visits may also help with early detection.

Main symptoms

The main symptoms of head and neck cancer are:

• Sores in the mouth or on the lips that do not heal

• Persistent hoarseness

• Red or white patches on the tongue, gums, roof of the mouth, or inside the cheeks

• Persistent pain in the mouth, neck, or throat

• Weight loss

• Difficulty or pain when swallowing, speaking, or breathing

• Lumps in the neck

• Numbness or paralysis of the facial muscles

Depending on the type and location of the cancer, a person may also have a stuffy nose, nosebleeds, persistent nasal discharge, jaw swelling or a mass, loss of appetite, ear pain or ringing in the ears, hearing problems, pain in the face or jaw, persistent headache, or persistent cough.

Confirming a diagnosis

Head and neck cancer is diagnosed by an oncologist or an ear, nose, and throat (ENT) specialist, based on an evaluation of symptoms, a physical exam, and the person’s personal and family health history.

To evaluate the affected area, the doctor may order imaging tests, such as an MRI, CT scan, X-ray, or PET scan. Endoscopic exams through the mouth or nose may also be recommended.

The doctor may also order a biopsy, which removes a small tissue sample to be analyzed in a lab and confirm whether cancer cells are present. According to the American Cancer Society, a biopsy is the only way to know for sure whether oral cavity or oropharyngeal cancer is present.

Main types

Depending on the location and symptoms of the disease, the types of head and neck cancer include:

1. Oral cavity cancer

Oral cavity cancer refers to a group of tumors that can develop in different areas of the mouth, such as the lips, tongue, gums, inside of the cheeks, or roof of the mouth.

The main symptoms of oral cancer include mouth sores that take a long time to heal, white or red patches on the gums, tongue, or inside of the cheeks, swelling of the jaw, bleeding, and mouth pain.

2. Laryngeal cancer

Laryngeal cancer affects the voice box, which is a passage made of cartilage located just below the pharynx and contains the vocal cords.

Symptoms that may occur with this type of head and neck cancer include difficulty breathing or speaking, hoarseness, pain when swallowing, or ear pain.

3. Pharyngeal cancer

Pharyngeal cancer affects the area that starts behind the nose and extends to the esophagus. This includes the nasopharynx, which is the upper part of the pharynx; the oropharynx, which includes the soft palate, base of the tongue, and tonsils; and the hypopharynx, which is the lower part of the pharynx.

Possible symptoms of pharyngeal (throat) cancer include pain when swallowing, persistent pain in the neck or throat, ear pain or ringing, and difficulty hearing.

4. Salivary gland cancer

Salivary gland cancer affects the glands that produce saliva, which are located near the jaw and lower part of the mouth. It can cause symptoms such as swelling in the chin or around the jaw, numbness or paralysis of the facial muscles, or persistent pain in the face, chin, or neck.

5. Nasal cavity and paranasal sinus cancer

Nasal cavity and paranasal sinus cancer is a type of cancer that develops in the small hollow spaces in the bones of the head around the nose, or in the space inside the nose.

Symptoms that may occur with this type of head and neck cancer include a stuffy nose, chronic sinus infections that do not improve with antibiotics, nosebleeds, frequent headaches, persistent nasal discharge, and pain in the upper teeth.

6. Thyroid cancer

Thyroid cancer is a tumor that develops in the thyroid gland and, in its early stages, may cause a lump in the neck.

Most of these tumors are slow-growing and not very aggressive, but some types can grow quickly and cause other symptoms, such as hoarseness and/or difficulty swallowing.

Risk factors

Head and neck cancer is caused by a mutation in the DNA of cells, which begin to multiply in an uncontrolled way and lead to tumor growth.

Factors that increase the risk of head and neck cancer include:

• Excessive alcohol consumption

• Smoking, including cigarettes, cigars, pipes, chewing tobacco, snuff, and secondhand smoke

• HPV infection

• Frequent exposure to wood dust, nickel dust, asbestos, cement, or formaldehyde

• Epstein-Barr virus infection

• Radiation exposure

• A diet low in fruits and vegetables

According to the National Cancer Institute, alcohol and tobacco use are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, hypopharynx, and voice box.

Some genetic conditions, such as Fanconi anemia, may also increase the risk of developing certain types of cancer, including head and neck cancer.

Treatment options

Treatment for head and neck cancer varies depending on the type and stage of the tumor and may include:

• Chemotherapy: Chemotherapy uses one medication or a combination of medications to kill cancer cells. It is more commonly recommended for advanced head and neck cancers.

• Radiation therapy: Radiation therapy may be recommended to treat different types of head and neck cancer, either on its own, after surgery, or together with chemotherapy.

• Surgery: Surgery may be recommended to remove the tumor and a margin of healthy tissue around it, or to remove lymph nodes in the neck, for example.

• Immunotherapy: Immunotherapy medications, such as pembrolizumab and nivolumab, stimulate the immune system to identify and destroy cancer cells more effectively. They may be used to treat some types of head and neck cancer that have spread or come back after treatment.

• Nutritional therapy: A nutrition plan should be prescribed by a registered dietitian to improve swallowing, help relieve symptoms from medical treatments, and prevent weight loss. This may include enteral nutrition or parenteral nutrition.

Physical therapy and speech therapy may also be recommended by the doctor to help restore speech and swallowing after treatment.

Can head and neck cancer be cured?

Head and neck cancer can be cured, especially when it is identified and treated in the early stages. The chance of cure also depends on factors such as the type of cancer, the person’s age, overall health, and how the body responds to treatment.