Our surgeons use the most advanced methods for cancer treatment, including the use of a surgical laser, to spare normal surrounding tissue and are all well versed in the latest and best reconstruction techniques for the area that has to be removed. Additionally, our surgeons make every attempt to achieve the best cosmetic results for our patients.
Patients also benefit from the expertise of radiation therapists, medical oncologists and speech-language pathologists, who offer the best chance of a cure with the least damaging effects on vital functions such as speaking and swallowing. We believe that the concentration of these well-trained and highly regarded professionals in one center ensures the seamless care of the patient affected by this disease.
What are some of the signs and symptoms of head and neck cancer?
What are cancers of the head and neck?
Early detection of head and neck cancers, like most cancers, gives the patient the highest chance of a cure. The following is a partial list of symptoms that may mean a cancer of the head and neck is present:
- A lump or swelling in the neck
- Change in the voice, or speech thickening
- A growth or sore in the mouth, either painless or painful
- Spitting or coughing up blood
- Swallowing problems or frequent coughing or choking with swallowing
- Abnormal skin growths or moles
- Persistent earache
What causes cancers of the head and neck?
Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (e.g., inside the mouth, nose and throat). These squamous cell cancers are often referred to as head and neck cancers. Cancer may also begin in the salivary glands, but salivary gland cancers are relatively uncommon. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.
Cancers of the head and neck are further categorized by the area of the head or neck in which they begin. Cancers of the brain, eye, esophagus and thyroid gland, as well as those of the scalp, skin, muscles and bones of the head and neck, are not usually classified as head and neck cancers because they do not start from the lining cells of the mouth, nose and throat. However, many of them begin in or will involve the head and neck at some point in the disease. Often the patient first becomes aware of their presence by a problem in the head and neck.
How common are head and neck cancers?
The most common types of cancer of the head and neck are caused by the abuse of alcohol coupled with tobacco use, either smoked or chewed. These risk factors are particularly important for cancers of the mouth, oropharynx (back of the mouth and throat), hypopharynx (lower throat, below the back of the tongue) and larynx (voice box). Tobacco and alcohol use are not risk factors for salivary gland cancers, as those have not yet been determined.
Infection with HPV (human papilloma virus, the virus causing warts of the skin and elsewhere) is a risk factor for some types of head and neck cancers, particularly oropharyngeal (mouth and throat) cancer that involves the tonsils or the base of the tongue. In the United States, the incidence of oropharyngeal cancers caused by HPV infection is increasing, while the incidence of oropharyngeal (mouth and throat) cancers related to other causes is falling.
How can I reduce my risk of developing head or neck cancer?
Head and neck cancers account for approximately 3 percent of all cancers in the United States. These cancers are nearly twice as common in men as they are in women. Head and neck cancers are also diagnosed more often among people over age 50 than they are among younger people.
How are head and neck cancers diagnosed?
People who are at risk of head and neck cancers―particularly those who use tobacco―should talk with their doctor about ways that they may be able to reduce their risk. They should also discuss with their doctor how often to have checkups.
In addition, ongoing clinical trials are testing the effectiveness of various medications in preventing head and neck cancers in people who have a high risk of developing these diseases.
The Food and Drug Administration has approved two vaccines to prevent HPV (Human Papilloma Virus, the virus causing warts) infection: Gardasil® and Cervarix®. Both vaccines are highly effective in preventing infections with HPV types 16 and 18 (threre are many species of Human Papilloma Virus, so they are identified by number). HPV type 16 is an increasing cause of oropharyngeal (mouth and throat) cancer, a type of head and neck cancer. Researchers are studying the effects of HPV vaccination to see if it reduces the incidence of the types of HPV infection in the oral cavity that can lead to oropharyngeal head and neck cancers.
How are head and neck cancers treated?
To find the cause of the signs or symptoms of a problem in the head and neck area, a doctor evaluates a person’s medical history, performs a physical examination and orders radiologic (X-ray, CT scan or MRI) tests. The exams and tests may vary depending on the symptoms. Examination of a sample of tissue under a microscope is always necessary to confirm a diagnosis of 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 an operating room), X-rays and other laboratory tests. Knowing the stage of the disease helps the doctor plan treatment.
What are the side effects of treatment?
The treatment plan for an individual patient diagnosed with head and neck cancer 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. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of treatments.
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.
What rehabilitation or support options are available for patients with head and neck cancers?
Surgery for head and neck cancers 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, if lymph nodes are removed, the flow of lymph in the area where they were removed may be slower and lymph could collect in the tissues, causing additional swelling (lymphedema). This swelling may last for a long time or be permanent.
After a laryngectomy (surgery to remove the larynx) or other surgery in the neck, 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 become weak and stiff.
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 the hardening of 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 discuss how to deal with them.
Is follow-up care necessary? What does it involve?
The goal of treatment for head and neck cancers is to control the disease, but doctors are also concerned about preserving the function of the affected areas as much as they can and helping the patient return to normal activities as soon as possible. Rehabilitation is a very important part of this process. The goals of rehabilitation depend on the extent of the disease and the treatment that a patient has received.
Depending on the location of the cancer and the type of treatment, rehabilitation may include dietary counseling, speech therapy and/or learning how to care for a stoma. A stoma is an opening into the windpipe through which a patient breathes after a laryngectomy (complete removal of the voice box). The patient breathes through an opening in the neck called a laryngostoma.
Sometimes, especially with cancer of the mouth, a patient may need reconstructive and plastic surgery to rebuild bones or tissues. However, reconstructive surgery may not always be possible because of damage to the remaining tissue from the original surgery or from radiation therapy. If reconstructive surgery is not possible, a prosthodontist may be able to make a prosthesis (an artificial dental and/or facial part) to restore satisfactory swallowing, speech and appearance. Patients will receive special training on how to use the device.
Patients who have trouble speaking after treatment may need speech therapy. Often, a speech-language pathologist will visit the patient in the hospital to plan therapy and teach speech exercises or alternative methods of speaking. Speech therapy usually continues after the patient returns home.
Eating may be difficult after treatment for head and neck cancer. Some patients receive nutrients directly into a vein after surgery or need a feeding tube placed directly into the stomach, until they can eat on their own. A feeding tube is a flexible plastic tube that is usually passed into the stomach through the nose or an incision in the abdomen. A swallowing therapist can help patients learn how to swallow again after surgery.
How can people who have had head and neck cancers reduce their risk of developing a second primary (new) cancer?
Regular follow-up care is very important after treatment for head and neck cancer to make sure that the cancer has not returned, or that a metastasis (spread of the cancer from the area where it began) has not developed. Depending on the type of cancer, medical checkups may include exams of the stoma, if one has been created, and of the mouth, neck and throat. Regular dental exams may also be necessary.
From time to time, the doctor may perform a complete physical exam, blood tests, X-rays and scans. The doctor may monitor vocal cord function, especially if the head or neck was treated with radiation and is likely to counsel patients to stop smoking. Research has shown that continued smoking by a patient with head and neck cancer may reduce the effectiveness of treatment and increase the chance of a second primary cancer.
People who have been treated for head and neck cancers have an increased chance of developing a new cancer, usually in the head, neck, esophagus or lungs. The chance of a second primary cancer varies depending on the site of the original cancer, but it is higher for people who continue to use tobacco and drink alcohol.
Especially because patients who smoke have a higher risk of a second primary cancer, doctors encourage patients who use tobacco to quit.
Patients who have other questions or concerns are urged to contact the Center for Head and Neck Oncology at the New York Head and Neck Institute (NYHNI).