Head and Neck Cancer – What you need to know

Head and neck cancer is the sixth most common malignancy in the world. It occurs in the throat, mouth and nasal cavity and accounts for 6% of all cancer cases worldwide. In Canada, more than 4,300 people are diagnosed with this cancer every year.

Find out more about what you need to know about head and neck cancer below:

You can also download a copy of our infographic here.

What is head and neck cancer?

Head and neck cancers occur in the throat, mouth, tongue and nasal cavity.

About 90% of head and neck cancers (HNC) originate in the squamous cells lining the mucosal surfaces of the mouth, nose and throat, including the larynx. Less common types of HNC occur in the thyroid, salivary glands or nasopharynx, the top of the throat near the nasal cavity.

Commonly diagnosed in people 50 and above, head and neck cancers are twice as frequent in men than in women.

Risk Factors

Important risk factors for HNC are:

  • Human papillomavirus (HPV): More than 75% of HNC are caused by HPV. They typically involve the tonsils or the tongue. For more information on HPV, visit: https://hpvglobalaction.org/hpv-info/.
  • Alcohol and tobacco: Smoking – including secondhand smoke – chewing tobacco and alcohol use also cause HNC.

Other risk factors include:

  • Radiation exposure: Excessive radiation to the head and neck area is a risk factor, particularly for salivary gland cancer.
  • Epstein-Barr virus: Epstein-Barr virus, also known as human herpesvirus 4, is a risk factor for cancers of the nasopharynx and salivary glands.
  • Genetics: Asian ancestry, particularly Chinese, is a risk factor for nasopharyngeal cancer.
  • Poor oral or dental hygiene: Poor oral hygiene, missing teeth and prolonged use of high-alcohol mouthwash may be risk factors.
  • Environmental or occupational inhalants: Prolonged exposure to various particles, such as wood or metallic dusts, or chemicals such as formaldehyde, is risky.
  • Dietary factors: Poor nutrition and/or excessive consumption of preserved or salted foods during childhood are risk factors.

Prevention

Prevention is the most effective way to avoid HNC:

  • Get vaccinated against the human papillomavirus (HPV). Vaccinations are available in Canada to males and females aged 9 to 45. These vaccinations also prevent other cancers, such as cervical cancer in women. For more information on HPV vaccination, visit: https://hpvglobalaction.org/hpv-info/.
  • Stop using tobacco of any kind, but particularly smokeless tobacco used in the mouth or nose.
  • Avoid alcohol or at least consume in moderation.
  • Maintain good oral hygiene practices.
  • Reduce dietary and nutrition risks.
  • Use appropriate protective equipment at work when exposed to chemicals mentioned in the section on Risk factors.

Signs and Symptoms

Head and neck cancers are curable if the signs and symptoms are caught early. Be vigilant and conduct regular self-exams. It could save your life.

Here is a list of key things to look for. While many of these are also symptoms of non-cancerous conditions, you should have them examined by a physician if any of them persist.

  • A sore, swelling or ulcer in the mouth that doesn’t go away
  • A lump in the neck that lasts more than two weeks
  • A white or red patch in the mouth
  • Persistent earache or sore throat or nasal congestion
  • Pain in the mouth, jaw or ear without obvious cause
  • Voice changes or hoarseness lasting longer than two weeks
  • Difficulties with swallowing
  • Blood appearing in the saliva or phlegm for more than a few days

Early Detection

You can take the following measures to ensure early detection and diagnosis. Early detection increases the chances of a successful treatment and better health outcomes:

  • Perform monthly self-exams of your face, neck, lips, nose and inside your mouth to find any lumps, sores or abnormalities that may be early signs of head or neck cancer.
  • Ask your dentist and/or physician to perform an oral, head and neck exam to seek or check on abnormalities.

Diagnosis and Staging

If your general practitioner (GP) suspects a possible cancer, you will be referred to a specialist for further tests. The specialist will likely perform a thorough head and neck exam, including feeling in affected areas for abnormal lumps and using special tools or equipment to allow them to see inaccessible areas. These exams can include passing tools down the throat or into the nose. Depending on the type of problem, x-rays or other imaging scans may be used.

A biopsy will be done if a tumour or other suspected abnormal tissue is found. Usually performed with either a local or general anesthetic, a biopsy involves removing a small portion of the abnormal tissue so it can be examined in a laboratory. If it is found to be cancerous, further analysis will determine the nature of the cancer (e.g., squamous cell, other).

Biopsies as well as the other tests performed will help determine the stage of the cancer. These findings will dictate the kind and duration of treatment. HNC can be characterized by size or spread from Stage 1 to 4. The higher the number the more serious the disease. The smaller the number, the more likely that treatment will be successful.

It is important to remember, however, that it is sometimes possible to effectively treat advanced Stage 4 cancers with the therapies that are now available.

Treatments

Potential treatments for HNC include chemotherapies, immunotherapies, gene-targeted therapies radiation and surgery. They are often used in combination. The treatment plan for an individual depends on the exact location of the tumour, the stage of the cancer, whether it is caused by HPV, and the person’s age and general health.

Immunotherapy is the newest form of HNC treatment approved by Health Canada. It activates the patients’ own immune system to help it recognize and kill the cancer cells.

Life After Treatment

HNC can take both an emotional and physical toll on people. Even with successful treatment, dealing with the effects of the disease or treatment is a life-long experience.

For example, head and neck cancer treatment can leave people with scars, changes in appearance, partial paralysis of the face, or problems with speech. Often, speech or other physical therapy are prescribed. Lack of saliva, challenges with swallowing and/or diet restrictions round out common post-treatment adverse effects. Diet and nutrition are especially important after treatment.

Sometimes, people are traumatized by the experience and need emotional support. Some patients live in fear that their cancer might return. As well, the emotional changes during a cancer journey can make re-establishing relationships difficult for some.

It is important for patients to be alert to their emotional well-being and discuss their feelings frankly with close family and friends. If necessary, they should seek professional help.

Other Resources

Head and neck patients and their caregivers face many challenges during and after their treatment. Here are a few resources that may help inform and support during the cancer journey:

Insights From A Head And Neck Cancer Survivor

John-Peter Bradford’s head and neck cancer started in his salivary glands. The Ottawa resident was diagnosed in 2009 with the disease already at stage 3, meaning the tumours were large and the cancer had spread from where it had started.

The radiation therapy and surgery that saved his life and eliminated the cancer have left him without functioning salivary glands, so speaking and eating require him to constantly drink water. The left side of his mouth and left shoulder and side of his body don’t function properly.

“But I’m happy as hell!” he says unreservedly. “I live a very full and productive life.”

He wasn’t always so accepting of his fate. “When you’re diagnosed with cancer you suddenly realize there is an expiration date on your birth certificate and you might know what it is,” he says. “It was almost paralysing to think of dying and the pain it would cause my family.”

His successful treatment came from participating in a clinical trial studying the use of very precise positron emission tomography (PET) scans to deliver radiation therapy in a very targeted way, and by varying the doses applied to different areas depending on the size and location of cancer as shown by the scans.

Since then, he co-founded the Life-Saving Therapies Network (LSTN), which works to obtain faster access to better treatments for Canadians with lethal diseases – including head and neck cancer. The aim is to save or extend lives of people who don’t have a lot of time. To do this, LSTN focuses on reform and innovative approaches to regulatory processes, clinical trial protocols, and reimbursement for treatments.