Head and Neck cancers are those that form in the throat, nose, sinuses, mouth, lips, salivary glands, and larynx (your voice box). When cancer forms in the head or neck, it is one of three types. These include squamous cell carcinoma, thyroid cancer and lymphoma.
The majority of head and neck cancers are caused by a combination of exposure to risk factors or viruses that cause healthy tissues to abnormally function and form lesions or tumors. Men are three times more likely than women to develop a case of head and neck cancer and most cases become apparent after age 40 in both men and women.
Cancers of the head and neck may develop without notice. However, once a tumor progresses and begins to disturb nearby organs, the symptoms that become apparent can be mild or mimic conditions that are thought to be temporary, such as sore throat, sinus and allergy issues. If you notice something abnormal or are experiencing symptoms that last several weeks, you will need to have an exam with an otolaryngologist to determine your diagnosis. An otolaryngologist is a specially trained surgeon who treats disorders of the ear, nose and throat (ENT) in addition to head and neck structures.
Regular dental check-ups and yearly exams with a primary care physician (including blood work) are your best defense for catching silent changes in your health. Take heart in knowing that when head and neck cancers are found early, they can be cured without many unpleasant side effects. Additionally, basic lifestyle changes can be effective in preventing most of these diseases.
1. Squamous Cell Carcinoma
Squamous cell carcinoma comprises approximately 90 percent of oral cancers. It is named squamous cell carcinoma because lesions form in the flat (squamous) cells which line the mucosal surface layers in the tonsils, throat, lips or base of the tongue.
Squamous cell carcinoma may appear as an ulcer in the mouth that will not heal. You may also experience unresolvable sinus congestion, earache, unusual pain or bleeding in the mouth, sore throat, difficulty swallowing or breathing or changes in your voice. Pay attention to the length of time you have these types of symptoms so you can report the information to your doctor.
Lifestyle habits typically contribute to the formation of squamous cell carcinoma. Excessive tobacco and alcohol use in combination can contribute to these cancer types, as well as unprotected UV ray exposure to the lips. The most recent and rapidly increasing risk factor for developing squamous cell carcinoma is infection from the human papilloma virus (HPV).
HPV is a sexually transmitted disease that can be passed by both men and woman primarily through oral sex. You can proactively fight this disease by getting an HPV vaccine which prevents the virus from infecting you. HPV vaccine is only effective in people who do not yet have the disease. Historically, the inoculation was recommended for females between the ages of 9 – 26. Physicians are now encouraging parents to have males in the age range of 9 – 26 vaccinated in order to protect against infection. Now that oral cancers have been associated with HPV infection, it is more important than ever to discuss changing recommendations for childhood vaccinations with your child’s pediatrician.
Because it is symptomless, oral HPV is not likely to be detected until abnormal tissue results in noticeable symptoms in the mouth or throat. Therefore, protecting yourself and your family from ever contracting this disease is extremely important. Currently, there is no screening for HPV, however, these infections are 100 percent preventable if patients are vaccinated before becoming sexually active. Condom use can lower the risk of infection but this method of protection is not known to be 100 percent effective.
To determine the stage and progression of squamous cell carcinoma, a CT scan may be ordered and an initial biopsy of the suspicious area using fine needle aspiration will be recommended. Fine needle aspiration is preferred instead of surgical removal in order to avoid dislodging abnormal cells as they could spread to other areas of the body. Squamous cell carcinomas are curable and may be treated with a combination of surgery, radiation and chemoradiation if needed. Function-sparing surgical techniques are now available that will lead to faster recovery with less damage to nearby tissues.
2. Thyroid Cancer
Thyroid cancer begins in the thyroid gland which is located in the front of your neck. It is made of two lobes that are symmetrical and shaped like a butterfly, the lobes rest on top of your trachea, or wind pipe. The thyroid gland is responsible for regulating important bodily functions such as heart rate and rate of metabolism. Several different types of thyroid cancer can form depending on which cells within the gland begin to grow abnormally.
Thyroid cancer can develop without any symptoms. Typically, patients with thyroid cancer go to their doctor due to other issues that occur when a tumor (called a thyroid nodule) is placing pressure on another structure in their neck. Those symptoms would include; swollen lymph node in the front of the neck, recurrent hoarseness, difficulty swallowing or breathing, sore throat or neck pain. If your symptoms linger for more than several weeks, the best course of action is to see your doctor, an otolaryngologist or an endocrine surgeon for an evaluation. Often, the tumor (nodule) is benign but will still need to be treated to alleviate symptoms.
Risk factors for the different thyroid cancer types include high levels of radiation exposure (resulting from medical treatment or contact with power plant accidents or nuclear weapons), hereditary conditions and family history of genetic conditions. Women are more likely than men to develop thyroid cancer, women are most commonly diagnosed after age 40, but men who develop the disease usually reach age 60 before having suspicious symptoms.
In addition to a physical exam to evaluate the size and firmness of your thyroid or enlarged lymph nodes in your neck, your physician may need to order blood tests, a radioiodine scan, ultrasound and possibly a biopsy to remove cells and fluid from the enlarged area for microscopic examination. If you require a biopsy, you can have this procedure in your physician’s office and they will use numbing medication (anesthesia) and fine needle aspiration to obtain the necessary cells for testing. Most patients do not need a general anesthetic during this procedure.
Although treatment for thyroid cancer may include partial or full removal of the gland, the good news is that cure rates are more than 90 percent for this disease.
Lymphoma is the least common of the three head and neck cancers. Lymphoma is a general term that encompasses cancers that involve the cells (lymphocytes) of the immune system. These cells are organized in groups called nodes. When lymphocytes begin to grow and multiply in an uncontrolled state, a mass may become apparent in the neck or face.
Lymphoma has many subtypes, most are classified as Hodgkin’s or Non-Hodgkin’s lymphoma. A fine needle aspiration is recommended as the first step to rule out another type of head and neck malignancy. An excision of the lesion is frequently needed for your physician to find your diagnosis. Symptoms that may lead your doctor to order a biopsy include changes in voice, difficulty swallowing or an abnormal/discolored area in your mouth (your dentist would identify this upon regular cleanings and X‑rays). If not caught early with preventive care, other symptoms you may notice could include any of the following: enlarged lymph nodes, loss of appetite, rapid weight loss, fatigue, recurring fever or night sweats.
Patients at risk for developing lymphoma usually have a combination of factors that, in combination, have caused cells in the lymph nodes to become reprogrammed so that they no longer progress through the break down process. This results in a mass, or tumor. Some risk factors include: treatment for HIV or hepatitis B or C, prolonged exposure to toxic chemicals and inherited immunodeficiency diseases.
The first step in treating lymphoma is for your otolaryngologist to determine if the cancer is growing on the outside of the lymph node or if it has penetrated the capsule of the node and spread to other areas of the body. Your otolaryngologist will perform a biopsy, or removal of some or all of the lymph node that is in question. Tests will be run to find out stage of the tumor and the type of cancer that has formed. At that point, your physician will recommend the best treatment options for your individual case.
Head and neck cancers are highly treatable when caught early. It is important to keep regular appointments for check-ups with your primary care physician and dentist so that your health is monitored and abnormalities are identified as soon as possible.