Center for Head and Neck Oncology

Types of Head and Neck Cancer

Cancer of the head and neck may begin in the skin of the head and neck (malignant melanoma, squamous cell carcinoma) and spread into the lymph nodes in the neck. Malignant melanoma is a cancer of the cells secreting pigment in the skin, while squamous cell cancer is a cancer of the type of cells that line the throat, mouth and upper airways.

Also, cancers that either began in other organs or have spread from another organ or place in the body, such as the lung, may spread into the lymph nodes of the neck before being detected in the lung.

Places cancer of the head and neck may form are:

  • The throat
  • The back of the nose (nasopharyngeal cancer)
  • Anywhere in the mouth, including the tongue
  • The voice box and areas next to it
  • Tissue of the cartilages
  • Muscles or tendons
  • Blood vessels at base of skull or in neck

Treatment of almost all of these cancers consists of surgical removal of the area combined with radiation treatment and/or chemotherapy.

Key Points

  • Most head and neck cancers begin in the squamous cells that line the moist surfaces inside the head and neck.
  • Tobacco use, alcohol use and human papillomavirus infection are important risk factors for head and neck cancers.
  • Typical symptoms of head and neck cancers include a lump or sore (e.g., in the mouth) that does not heal, a sore throat that does not go away, difficulty swallowing and a change or hoarseness of the voice.
  • Rehabilitation and regular follow-up care are important parts of the treatment for patients with head and neck cancers.

Symptoms of Head and Neck Cancer

A Lump in the Neck
Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible. Of course, not all lumps are cancer, but a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voice box (larynx), thyroid gland or of certain lymphomas (cancer of the lymph glands) and blood cancers (leukemia). Such lumps are generally painless and continue to enlarge steadily.

Change in the Voice
Most cancers in the larynx (voice box) cause some changes in voice. An otolaryngologist is a head and neck specialist who can examine your vocal cords easily and painlessly in the office. While most voice changes are not caused by cancer, you shouldn’t take chances. If you are hoarse or notice voice changes for more than two weeks, see your doctor.

A Growth in the Mouth
Most cancers of the mouth or tongue cause a sore or swelling that doesn’t go away. These may be painless, which can be misleading, and bleeding may occur, but often not until late in the disease.
If an ulcer or swelling does not go away after a week or is accompanied by lumps in the neck, you should see to it immediately. Your dentist or doctor can determine if a biopsy (tissue sample test) is needed and can refer you to a head and neck surgeon who can perform this procedure.

Bringing up Blood
This is often caused by something other than cancer. However, tumors in the nose, mouth, throat or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, see your physician.

Swallowing Problems
Cancer of the throat or esophagus may make swallowing solid foods—and sometimes liquids—difficult. The food may “stick” at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should be examined by a physician.

Usually a barium swallow X-ray (a procedure where the patient swallows a material that shows up as white on the film with dark areas indicating a tumor) or an esophagoscopy (direct examination of the swallowing tube with a scope) will be performed to find the cause.

Changes in the Skin
The most common head and neck cancer is basal cell cancer of the skin. Fortunately, this is rarely serious if treated early. Basal cell cancers appear most often in sun-exposed areas like the forehead, face and ears, but can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, producing a central “dimple” and eventually an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. Some basal cell cancers show color changes.
Other kinds of skin cancers, including squamous cell cancer (cancer of the regular skin cells) and malignant melanoma (cancer of the pigment producing skin cells), also occur on the head and neck. Most squamous cell cancers occur on the lower lip and ear and may look like basal cell cancers, and if caught early and properly treated, usually are not dangerous.

Be sure to see your physician if you have:

  • A sore on the lip, lower face or ear that does not heal
  • Moles that change size, color or bleed
  • Blue-black or black discoloration of the skin (particularly if it changes size or shape)

Persistent Earache
Constant pain in or around the ear when you swallow can be a sign of infection or tumor growth in the throat. This is particularly serious if it is associated with difficulty in swallowing, hoarseness or a lump in the neck. These symptoms should be evaluated by a physician as soon as possible.

