Questions about head and neck cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on May 19, 2022.

Head and neck cancer is a complex disease that requires a comprehensive diagnostic evaluation and sophisticated treatment. Cancers of the head and neck include those of the oral cavity, larynx (voice box), pharynx, salivary glands and nasal cavities. To help you make informed decisions about the journey ahead, it’s important to educate yourself on the various types of head and neck cancer, including their symptoms, potential side effects and available treatments.

What you should know about head and neck cancer

Head and neck cancer accounts for an estimated 3 percent of all cancers in the United States. An increasing number of younger patients in their 40s and 50s are being diagnosed with the disease, largely because of a rise in human papillomavirus (HPV)-linked cancers. Still, more patients overall are surviving head and neck cancer, thanks in part to public health awareness efforts about tobacco use—the single largest risk factor for the disease—and advances in treatment options.

What is head and neck cancer?

Head and neck cancer originates in the tissues and organs of the head and neck area. Most head and neck cancers begin in the squamous cells that line the mouth, nose and throat. These types of cancer are generally referred to as squamous cell carcinomas and may include cancer that develops in the larynx, throat, lips, mouth, nose or salivary glands.

What are the symptoms of head and neck cancer?

The most common symptoms of head and neck cancer are swelling and a sore that doesn’t heal. Other symptoms include voice changes or hoarseness, a neck mass, a sore throat that doesn’t respond to an antibiotic, coughing up blood, trouble swallowing or breathing, a red or white patch in the mouth, frequent nose bleeds or unusual discharge, ear pain or trouble hearing, headaches and frequent coughing.

What are the main types of head and neck cancer?

The five main types of head and neck cancer are classified according to the part of the body in which they develop:

Laryngeal and hypopharyngeal cancer may start in the larynx (voice box), which is located at the top of the trachea (windpipe), and is used in breathing, speaking and swallowing. Or the cancer may start in the hypopharynx (gullet), which is the lower part of the throat that surrounds the larynx. Cancer that starts in the larynx is one of the most common types of head and neck cancer.

Nasal cavity and paranasal sinus cancer may start in the space just behind the nose, where air passes on its way to the throat. Or it may start in the air-filled areas that surround the nasal cavity (paranasal sinuses). Nasal cavity and paranasal sinus cancer are uncommon.

Nasopharyngeal cancer begins in the nasopharynx, which is an air passage located at the very upper part of the throat, just behind the nose. This disease is uncommon.

Oral and oropharyngeal cancer occurs in the mouth or tongue—both part of the oral cavity—or in the middle of the throat (oropharynx), which extends from the tonsils to the top of the larynx. Oral cancer is the ninth most common cancer among men.

Salivary gland cancer starts in the salivary glands, which produce the saliva that is essential for breaking down food. Salivary gland cancer is uncommon.

What are the biggest risk factors for head and neck cancer?

Tobacco use is the biggest risk factor for head and neck cancer. In fact, an estimated 85 percent of head and neck cancers are linked to tobacco use, and 75 percent of head and neck cancers are associated with a combination of tobacco and alcohol use, though tobacco and alcohol use are not significant risk factors for salivary gland cancers.

Other primary risk factors include:

  • Gender: Men are two to three times more likely than women to have head and neck cancer.
  • Age: Head and neck cancers are more common in people over the age of 50.
  • Certain illnesses: The Epstein-Barr virus (EBV), the human papillomavirus (HPV) and two inherited genetic syndromes are among the illnesses that may raise the risk of head and neck cancer.
  • Sun exposure: Prolonged exposure to sunlight may increase the risk of lip cancer, which is a type of oral cancer.

What type of doctor should I see if I think I have head and neck cancer?

If you have a symptom of head and neck cancer, a timely diagnostic evaluation is essential to starting a treatment plan. An oncologist trained and experienced in treating head and neck cancer may diagnose your cancer and advise you on a treatment or combination of treatments tailored to your needs and your specific cancer. You may want to specifically seek out an otolaryngologist, a doctor who treats diseases of the ear, nose and throat, especially one who has experience treating cancer, to diagnose the disease and advise you on what you should do next.

Questions about head and neck cancer treatment

Designing a head and neck cancer treatment plan is often determined by where the cancer originated, whether it’s spread and how severe the side effects may be. Typically, head and neck cancer therapies are used in combination, with a treatment plan managed by a multidisciplinary team of oncologists, nurses and other clinicians.

How is head and neck cancer typically treated?

Most head and neck cancers are treated with surgery, radiation therapy, chemotherapy, immunotherapy or targeted therapy, either alone or in combination.

Surgery is generally the first-line treatment for head and neck cancer, with procedures designed to remove the tumor and affected surrounding tissue. Because of advances in robotic surgery techniques, some hard-to-reach tumors may be removed with less invasive technologies designed to improve recovery times, reduce pain and cause less damage to tissues and muscles critical to eating and other daily activities.

