About head and neck cancers

What are head and neck cancers?

Head and neck cancer is a general term for a range of cancers that start in the head and neck area. About 9 out of 10 head and neck cancers start in the moist lining of the mouth, nose or throat. The lining is called the squamous epithelium, and these cancers are called mucosal squamous cell carcinomas (SCCs). Some head and neck cancers start in glandular cells, and many of these cancers are called adenocarcinomas. SCCs and adenocarcinomas can also occur in other parts of the body.

Non-melanoma skin cancers may also be called head and neck cancers when they start in this part of the body.

The first sign of many cancers is often a lump under the skin of the neck or cheek. This can happen when cancer has spread to a lymph node. Your doctors will run tests to work out what type of cancer it is. It might be a head and neck cancer or it might be a cancer that has spread from elsewhere in the body. For example, stomach cancer can spread to a lymph node in the neck and will still be considered stomach cancer.

Occasionally, tests show that a cancer in the head and neck started in another part of the body, but it is unclear where it started. This is called cancer of unknown primary (CUP).

How common are head and neck cancers?

It’s estimated that almost 5600 Australians are diagnosed with a head and neck cancer each year (not including skin cancers).

Head and neck cancers are more common after the age of 40. Women make up about 25% of cases of head and neck cancer, and men about 75% of cases. This is mainly due to men having higher smoking and drinking rates. However, the rate of oral cancer in females who don’t smoke tobacco is increasing.

The head and neck

In cancer medicine, the region called “head and neck” includes the:

• mouth – made up of the lips and the structures inside the oral cavity, including the tongue, roof of the mouth (the palate), jaw and gums
• throat – known as the pharynx
• voice box – known as the larynx
• nose – made up of the nasal cavity, which is the area inside and behind the nose, and the sinuses
• salivary glands – in the floor of the mouth, near the lower jaw and in front of the ear
• the skin – on the head and neck.

The thyroid is a hormone-producing gland found at the front of the neck and just below the voice box. Thyroid cancer has a different cause and is managed differently to most head and neck cancers.

Areas that are not considered part of the head and neck in cancer medicine include the brain, eyes, oesophagus (the food pipe), trachea (the windpipe), and the bones and muscles of the head and neck. These areas may still develop cancer, and they can also be affected by nearby head and neck cancers and their treatment.

Lymph nodes in the head and neck

The whole body, including the head and neck, contains many lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body. They form part of the lymphatic system, which helps protect the body against disease and infection. When cancer spreads, it usually spreads to nearby lymph nodes first.

Anatomy of the head and neck

Types of head and neck cancers

Mouth (lip and oral cavity) cancers

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Cancer that starts in the mouth is known as oral cancer. The mouth is made up of the lips and the oral cavity. The oral cavity includes the:

• gums
• lining of the cheeks and lips
• front two-thirds of the tongue (oral or mobile tongue)
• floor of the mouth (under the tongue at the front of the mouth)
• bony roof of the mouth (hard palate)
• small area behind the wisdom teeth (retromolar trigone).

The area at the back of the mouth is called the oropharynx. It includes the base of the tongue, the tonsils, the uvula and the soft palate, as well as the middle section of the throat. Cancer of the oropharynx is known as oropharyngeal cancer.

Oral cavity

Throat (pharyngeal) cancers

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The throat, also called the pharynx, is a hollow tube that starts behind the nose and leads to the food pipe (oesophagus) and the windpipe (trachea).

The pharynx has 3 main parts:

• nasopharynx – the upper part behind the nose and above the soft palate; cancer starting in this area is called nasopharyngeal cancer
• oropharynx – the middle part, the area from the soft palate and base of the tongue to the back of the mouth, including the tonsils; cancer starting in this area is called oropharyngeal cancer
• hypopharynx – the lower part, around the voice box (larynx); cancer starting in this area is called hypopharyngeal cancer.

Cancers in the 3 parts of the pharynx behave differently and are treated differently.

Pharynx

Voice box (laryngeal) cancers

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The voice box, also called the larynx, is the entry point to the windpipe (trachea). It contains the vocal cords and protects the lungs. Cancer that starts in the larynx is called laryngeal cancer.