What to do if you have one or more of these symptoms and signs

All of the symptoms and signs described above can occur with no cancer present. In fact, complaints of this type often are due to another condition. However, a diagnosis cannot be made without an examination, and when found early, most cancers in the head and neck can be cured with few side effects.

So be sure to see your doctor immediately if you have any symptoms, because early detection means a higher chance of a cure. And always practice good health habits that help prevent these diseases.

Additional Head and Neck Cancer Sites

Oral Cavity

Cancer of the oral cavity sites include:

  • The lips
  • The front two-thirds of the tongue
  • The gums
  • The lining inside the cheeks and lips
  • The floor (bottom) of the mouth under the tongue
  • The palate (bony top of the mouth) and the small area of the gum behind the wisdom teeth

Symptoms: A white or red patch on the gums, the tongue or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.

Risk Factors: Alcohol or tobacco use. Poor oral hygiene and missing teeth may be weak risk factors for cancers of the oral cavity, and use of mouthwash with high alcohol content is a possible weak risk factor, as well. However, this has yet to be proved.

Pharyngeal

The pharynx is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts:

  • The upper part -- behind the nose (nasopharynx).
  • The middle part -- the base of the tongue, and the tonsils (oropharynx)
  • The lower part – hypopharynx

Symptoms: Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain or ringing in the ears; or trouble hearing.

Risk Factors: Alcohol or tobacco use. Asian ancestry, particularly Chinese, is a risk factor for nasopharyngeal cancer, along with infection (with a particular virus called the Epstein-Barr virus), occupational exposure to wood dust and consumption of certain preserved or salted foods during childhood. HPV (human papilloma virus, the virus causing warts) infection is also known to cause oropharyngeal cancer.

Laryngeal

The larynx, also called the voice box, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords and has a small piece of tissue called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages in much the same manner as a flip lid on a refuse can.

Symptoms: Pain when swallowing or ear pain.

Risk Factors:Alcohol or tobacco use. Certain industrial exposures, including exposure to asbestos and synthetic fibers, have been associated with cancer of the larynx, but the increase in risk remains uncertain. People working in certain jobs in the construction, metal, textile, ceramic, logging and food industries may have an increased risk of cancer of the larynx.

Paranasal Sinuses and Nasal Cavity

The sinuses are small hollow, air-filled spaces in the bones of the head above and surrounding the nose, as well as a single one at the middle of the base of the skull. The nasal cavity is the hollow space inside the nose.

Symptoms: Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.

Risk Factors: Certain industrial exposures, such as wood, nickel dust or formaldehyde.

Salivary Glands

The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.

Symptoms: Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away.

Risk Factors: Radiation to the head and neck, for noncancerous conditions or cancer; infection with Epstein-Barr virus (a virus common in Asia and Africa that is known to cause a rare cancer of the lymph glands).

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Meet An Expert

Dennis Kraus, MD

Dr. Dennis Kraus

Dr. Dennis Kraus's clinical practice focuses on the management of head and neck oncologic disease.


Doug K. Frank, MD

Dr. Douglas Frank

Dr. Douglas Frank’s areas of specialization include head and neck tumor surgery, thyroid and parathyroid surgery, salivary gland surgery, surgery for head and neck melanoma and advanced non-melanoma skin cancer, and skull base surgery.


Gady Har-El, MD, FACS

Dr. Gady Har-El

Dr. Gady Har-El is a nationally and internationally renowned otolaryngologist/head and neck surgeon who is widely recognized for clinical and academic achievements in head and neck surgery as well as skull base and sinus surgery.


Jessica W. Lim, MD

Dr. Jessica Lim

Dr. Jessica Lim is an otolaryngologist who treats patients of all ages and has a particular interest in endocrine surgery (thyroid, parathyroid), sinus disease, airway (larynx and trachea) disorders and head and neck tumor surgery.


Dr. John Boockvar

Dr. John Boockvar is Director of the Center for Crainial Base Surgery as well as the director for the Center for Head & Neck Oncology. He is also the Director of the Brain Tumor Center at Lenox Hill Hospital.