Key Facts
The more common head and neck cancers include cancers of:
Treatment for all of these cancers is similar - radiotherapy is an important part of treatment.
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Key Figures
Head and neck cancers together make up 5% of all cancers diagnosed each year – 120,000 across Europe.
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Cancer of the Mouth or Oral Cavity
Oral cavity cancers can include those arising from the lips, the buccal mucosa, the gums, the front two-thirds of the tongue, the floor of the mouth and the hard palate.
Two conditions can give rise to cancer - leukoplakia and erythroplakia:
- Leukoplakia is a white patch on the lining of the mouth
- Erythroplakia is a raised, red area that bleeds easily if scraped
25% of leukoplakia cases develop into cancer - treatment at this stage is simple, prevents cancer and the results are very good.
70% of erythroplakias are an early form of cancer.
Over 90% of mouth cancers are squamous cell cancers. Verrucous carcinoma is a less common type of squamous cell carcinoma. It rarely spreads to other parts of the body but does invade surrounding tissue.
Salivary Gland cancers are adenocarcinomas. They are very rare.
Lymphomas can develop from the tonsils.
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Causes of Oral Cancer
Oral cancer mainly affects people over the age of 50.
The main risk factors for developing oral cancer are:
- smoking, especially combined with heavy alcohol consumption
- sun exposure to the lips
- infection of the mouth with the Human Papilloma Virus (HPV)
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Symptoms of Oral Cancer
Often there are no symptoms and cancers are detected by dentists and other health professionals during routine examinations.
Symptoms can include:
- a painless ulcer that fails to heal
- pain, numbness or soreness in the mouth
- a red or white patch in the mouth - leukoplakia and erythroplakia respectively
- unexplained bleeding
- loose teeth
- a lump in the neck
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Oral Cancer Diagnostic Tests
A biopsy of any abnormal area or lump is required to make a definite diagnosis of oral cancer.
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Cancer of the Pharynx
The pharynx is the cavity inside the neck, starting behind the nose and ending at the top of the larynx and oesophagus. It is sometimes divided into the nasopharynx (the upper part of the throat behind the nose), the oropharynx (the middle part of the pharynx) and the hypopharynx (the lowest part of the pharynx).
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Causes of Pharyngeal Cancer
The cause of pharyngeal cancer is no known, however risk factors may include:
- diet. The cooking of salt-cured fish and meat, and a diet lacking in fruits and vegetables, which is common in some parts of Asia, is thought to increase the risk
- the Epstein-Barr virus may also be linked to an increased risk of pharyngeal cancer
- tobacco use, both smoking and chewing tobacco
- excessive alcohol
- poor dental hygiene
- human papilloma virus (HPV)
- exposure to asbestos
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Types of Pharyngeal Cancer
Several types of cancers develop in squamous cells in the pharynx:
Other tumour types are:
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Symptoms of Pharyngeal Cancer
Symptoms of phyaryngeal cancer can include:
- a lump in the neck that does not go away after several weeks
- hearing loss, just on one side
- a blocked nose, particularly if just on one side
- blood-stained discharge from the nose
- headache
- numbness in the lower part of your face
- difficulty in swallowing
- changes in the voice, such as hoarseness
Pharyngeal Cancer Diagnostic Tests
- endoscopy - to look for abnormalities in the throat
- biopsy - obtaining a sample of any suspicious area for laboratory testing
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Cancer of the Larynx
The larynx includes the vocal cords.
Cancer of the larynx most commonly develops from skin-like cells on the vocal cords, and is a squamous cell carcinoma.
Causes of Laryngeal Cancer
- age: cancer of the larynx is more common in older people - very few cases are in people under 50 years of age
- drinking alcohol and smoking are the main risk factors for cancer of the larynx
- poor diet
- a weakened immune system
- exposure to chemicals, wood, dust or soot
- acid reflux
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Symptoms of Laryngeal Cancer
Symptoms of laryngeal cancer include:
- hoarseness or other voice changes
- difficulty in swallowing
- sensation of a lump in the throat
- less commonly, bad breath and shortness of breath
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Laryngeal Cancer Diagnostic Tests
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Cancer of the Sinuses
The sinuses are in the bones of the skull. There are three types:
- Frontal sinuses - above the eyes
- Ethmoid sinuses - behind the nose
- Maxillary sinuses - in the bones of the cheeks
They are lined with cells that produce mucus to moisten the air that we breathe in and give tone to our voices. Sinus cancer is very rare, affects people over 40 years and is more common in men than women.
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Causes of Sinus Cancer
The exact causes of sinus are not known. Risk factors include:
- using snuff for many years
- exposure to chemicals, wood, dust or soot
- smoking
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Symptoms of Sinus Cancer
The symptoms of sinus cancer are:
- a feeling of being "blocked up", which does not clear
- pain behind the nose, above the eyes or in the upper teeth
- swelling around the eyes
Less common symptoms include:
- numbness in parts of the face
- nosebleeds
- headaches
- double vision
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Sinus Cancer Diagnostic Tests
Sinus cancer is diagnosed using a number of special tests including:
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Treatment
Before deciding on treatment, an exact diagnosis is required to determine the type of cancer, its size and whether it has spread from the area it started from.
Staging head and neck cancers is complicated because there are a large number of different cancers and for each different cancer, there are different criteria for assessing how advanced it is.
In general:
- Stage I and stage II cancers are small, have not spread from where they started and are usually curable
- Stage III cancers have spread to nearby tissues and/or to local lymph nodes
- Stage IV cancers have spread to other areas of the body and for this reason surgery may not be the best treatment option
Treatment for head and neck cancers usually involves a multi disciplinary team including one or more surgeons, a radiation oncologist, a medical oncologist and other health professionals who are specialists in helping patients with speech, swallowing and other difficulties.
The principle underlying all treatments is to cure the patient and, when possible, to preserve the organ (for example, the tongue or larynx) normally using more than more than one form of treatment.
Radiotherapy
Radiotherapy is frequently used to treat head and neck cancers. Radiotherapy uses high energy X-ray beams, generated from linear accelerators, to kill cancer cells.
Chemotherapy
Chemotherapy is helpful for many cancers. However, it is not very effective in treating sinus cancer and is only used occasionally.
Concurrent chemotherapy and radiotherapy
Used together (concurrent therapy), radiotherapy and chemotherapy are more effective than using the two treatments one after the other.
Monoclonal antibody treatment
Monoclonal antibodies target specific proteins necessary for the progression of the cancer and cause very few side effects. In head and neck cancer, one of these agents, cetuximab, has been shown to be effective.
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Key Trends
- Human Papilloma Virus (HPV) appears to be associated with oropharyngeal cancers in women, and the prognosis for this form of cancer seems to be better.
- Treatment with monoclonal antibodies is increasing.
- The importance of quality of life issues as a factor in deciding on what the most appropriate treatments are.
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Important Research Areas
- Refining treatments to improve organ sparing strategies.
- The use of genomics to determine which patients will benefit from specific treatments.
- Improving strategies for local control of cancer and treatment of metastatic disease.
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