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  • What are head and neck cancers?

    Last reviewed June 2012

    Contents

    The mouth includes the lips, gums and tongue. The tongue is the largest organ in the mouth. The muscles of the base of the tongue (tongue base) continue into the upper throat (oropharynx).

    The roof of the mouth is called the hard palate. Behind the hard palate is the soft palate, which is an arch of muscle going into the throat. The soft palate lifts to close off the passageways to the nose so food does not go through the nose on swallowing.

    Under the tongue and near the upper back teeth are salivary ducts that release spit (saliva) into the mouth. The ducts are joined to salivary glands where saliva is made. The major glands are in front of the ears, and beneath the jaw and tongue. There are hundreds of minor glands in the lining of the mouth.

    Throat (pharynx)

    The pharynx is a tube that runs from the back of the nose to the gullet (oesophagus) and the windpipe (trachea). The pharynx has three parts: the nasopharynx, oropharynx (including the tonsils) and hypopharynx.

    Only air passes through the nasopharynx as you breathe in and out. Both food and air pass through the oropharynx and hypopharynx. Food is directed into the oesophagus and goes into the stomach, while air goes into the trachea to get to the lungs.

    The voice box (larynx)

    The larynx is a short passageway that connects the lower part of the pharynx (hypopharynx) with the windpipe (trachea). It contains the vocal folds or vocal cords (glottis), which vibrate when air passes through them to produce sound.

    Above the vocal folds is a small flap of tissue called the epiglottis, which prevents food going into the trachea when you swallow.

    Below the vocal folds is the subglottis. Under the voice box, in front of the trachea, is the thyroid gland.

    Nasal cavity and paranasal sinuses
    The nasal cavity is the large, air-filled space behind the nose. The nose and upper respiratory tract warm, moisten and filter the air that you breathe. Paranasal sinuses are air-filled spaces within your skull that help to lighten the weight of your head. They also produce mucus and vibrate sound when you speak or sing. The sinuses are in four locations: frontal, ethmoid, sphenoid and maxillary.

    What are head and neck cancers?

    These cancers occur when malignant tumours grow in any of the tissue in the head or neck. Not all tumours in the head and neck are malignant but benign and malignant tumours are treated in a similar way.

    Mouth or oral cancer includes cancer that starts anywhere in the mouth, such as the lips, inside cheeks, the front two-thirds of the tongue and the gums.

    Salivary gland cancer can occur in any of the paired major glands in front of the ears or beneath the jaw or tongue.

    Pharyngeal cancer defines cancers in the pharynx (throat): nasopharyngeal, oropharyngeal and hypopharyngeal cancers.

    Laryngeal cancer starts in the larynx (voice box).

    Nasal cancer or paranasal sinus cancer includes cancers starting in the nose, nasal cavity or the sinuses.

    Other cancers in the head and neck area
    Cancer can start in the tissue of the brain, eye, oesophagus, thyroid gland, skin and scalp. It can also start in the bone or muscle of the head and neck. This is not classified as head and neck cancer.

    The types of cells affected
    Most head and neck cancers start in the cells that line the mouth, nose or throat (squamous cells). This is called squamous cell carcinoma. Some cancers start in glandular cells. Many of these are called adenocarcinomas but other rarer types can occur.

    Causes and risk factors

    Smoking is the biggest known risk factor for developing most types of head and neck cancer except for salivary gland cancer. Other risk factors include alcohol, being a man, aged over 50, race, inhaling certain chemicals, exposure to Human Papillomavirus (HPV), red or white patches in your mouth and sun exposure. Statistics show smoking and drinking rates are higher in men than in women. This is probably a reason why head and neck cancer is more common in men. 

    Having one or more of these risk factors does not mean you will get a head and neck cancer or that it is definitely the cause of the cancer. Talk to your doctor if you are concerned about any of these risk factors.

    Tobacco or marijuana use

    Smoking cigarettes or pipes, using chewing tobacco and dipping snuff causes about 85 per cent of head and neck cancers.

    Alcohol use

    A person’s risk increases with the amount of alcohol consumed. Using both tobacco and alcohol further increases the risk.

    Age                                          

    Head and neck cancer is most common in people aged 50 and older.

    Gender                                    

    Men are about three times more likely than women to get head and neck cancer.

    Race                                        

    People from some cultural backgrounds may be more likely to develop certain types of head and neck cancer. For example, people from southern China and South-East Asia may have an increased risk of nasopharyngeal cancer.

    Inhalation of certain chemicals or dusts Breathing in sulphuric acid mist, asbestos fibres, dry-cleaning solvents or certain types of paint or nickel may increase the risk.
    Sun exposure

    Ultraviolet (UV) radiation may cause lip cancer, and is the biggest cause of skin cancer in the head and neck.

    White or red patches

    Having white (leukoplakia) or red (erythroplakia) patches in your mouth may lead to oral cancer.

    Chewing areca nut

    Chewing this type of palm tree seed – also known as betel nut or paan – often wrapped in leaves, may cause oral cancer.

    Human papillomavirus (HPV) HPV may be associated with some cancers of the oropharynx. This may be related to oral sex, which transmits the virus.

    Symptoms

    There are different symptoms depending on which area of the head or neck are affected.

    Oral cancer

    • Mouth pain or pain on swallowing
    • A sore or swelling in your mouth or jaw that doesn’t go away
    • White patches (leukoplakia) or red patches (erythroplakia) on your gums, tongue or mouth
    • Changes in speech or difficulty pronouncing words
    • Difficulty chewing or swallowing food
    • A lump in your neck
    • Loose teeth or dentures that no longer fit.

    Salivary gland cancer

    • Swelling or numbness on one side of the face or under the jaw
    • Different appearance on each side of the face or neck
    • Difficulty swallowing
    • Drooping or muscle weakness on one side of the face (palsy).

    Pharyngeal cancer

    • Throat pain
    • A persistent sore throat or cough
    • Coughing up bloody phlegm
    • Voice changes or hoarseness
    • Dull pain around the breastbone
    • Difficulty swallowing
    • A lump in the neck
    • An earache
    • Feeling that your air supply is blocked
    • Numbness of the face.

    Laryngeal cancer

    • Swelling in the neck or throat
    • A persistent sore throat
    • A change in the sound of your voice or hoarseness
    • Difficulty swallowing or painful swallowing
    • A lump in the neck.

    Nasal or paranasal sinus cancer

    • Decreased sense of smell
    • A persistent blocked nose, particularly in one nostril
    • Nosebleeds
    • Mucous drainage in the back of your nose or throat
    • Frequent headaches or sinus pressure
    • Difficulty swallowing
    • Loose or painful teeth
    • A lump on/in your face, nose or mouth
    • Numbness of the face or within the mouth
    • Pressure or pain in your ears
    • A bulging or watery eye, double vision or complete or partial loss of eyesight.

    Information reviewed by:  Dr Tim Iseli, ENT Surgeon, Royal Melbourne Hospital; Katrina Blyth, Senior Speech Pathologist, Royal Prince Alfred Hospital, NSW; Dr David Boadle, Staff Specialist, Medical Oncology, Royal Hobart Hospital; Geoffrey Booth, Consumer; Teresa Brown, Team Leader, Royal Brisbane and Women’s Hospital; Marty Doyle, Co-founder and Facilitator, Head and Neck Cancer Support Group, Brisbane; Dr Peter Foltyn, Dental Department, St Vincent’s Hospital, NSW; Noelene Hunt, Consumer; Dr Michael Jackson, Director, Radiation Oncology Department, Prince of Wales Hospital, NSW; Len McDowall, Consumer; and Cancer Council SA Helpline Consultant.

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