The larynx has 3 main parts:

• supraglottis – the area above the vocal cords; includes the epiglottis, a small flap of tissue that covers the larynx when you swallow and prevents food and fluids going into the trachea and lungs
• glottis – the area containing the vocal cords, which vibrate when air passes through them to produce the sound of your voice
• subglottis – the area below the vocal cords leading to the trachea.

The thyroid gland sits in front of the trachea under the voice box. It may be treated by a head and neck doctor.

Larynx

Nose (nasal cavity and sinus) cancers

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The nasal cavity is the large, hollow space behind the nose. It is separated into 2 main cavities by the nasal septum, a thin wall of bone and cartilage in the centre of the nose.

The paranasal sinuses are small, air-filled spaces in the side walls of the nose. They help to warm and moisten air passing to the lungs. They also influence the sound and tone of your voice. There are 4 pairs of paranasal sinuses:

• maxillary sinuses – under the eyes and in the cheek area
• frontal sinuses – behind the forehead
• ethmoid sinuses – above the nose and between the eyes
• sphenoid sinuses – behind the nose and between the eyes.

Cancer that starts in the upper part of the throat behind the nose is called nasopharyngeal cancer nasopharyngeal cancer.

Nasal cavity and sinuses

Salivary gland cancers

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The salivary glands make the watery substance known as saliva. This keeps the mouth moist to help with swallowing and talking, and helps protect the mouth and teeth.

There are 3 pairs of major salivary glands:

• parotid glands – in front of the ears
• submandibular glands – under the lower jaw
• sublingual glands – under the tongue.

There are also hundreds of smaller glands throughout the lining of the mouth, nose and throat. These are known as the minor salivary glands.

Cancers can start in the major or minor salivary glands. When cancer is found in one of the parotid glands, it may have spread from a skin cancer on the head or neck.

Salivary glands

Health professionals you may see

Your GP will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist, who will arrange further tests. If head and neck cancer is diagnosed, the specialist will consider treatment options. Usually these will be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting.

Guides to Best Cancer Care

An overview of what you can expect and what is recommended at every stage of head and neck cancer care.

During and after your treatment, you will see a range of health professionals who specialise in different aspects of your care. It’s recommended that complex head and neck cancer is treated in a specialist centre. If you have to travel a long way for treatment, transport and accommodation assistance may be available to you. Call Cancer Connect on 13 11 20 for details.

• ENT (ear, nose and throat) specialist – treats disorders of the ear, nose and throat
• head and neck surgeon – diagnoses and treats cancers of the head and neck; may be an ENT, general, plastic, or oral and maxillofacial surgeon
• oral (maxillofacial) surgeon – performs surgery and treats disorders of the mouth, face and jaws
• reconstructive (plastic) surgeon – performs surgery that restores, repairs or reconstructs 
  the body’s appearance and function
• oral medicine specialist – evaluates and treats the mouth, face, jaw and salivary glands, which can be affected by cancer treatment
• medical oncologist – treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (systemic treatment)
• cancer care coordinator – coordinates your care, liaises with MDT members, and 
  supports you throughout treatment
• radiation oncologist – prescribes and oversees a course of radiation therapy
• radiation therapist – plans and delivers radiation therapy
• radiologist – analyses and interprets diagnostic scans
• nurse, clinical nurse consultant/specialist – administer drugs and provides care, information and support throughout treatment
• speech pathologist – evaluates and treats communication, voice and swallowing difficulties during and after treatment
• dietitian – helps with nutrition concerns and recommends changes to diet during treatment and recovery
• social worker – links you and your family to support services and helps with emotional, practical and financial issues
• Aboriginal and Torres Strait Islander liaison officer – supports Aboriginal and Torres Strait Islander people and their families during treatment and recovery
• physiotherapist, exercise physiologist – help restore movement and mobility; improve fitness and wellbeing; physiotherapists also help with breathing and airway clearance and managing lymphoedema
• occupational therapist – assists in adapting your living and working environment to help you resume usual activities after treatment
• psychologist – helps you manage your emotional response to cancer
• dentist – evaluates and treats teeth when affected by treatment
• pharmacist – dispenses and gives advice about medicines and drugs.