Depending on the patient’s needs and other factors, plastic surgeons may also repair areas of the head and neck using reconstructive microsurgery techniques, which involve rebuilding the nose, tongue or throat using tissues from other areas of the body, such as the thigh, abdomen or forearm.

Radiation therapy may be recommended as the main treatment for head and neck cancer, or it may be offered after surgery to kill microscopic disease that was not removed in the operating room. Brachytherapy, a form of radiation treatment, may also be used during surgery to kill small areas of cancer using a technology designed to reduce damage to healthy tissue.

Chemotherapy may be recommended if the cancer has metastasized to the bones or elsewhere in the body.

The U.S. Food and Drug Administration has approved two checkpoint inhibitor drugs—a form of immunotherapy—to treat patients with recurrent or metastatic head and neck cancer that hasn’t responded to chemotherapy: pembrolizumab (Keytruda®) and nivolumab (Opdivo®).

Targeted therapy drugs may also be an option. The drugs are designed to interfere with a tumor protein called epidermal growth factor receptor (EGFR). Research has found that drugs that block EGFR may help slow or stop the growth of certain types of head and neck cancer.

What are the potential side effects of head and neck cancer treatment?

The two most common treatment-related side effects for head and neck cancer are changes in voice and difficulty swallowing. Voice changes are typically caused by surgery to remove the vocal cords. Radiation therapy may also cause hoarseness. Trouble swallowing (dysphagia) may range from chronic dry mouth to an inability to swallow anything, including saliva.

Other common side effects of head and neck cancer treatment include hearing loss, difficulty chewing, decreased thyroid gland function, swelling of the mouth and throat area, facial disfigurement, changes in taste, loss of appetite, redness or skin irritation, dry mouth, thickened saliva, lymphedema, bone pain, nausea, fatigue, mouth sores and a sore throat.

How long do side effects last?

Treatment-related side effects for head and neck cancer often linger for months or even years after treatment ends. These side effects may affect patients’ long-term quality of life and ability to perform everyday tasks. Other, less severe side effects, such as nausea and fatigue, are more temporary and go away shortly after treatment.

Can treatment-related side effects be managed?

Recent advances in head and neck cancer treatments may help limit the severity of side effects that impair patients’ ability to swallow, eat, speak and perform other important everyday functions. Many of these side effects may be managed with supportive care therapies, such as nutrition therapy, naturopathic support and oncology rehabilitation, depending on the patient’s needs and preferences. Side effect management may begin before, during or after treatment.

Questions to ask your doctor

If you suspect you have head and neck cancer or you have recently been diagnosed with the disease, you may have a number of questions for your doctor. An otolaryngologist or other cancer expert experienced in treating head and neck cancer may help answer your questions and advise you on a course of treatment tailored to your specific cancer, needs and preferences.

Do I have head and neck cancer?

One of the first questions you’ll want answered is learning whether you even have cancer. Some symptoms of head and neck cancer—headaches, a lasting sore throat or ear pain, for example—may be caused by a number of less serious illnesses. But if your symptoms persist or you believe you may have cancer, seeing a doctor may help bring you peace of mind, or at least offer you key information to help you decide what to do next. It is important to diagnose head and neck cancer early, when more treatment options may be available. If you have symptoms of head and neck cancer, such as voice changes, a neck mass, a sore throat that lasts longer than two weeks and/or that doesn’t respond to an antibiotic, or you are coughing up blood, you may consider seeing a head and neck cancer expert to begin a diagnostic evaluation.

Some younger patients may be more likely to discount the seriousness of certain symptoms because of their age. But even though head and neck cancers most commonly affect people over the age of 50, the disease is on the rise among men and women younger than 50, largely because of an increase in human papillomavirus (HPV)-linked cancers.

Is flexible robotic surgery a treatment option for me?

Flexible robotic surgery may be an option for some head and neck cancer patients. The technology, fitted with a flexible scope, is designed to allow surgeons to access hard-to-reach areas of the mouth and throat that aren’t typically or easily accessible with standard instruments. Benefits may include shorter hospital stays, reduced post-surgical pain and a faster return to normal activities.

Candidates for flexible robotic surgery may include patients with cancer in the tonsils, base of the tongue, hypopharynx (located in the throat next to and behind the larynx, or voice box) or supraglottis (upper part of the larynx).

How important are follow-up appointments after treatment is complete?

After treatment has ended, it is important to continue to see your cancer care team for follow-up scans, bloodwork and routine physical exams to monitor for cancer recurrence. Head and neck cancer most commonly recurs in the first one to two years after treatment has ended. The frequency of your follow-up appointments may follow this schedule:

  • Every four to six weeks during the first year after treatment
  • Every two to three months during the second year
  • Every three to four months during the third year
  • Every four to six months during the fourth year
  • Once a year after five years have passed since treatment ended

Next topic: What are the facts about head and neck cancer?

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