Head and neck cancer is an umbrella term for cancers that form in the mouth, throat, voice box, sinuses, naval cavity or salivary glands.
Head and neck cancers can be especially challenging to treat because they grow in a small, intricate area of the body that controls essential functions like breathing, swallowing and speaking. Because of this, surgery or radiation treatment must be carefully planned to remove the cancer while trying to protect these important functions.
Another challenge is that the symptoms of head and neck cancer can look like common, less serious conditions. Signs such as a persistent sore throat, a lump in the neck or changes in the voice may be mistaken for infections or other illnesses. As a result, these cancers are often not diagnosed until they are at a more advanced stage.
More important facts to know about head and neck cancer:
- It’s the seventh most common type of cancer globally, accounting for about 4.5% of all cancer diagnoses worldwide.
- It’s more prevalent in South Asia, Central Asia and Eastern Europe.
- Head and neck cancer is two to three times more likely to be diagnosed in men, though cases in women have been rising in recent years.
- Patients with head and neck cancer have some of the strongest unmet needs in oncology.
Even when treatment is successful, “side effects can have a significant impact on a patient’s quality of life, as treatment such as surgery or radiation may affect speech, swallowing or taste, depending on the location of the cancer,” explains Sujay Shah, M.D., Global Medical Head of Oncology Research and Development at Johnson & Johnson.
Learn more about head and neck cancer, including the most common types, lifestyle factors that increase the risk and ongoing clinical trials for Johnson & Johnson therapies that may potentially improve patient outcomes.
The most common types of head and neck cancer
Doctors typically classify head and neck cancer into several groups based on their anatomical location, says Kiran Devisetty, M.D., Senior Director of Clinical Development in Interventional Oncology at Johnson & Johnson. These are the most common body areas where malignancies can form:
• Oral cavity: first two-thirds of the tongue, gums and lips
• Oropharynx: back of the tongue and middle of the throat
• Hypopharynx: lowest part of the throat
• Larynx, also known as the voice box
These four body areas of head and neck cancers most often involve squamous cell carcinoma (SCC), because SCC commonly develops in the mucosal surfaces of the mouth, throat and larynx.
However, SCC can also occur in other parts of the head and neck, and these four areas can sometimes develop other cancer types as well. When cancers in these mucosal areas are SCC, they are often grouped together as head and neck squamous cell carcinoma (HNSCC).
Less common head and neck cancer sites include the sinuses, nasal cavity, nasopharynx (behind the nose) and salivary glands. While these areas can also develop SCC, they more frequently involve other types of cancer, depending on the specific tissue where the tumor begins.
When cancer appears in other organs in the head and neck, such as the brain, eyes, thyroid and upper part of the esophagus, it is not considered head and neck cancer but rather its own distinct type of cancer.
Head and neck cancer risk factors
Alcohol and tobacco use are the main risk factors for head and neck cancer, especially for cancers in the oral cavity, oropharynx, larynx and hypopharynx. “These are the most common areas in the mouth and throat because they get the most exposure when a person drinks or smokes,” says Dr. Devisetty.
Human papillomavirus (HPV), an infection transmitted via direct skin contact that’s commonly associated with cervical cancer, is also linked to head and neck cancer—particularly cancers forming in the oropharynx. HPV-related oropharyngeal cancer is the fastest-growing type of head and neck cancer in the U.S., though globally most head and neck cancers are still HPV-unrelated.
Less common risk factors include a prior infection with the Epstein-Barr virus, which causes mononucleosis. Having a history of Epstein-Barr infection has been linked to nasopharyngeal and salivary gland cancer. Occupational exposure to dust, asbestos, synthetic fibers or other pollutants may also play a role in developing head and neck cancer.
Head and neck cancer symptoms can vary by body area
The symptoms of head and neck cancer vary depending on the cancer’s location; some, such as a rough patch on the palate or tongue, can be hard to detect. Symptoms can also be mistaken for a respiratory infection like a lingering cold, or from an allergic reaction or sinus infection.
“You could develop a persistent sore throat, trouble swallowing or changes in your voice,” says Dr. Shah. “An ulcer in the mouth that doesn’t go away is another sign, as are things like a growing mass in the neck.” Other symptoms include neck or ear pain, or swollen or blocked sinuses that don’t get better over time.
Tests and scans doctors use to diagnose head and neck cancer
A primary care provider or ear, nose and throat physician will often first conduct a physical exam to evaluate any swelling, masses or other symptoms, says Dr. Shah.
If cancer is suspected, a tissue sample (i.e., biopsy) will be taken and examined under a microscope. An endoscope (a long tube equipped with a light and specialized camera) inserted into the nose or mouth may also be used to examine and obtain cell samples from difficult-to-reach areas in the head and neck.
Imaging tests, such as a CT scan or MRI, can help clinicians understand the extent of the disease, including its size and exact location, so they can recommend the most appropriate treatment, says Dr. Devisetty.
Treatment of head and neck cancer depends on the type and stage
• Surgery to remove the tumor is one option if it’s small and early stage, says Dr. Devisetty.
• Radiation, either with or without chemotherapy, is typically used when a tumor is large or has spread to the lymph nodes.
• Chemotherapy with immunotherapy, a type of cancer treatment that helps immune cells fight cancer cells, is recommended for patients whose cancer is metastatic or who have experienced relapses.
Treating head and neck cancer is especially challenging because the tumors form in an area packed with nerves and blood vessels that also support essential functions like eating, speaking and swallowing.
As a result, treatments such as surgery or radiation can lead to significant short- and long-term side effects, including difficulty swallowing, changes in taste and challenges with speech.
These potential impacts can greatly influence a person’s daily life and overall well-being and should be part of treatment conversations, as clinicians work closely with patients to understand their goals and help them navigate the options available.
Developing additional effective therapies for head and neck cancer
The treatment options for head and neck cancer have only changed slightly in the past few decades, “and that’s where the unmet need is,” says Dr. Devisetty.
Earlier detection is another area of opportunity, which could potentially improve cure rates as well as boost the odds of maintaining the ability to swallow, speak or eat.
Johnson & Johnson is currently running clinical studies investigating targeted therapies to enhance the effectiveness of radiation therapy in locally advanced head and neck tumors. Other studies are evaluating the safety and efficacy of new treatments for patients with metastatic HNSCC.
“It’s about striving to develop treatments that may allow patients to have a good long-term quality of life,” adds Dr. Devisetty.
