Involve. Supporting you. Supporting your patients with cancer
As a healthcare provider, you participate in every aspect of care for patients facing a cancer diagnosis. Use this section to refresh your knowledge of head and neck cancer or share the information with patients who are facing a head and neck cancer diagnosis.
- Facts and Statistics
- Risk Factors
- Screening and Early Detection
- Diagnosis and Staging
- Head & Neck Cancer Treatment Options
Facts and Statistics
Head and neck cancers include those cancers that arise in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx. While many head and neck cancers are rare, together they comprise a large number of tumors. According to the American Cancer Society:
- In 2009, there will be an estimated 12,290 new cases of laryngeal cancer, with 3,660 deaths.
- An estimated 2,850 cases of hypopharyngeal cancer are diagnosed each year in the US.
- Approximately 2,000 people in the US develop cancer of the nasal cavity and paranasal sinus each year.
- Nasopharyngeal cancer is fairly rare, occurring in about 7 in every 1 million people in the US.
- An estimated 28,500 new cases of oral cavity and oropharyngeal cancer will be diagnosed in the US in 2009, with an estimated 6,100 deaths.
- Salivary gland cancers account for less than 1% of cancers in the US, occurring at a yearly rate of about 2 cases per 100,000 people.
Risk Factors
There are several factors that may increase the risk of developing head and neck cancer, the primary risk factor being tobacco use. Smoking or chewing tobacco is linked to 85% of head and neck cancer cases. Many risk factors are specific to the location of the cancer:
- Oral Cavity: Risk factors include tobacco use, alcohol use, sun exposure, and possibly human papillomavirus (HPV) infection. Oral use of paan (betel quid), typically used by Southeast Asian immigrants, and consumption of mate, primarily seen among Southern Americans, also may increase the risk of oral cancers, as well as cancer of the throat, esophagus, and larynx.
- Salivary Glands: Risk factors include radiation therapy and diagnostic X-rays.
- Paranasal Sinuses and Nasal Cavity: Risk factors include inhalation of certain industrial elements (eg, wood or nickel dust) and possibly tobacco and alcohol use.
- Nasopharynx: Risk factors include work-related exposure to wood dust, consuming certain salted foods or preservatives, and the Epstein-Barr virus. Individuals of Asian ancestry appear to be at greater risk for developing nasopharynx cancer.
- Oropharynx: Potential risk factors include poor oral hygiene, use of mouthwash with high alcohol content, and HPV infection.
- Hypopharynx: Risk factors include Plummer-Vinson syndrome, also known as Paterson-Kelly syndrome.
- Larynx: Risk factors include tobacco use, alcohol use, and exposure to airborne asbestos, especially in the work environment.
Screening and Early Detection
There are no established screening procedures for head and neck cancers in general. However, some healthcare providers, including dentists, may be able to detect head and neck cancer during routine exams, and an oral cancer screening is considered a critical component of a routine dental hygiene exam. Given the infrequency of head and neck cancer, it is even more important that healthcare providers discuss risk factors with patients.
Diagnosis and Staging
Several options are available for the diagnosis of head and neck cancer:
- Endoscopy: An endoscope, a flexible, skinny tube with a light on it, is inserted through either the nose or mouth, depending on what parts of the head and neck need to be examined.
- Laboratory Tests: Urine, blood, or other samples may be obtained and examined for evidence of cancer.
- X-rays: X-rays may allow for visualization of tumors or suspected lesions in the head and neck.
- Computed Tomography (CT) Scan: A CT scan, generated by computer and X-ray, creates detailed pictures of the head and neck.
- Magnetic Resonance Imaging (MRI): An MRI utilizes strong magnets and a computer to generate detailed pictures of the head and neck.
- Positron Emission Tomography (PET): A PET scan, which uses radioactive sugar injected into a vein, also allows visualization of potential cancerous areas in the head and neck.
- Biopsy: A biopsy is the only definitive way to determine if a lesion is cancerous.
