Head and Neck Cancer

These symptoms may also be signs of other health conditions. If you experience any of these symptoms, it's always best to talk to a doctor.

What causes head and neck cancers?

Not everyone diagnosed with head and neck cancer has a known risk factor. However, chewing or smoking tobacco, drinking alcohol, and being infected with human papillomavirus (HPV) are the most common risk factors associated with these cancers. Learn more below.

• Tobacco use: Both smoking and using smokeless tobacco (such as chewing tobacco) increases your risk of head and neck cancer. Exposure to secondhand smoke can also elevate your risk.
• Alcohol: Consuming alcohol is a major risk factor, especially if you also use tobacco.
• HPV-16 infections: Infection with cancer-causing types of HPV, especially HPV-16, is a risk factor for oropharyngeal cancers that involve the tonsils or the base of the tongue.

Other risk factors for cancers of the head and neck include the following:

• Gender and age: Males over 50 are typically the most likely to develop certain forms of these cancers, although anyone can get them.
• Paan (betel quid): People from Southeast Asia who use paan (betel quid) in the mouth should be aware that this habit has been strongly associated with an increased risk of oral cancer.
• Maté: Consumption of maté, a tea-like beverage habitually consumed by South Americans, has been associated with an increased risk of cancers of the mouth, throat, and larynx.
• Occupational exposure: Wood and nickel dust, formaldehyde, asbestos, and synthetic fiber exposures have been associated with cancer of the larynx and sinuses, and some jobs in the construction, metal, textile, ceramic, logging, and food industries may have an increased risk of cancer of laryngeal cancer.
• Radiation exposure: Radiation to the head and neck, for noncancerous conditions or cancer, is a risk factor for cancer of the salivary glands and thyroid.
• Epstein-Barr virus infection: Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer.
• Ancestry: Individuals from Southeast Asia are at higher risk for developing nasopharyngeal cancer.

Screening and prevention

Can head and neck cancer be prevented?

Unlike other cancers, there are no widespread screening guidelines to detect head cancer or neck cancer early. However, regular dental care typically involves an inspection of the oral cavity. In addition, routine primary care visits may involve physical examination of the head and neck.

While they can't always be prevented, there are several things you can do to lower your head and neck cancer risk.

• Avoid tobacco or quit smoking/chewing. If you need help quitting, we offer several smoking cessation programs throughout the Maryland and Washington, D.C., region. Search for a program near you. 
• Moderate your alcohol consumption.
• Get vaccinated against HPV to protect yourself from the infection.
• Seek regular dental care, as your dentist will examine for early signs of mouth cancer in the oral cavity.

Diagnosis

How are these cancers diagnosed?

Some people are referred to an ear, nose, and throat specialist (also called an ENT doctor or otolaryngologist) after experiencing symptoms. In other instances, suspicious signs of cancer are found incidentally during an exam for an unrelated health condition.

An accurate diagnosis is essential to getting the best possible treatment for your cancer. At MedStar Health, we use sophisticated imaging and pathology to provide your cancer team with information that will allow us to personalize your treatment. We may use several diagnostic tools and tests to learn as much as we can about your disease, including:

• Physical examination: Your physician will thoroughly evaluate your head and neck region for anything concerning. Depending on your symptoms, they may feel for lumps around the neck or look inside the mouth or nose using a thin lighted tube to help them examine difficult-to-reach areas.
• Medical history: Your ENT specialist will also ask questions about your symptoms and overall health, including your lifestyle habits, history of other medical conditions, and more.
• Biopsy: We will need to collect a tissue sample to make an accurate diagnosis. The type of biopsy we use to remove the sample will vary based on the location of your tumor. This tissue is then examined under a microscope by specialized pathologists.
• Imaging studies: Imaging tests, such as computed tomography (CT) scans, PET scans, or MRIs, may be useful in determining the size and depth of the cancer and if it has spread. This helps to classify the cancer's stage (how advanced it is) and whether or not surgery may be your best treatment option.

Types of cancer

What are the most common types of head and neck cancers?

This cancer group encompasses a wide range of malignant tumors affecting different parts of the head and neck. Many types of head cancer or neck cancer also have several subtypes based on the cell type where the cancer originates.

