Head and neck cancer includes cancers of the oral cavity, pharynx (throat), larynx (voice box), paranasal sinuses, and salivary glands. Most are squamous cell carcinomas. Risk factors include tobacco, alcohol, and HPV infection.

What Is Head and Neck Cancer?

Head and neck cancers (HNSCC - head and neck squamous cell carcinoma) occur in the mucous membranes lining your mouth and throat. Unlike many cancers, they often develop in younger people, particularly those with HPV infection.

Key fact: HPV-positive HNSCC (especially oropharyngeal cancer) is increasing in younger people and has better prognosis than tobacco-related cancers.

Types

  • Oropharyngeal cancer: Back of mouth, throat, soft palate, base of tongue. Often HPV-related.
  • Laryngeal cancer: Voice box. Usually from smoking.
  • Nasopharyngeal cancer: Upper throat behind nose. Associated with Epstein-Barr virus (EBV).
  • Oral cavity cancer: Lip, mouth, tongue. Usually tobacco-related.
  • Hypopharyngeal cancer: Lower throat.
  • Salivary gland cancer: More varied histology; rarer.

Risk Factors

  • Tobacco use: Smoking and chewing increase risk significantly.
  • Alcohol: Heavy drinking is a major risk factor.
  • HPV infection: HPV-16 and HPV-18 are associated with oropharyngeal cancer. HPV vaccine prevents these cancers.
  • Age: Usually 50+, but HPV-positive cancers can occur in 30-40 year-olds.
  • Male sex: Men are more commonly affected, though this is changing with HPV.
  • Weakened immune system: HIV+ individuals have higher risk.
  • Prior radiation: Radiation to head/neck increases subsequent cancer risk.

Symptoms

  • Persistent sore throat or mouth pain
  • Difficulty swallowing (dysphagia)
  • Lump in mouth, throat, or neck
  • Ear pain (often referred pain)
  • Hoarseness or voice changes (laryngeal cancer)
  • Persistent cough or hemoptysis (coughing up blood)
  • Mouth sores that don't heal in 2+ weeks
  • Unexplained weight loss
  • Swollen lymph nodes in neck

Diagnosis

Tools and tests:

  • Physical exam: Doctor examines mouth, throat, and palpates neck.
  • Endoscopy: Camera down throat to visualize tumor.
  • Biopsy: Tissue sample for pathology confirmation.
  • CT/MRI: Imaging to assess tumor extent and lymph node involvement.
  • HPV testing: Important for oropharyngeal cancers; affects prognosis and treatment.

Staging

Uses TNM system (Tumor, Nodes, Metastasis):

  • Stage I-II: Small tumors, no or minimal node involvement.
  • Stage III-IV: Larger tumors or significant node involvement.

HPV status significantly affects staging and prognosis—HPV-positive cancers have better outcomes even at higher stages.

Treatment Options

Surgery

Removing the tumor and often surrounding tissue and lymph nodes (neck dissection). Approaches range from minimally invasive endoscopic surgery to more extensive open procedures.

Radiation Therapy

High-energy beams kill cancer cells. Often used alone or after surgery. External beam radiation (IMRT - intensity-modulated radiation therapy) is standard.

Chemotherapy

Often combined with radiation (chemoradiation). Cisplatin + radiation is common for locally advanced disease.

Targeted Therapy

Cetuximab (Erbitux) targets EGFR and can be used with radiation or as monotherapy in some cases.

Immunotherapy

Checkpoint inhibitors (nivolumab, pembrolizumab) are now approved for recurrent/metastatic HNSCC and increasingly used in first-line treatment.

De-Intensification (HPV+ Cancers)

Trials are exploring reduced chemotherapy or radiation doses for HPV-positive oropharyngeal cancers to preserve quality of life while maintaining cure rates.

Side Effects & Survivorship

Surgery side effects: Difficulty swallowing, speech/voice changes (if larynx involved), loss of taste/smell, neck stiffness.

Radiation side effects: Dry mouth (xerostomia), difficulty swallowing, mouth sores, fatigue.

Chemotherapy: Nausea, mouth sores, hair loss, kidney toxicity (with cisplatin).

Long-term survivorship: Many survivors experience swallowing difficulty, voice changes, and dry mouth. Speech and swallowing therapy helps. Dental care is critical (radiation damages teeth).

Prognosis

Depends on stage, HPV status, and treatment response.

  • Early-stage (I-II): 80-90% 5-year survival with surgery ± radiation.
  • HPV-positive oropharyngeal: Better outcomes than HPV-negative; 60-80% 5-year survival even at stage III-IV.
  • Recurrent/metastatic: Immunotherapy is improving outcomes; median survival 10-15+ months.

Seek Immediate Care If You Experience:

  • Difficulty breathing or choking
  • Persistent severe throat pain affecting ability to eat/drink
  • Severe bleeding from mouth or throat
  • Sudden voice loss or severe hoarseness

Key Questions for Your Doctor

  • What is my HPV status?
  • What stage is my cancer, and what does that mean for treatment?
  • Is surgery, radiation, or chemoradiation recommended?
  • What are the specific side effects I should expect from my treatment?
  • Will I need a feeding tube during treatment?
  • Are speech and swallowing therapy available?
  • Are there immunotherapy options or clinical trials available?