Once head and neck cancer is diagnosed, the disease is staged:
| Head & Neck Cancer* Stages | |||
|---|---|---|---|
| Stage | Primary Tumor (T) | Lymph Nodes (N) | Metastasis (M) |
| 0 | Tis | N0 | M0 |
| I | T1 | N0 | M0 |
| II | T2 | N0 | M0 |
| III | T3 | N0 | M0 |
| T1 | N1 | M0 | |
| T2 | N1 | M0 | |
| T3 | N1 | M0 | |
| IVA | T4a | N0 | M0 |
| T4a | N1 | M0 | |
| T4 | N0 | M0 | |
| T1 | N2 | M0 | |
| T2 | N2 | M0 | |
| T3 | N2 | M0 | |
| T4a | N2 | M0 | |
| IVB | T4b | Any N | M0 |
| Any T | N3 | M0 | |
| IVC | Any T | Any N | M1 |
| *Tumor sites include the lips and oral cavity, pharynx [nasopharynx, oropharynx, and hypopharynx], and larynx and exclude the nasal cavity, paranasal sinuses, salivary glands, and thyroid. For all included sites above, except nasopharynx, Stage IVA refers to locally advanced resectable disease, and Stage IVB refers to locally advanced unresectable disease, whereas Stage IVC refers to advanced distant metastatic disease. | |||
| Head & Neck Cancer* TNM Staging Guide | |
|---|---|
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ |
| T1 | Tumor ≤2 cm |
| T2 | Tumor >2 cm but ≤4 cm |
| T3 | Tumor >4 cm |
| T4a, T4b | Tumor of any size that is fixed or invades other tissues and structures |
| *Primary Tumor (T) includes lips and oral cavity, oropharynx, and hypopharynx. For larynx and nasopharynx, one should refer directly to the AJCC Cancer Staging Handbook, 6th ed., XIV, pp. 43, 55, Springer-Verlag, Inc., New York, 2002. For all included sites above except nasopharynx, T4 lesions are divided into T4a (resectable) and T4b (unresectable). | |
| Head & Neck Cancer TNM Staging Guide | |
|---|---|
| Regional Lymph Nodes (N) | |
| NX | Regional lymph node metastases cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis ≤3 cm in only 1 lymph node on the same side of the head or neck as the primary tumor |
| N2 | Metastasis >3 cm but ≤6 cm in 1 or more than 1 lymph node on the same side or both sides of the head and neck as the primary tumor |
| N3 | Metastasis >6 cm in a lymph node |
| Head & Neck Cancer* TNM Staging Guide | |
|---|---|
| Distance Metastasis (M) | |
| MX | Distant metastasis cannot be assessed |
| M0 | No distant metastasis |
| M1 | Distant metastasis present |
| *Tumor sites include the lips and oral cavity, pharynx [nasopharynx, oropharynx, and hypopharynx], and larynx and exclude the nasal cavity, paranasal sinuses, salivary glands, and thyroid. Due to the complicated anatomy of the various head and neck cancer sites, for more detail on the precise staging system for each separate anatomical site, refer directly to the AJCC Cancer Staging Handbook, 6th ed., XIV, pp. 35-71, Springer-Verlag, Inc., New York, 2002. | |
Head & Neck Cancer Cancer Treatment Options
As a healthcare provider, you may find yourself educating patients about their treatment options. The following is a brief summary of common therapies used to treat the different types of head and neck cancer.
- Hypopharyngeal Cancer: The treatment of hypopharyngeal cancer is controversial, and it is difficult to define the ideal therapy for a specific site or stage of hypopharyngeal cancer. In general, both surgery and radiation therapy are the mainstays of most curative efforts. In recent years, chemotherapy has been added to the treatment strategies for selected advanced presentations. In pyriform sinus cancer, neoadjuvant chemotherapy followed by radiation therapy may afford larynx preservation without jeopardizing survival.
- Laryngeal Cancer: Although most early lesions can be cured by either radiation therapy or surgery, radiation therapy may be reasonable to preserve the voice, leaving surgery for salvage. Locally advanced lesions, especially those with large clinically involved lymph nodes, are poorly controlled with surgery, radiation therapy, or combined modality treatment. Therapy recommendations for intermediate lesions are based on a variety of complex anatomic, clinical, and social factors, which should be individualized and discussed in multidisciplinary consultation (surgery, radiation therapy, and dental and oral surgery).
- Lip and Oral Cavity Cancers: Most patients present with early cancers of the lip, which are highly curable by surgery or by radiation therapy. Small cancers of the oral cavity also are highly curable by radiation therapy or surgery. Moderately advanced and advanced cancers of the lip can be controlled effectively by surgery or radiation therapy or a combination of these.
- Nasopharyngeal Cancer: Small cancers of the nasopharynx are highly curable by radiation therapy. Moderately advanced lesions without clinical evidence of cervical lymph involvement often are curable. Advanced lesions are poorly controlled by local radiation therapy with or without surgery, and the lesions often develop distant metastases despite local control.
- Oropharyngeal Cancer: Surgery and/or radiation therapy have been the standards for treatment of oropharyngeal cancers. However, these modalities frequently are complicated by suboptimal control of locoregional disease and significant long-term functional deficits. Although specific indications for primary surgical resection exist, some suggest that the concurrent use of multi-agent chemotherapy and radiation has become the standard of care for the management of patients with late-stage disease, and surgery is often reserved for salvage of those patients who fail definitive nonoperative treatment.
- Paranasal Sinus Cancer: The majority of tumors of the paranasal sinuses present with advanced disease, and cure rates are generally poor (≤50%). Pretreatment evaluation and staging, as well as the need for multidisciplinary planning of treatment, are very important.
- Salivary Gland Cancer: Early-stage low-grade malignant salivary gland tumors usually are curable by surgical resection alone. Large, bulky tumors or high-grade tumors carry a poorer prognosis and may best be treated by surgical resection combined with postoperative radiation therapy.
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