We have experience treating all forms of these cancers, including:

• Laryngeal cancer: Also known as the voice box, the larynx lies within the throat in between the back of the tongue and the windpipe. Cancer can affect any part of the larynx.
• Nasal and sinus cancer: Rarely, cancer can develop in the nasal cavity or nearby in the paranasal sinuses.
• Oral (mouth) cancer: This cancer can affect the mouth, lips, or front two-thirds of the tongue.
• Salivary gland cancer: Although unusual, tumors can develop in the parotid glands, submandibular gland, sublingual gland, and the minor salivary glands.
• Skin cancers of the head and neck: Squamous cell carcinoma or basal cell carcinoma can develop on the face because it is frequently exposed to the sun.
• Throat cancer: The throat or pharynx extends from the back of the nose and mouth to your windpipe (trachea). Cancer can develop in any part of the throat and is classified by its precise location:
  • Nasopharyngeal cancer develops at the top of the throat.
  • Oropharyngeal cancer refers to malignancies in the middle of the throat, including the tonsils and the back of the tongue.
  • Hypopharyngeal cancer affects the bottom of the throat.
• Thyroid cancer: The thyroid is located below your voice box and is part of the endocrine system. When abnormal cells multiply uncontrollably in the thyroid gland, tumors can develop. These can be cancerous or benign.

Treatments

Your head and neck treatment depends on the type and stage of your tumor.

If you are diagnosed with head and neck cancer, your case will be discussed within a multidisciplinary tumor board that involves experts in head and neck surgery, radiation and medical oncology, radiology, pathology, speech therapy, and more. These specialists will collaborate on the appropriate recommendations for your treatment, including how to best preserve your natural appearance and functions, such as breathing, swallowing, and speaking.

Treatment will vary depending on the location and stage of your tumor, as well as your overall health and preferences. Your care team will thoroughly review the pros and cons of each of your treatment options, so you can feel confident in making the right decision for your best possible outcome.

Surgery

Depending on the location and progression of your cancer, surgery is often an effective treatment option, especially in early stages. If your doctors recommend surgery, the type of surgery you will have and the techniques used to perform your surgery will vary based on your unique case. At MedStar Health, our ENT and reconstructive surgeons are skilled at performing a wide range of surgical procedures, including but not limited to:

• Minimally invasive procedures that may offer faster recovery and shorter hospital stays, when appropriate
• Transoral Robotic Surgery (TORS), which combines 3D imaging with tiny robotic instruments to remove tumors affecting the oropharynx through the mouth
• Skull-base surgery which may involve transnasal endoscopy to remove tumors in or around the nose
• Complex procedures when tumors are in hard-to-reach areas or surrounded by critical structures in the head and neck region.
• Sophisticated reconstructive surgeries, including the ability to rebuild the tongue, throat, or jaw and restore the voice after larynx surgery

Our head and neck surgeons are dedicated to preserving your quality of life. To do so, they will use state-of-the-art tools and techniques to meticulously protect your ability to swallow, taste, or hear. For example, real-time intraoperative nerve monitoring technology allows them to identify and protect nearby nerves related to daily functions during surgery.

Chemotherapy

Chemotherapy is a powerful medicine given intravenously (through a vein) to destroy cancer cells throughout the body. At MedStar Health, we have medical oncologists who focus solely on treating these types of cancers, making us highly experienced in choosing the right type and dose of drugs at the appropriate time.

Depending on the location and stage of your head and neck tumor, chemotherapy may be used after surgery or in place of surgery alongside radiation therapy for functional preservation. For example, if you have cancer in the larynx, surgery may affect your natural ability to breathe and talk. In this instance, we may want to consider chemotherapy and radiation, which would prevent losing your larynx and preserve your voice.

If your cancer team recommends chemotherapy, they'll work closely with you to minimize and manage any possible side effects.

Learn More About Chemotherapy

Immunotherapy and targeted therapy

Some patients, especially those with recurring head and neck tumors, may benefit from other drug therapies that leverage the body's immune system (immunotherapy) or target genetic markers in tumors (targeted therapy). At times, this may be used alongside chemotherapy. Our head and neck medical oncologists will work with you and your care team to discuss your options, including whether or not you may benefit from an emerging treatment only available through a clinical trial.

Learn More About Immunotherapy

Learn More About Targeted Therapy

Radiation therapy

Radiation therapy uses high-energy waves to kill cancer. A radiation oncologist will be part of the multidisciplinary tumor board that reviews your case to determine if this treatment will be advantageous to treating your cancer and preserving your quality of life. At MedStar Health, our radiation oncologists have exceptional experience in delivering radiation in the most precise manner while limiting the amount of exposure to nearby healthy tissue and critical organs. Our goal is to maximize the effectiveness of radiation on a tumor while limiting potential side effects. To that end, we use the latest advances in radiation therapy, such as proton therapy and other cutting-edge radiation technologies.

Learn More About Radiation Therapy