Head and Neck Cancer Overview
Head and Neck Cancers are a range of malignant tumours that can develop in or around the throat, larynx, nose, sinuses, mouth and neck.
Head and Neck Cancer is the eighth most common cancer in the UK and the fourth most common in males. There are over 4,000 deaths per year from Head and Neck Cancer. The effects of the cancer and its treatment can be devastating in some.
Thyroid cancer is usually considered separately and is the 20th most common cancer, with around 400 deaths per year in the UK.
Most Head and Neck Cancers arise from the lining of mouth (oral cavity), throat (pharynx), voice box (larynx) or, less commonly, nose and sinuses. Head and Neck Cancer can also arise from salivary glands in the neck (parotid and submandibular glands most commonly) and also the thyroid gland. cancers can also arise from the skin or eye area and invade into the facial or nasal structures.
Given the sites from which cancer can arise, the disease can have a profound impact on fundamental functions such as speech, eating and swallowing, breathing, and overall appearance. Managing these implications is a critical aspect of treatment and survivorship care.
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The commonest cancer sites are the oropharynx (throat), oral cavity (mouth) and larynx (voicebox).
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What causes Head and Neck Cancer?
Many cancers of the mouth, throat and voice box are linked to smoking and alcohol. There is also an independent link to deprivation.
Most cancers of a part of the throat called the oropharynx (tonsils and tongue base) are caused by previous Human Papillomavirus (HPV). Most adults at some point in their lives are thought to be infected with HPV in the mouth or throat, even simply through kissing. In some, the virus persists and can cause cancer many years or decades later.
For other head and neck cancers, the cause is often unknown.
These are the main cancer types (where the cancers arise from).
Types of Cancer:
Oral Cavity or Mouth
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Oral cancers affect the mouth and tongue. Treatment is usually through surgery with possible loss of function (eating, talking) and appearance. Surgery may involve removal of part of the tongue, upper jaw or lower jaw, usually requiring reconstruction.
Oropharyngeal (Upper throat) Cancer
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These are cancers of tonsils and back of the tongue (inside the throat).
These cancers are rapidly rising in incidence throughout most of the world due to HPV infection.
Treatment is generally either through radiotherapy, chemotherapy and radiotherapy together, or surgery via the mouth (using a laser or robot), often with radiotherapy afterwards. Treatment can affect the ability to swallow.
Laryngeal and Hypopharyngeal (voice box and lower throat) Cancer
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Laryngeal cancer affects the larynx or voice box, which is important for breathing, talking and swallowing.
Hypopharynx cancer affects the lower part of the throat that surrounds the larynx. Treatment of early laryngeal cancers, through radiotherapy or laser surgery is often successful and preserves most functions.
More advanced cancers are treated with chemotherapy and radiotherapy which can cause more loss of function. For many advanced cancers, or when initial radiotherapy fails, surgery involves removing the voice box.
Cancer of the Nose and Sinuses
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This cancer affects the space behind the nose and face. These cancers are usually treated with surgery, often with radiotherapy afterwards. Surgery can involve removal of the cheekbone and eye.
Cancer of the Neck (Lymph Nodes), Salivary Glands and Thyroid Gland
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Cancer can spread to lymph nodes of the neck from the mouth or throat and from other primary cancers. Cancer can arise from the main glands that produce saliva for the mouth (the parotid and submandibular glands), and also from the thyroid gland, a gland in the lower front part of the neck that produces a hormone.
Surgery in these areas can affect vital nerves for facial movement, eating, speaking and shoulder movement.
There are several other areas in the head and neck that can be affected by cancer such as the brain and eyes but as these cancers are treated differently to those above they do not come under the classification of Head and Neck cancer. Skin cancers are often not regarded or classified as head and neck cancers, but advanced cases can invade the face, sinuses and eye and / or spreading to lymph nodes in the neck and so there are many similarities in treatment from a patient point of view.
Other useful links
UK Head and Neck Cancer Multidisciplinary Guidelines – lay summary for non-clinicians
Patient information can also be found here:
Head and Neck Cancer (mainly mouth, throat and larynx)
www.nhs.uk/conditions/head-and-neck-cancer/
www.cancerresearchuk.org/about-cancer/head-neck-cancer
www.macmillan.org.uk/cancer-information-and-support/head-and-neck-cancer
Thyroid Cancer
www.nhs.uk/conditions/thyroid-cancer/
www.cancerresearchuk.org/about-cancer/thyroid-cancer
www.macmillan.org.uk/cancer-information-and-support/thyroid-cancer