Head and neck cancer

What is head and neck cancer?

Head and neck cancers occur inside the sinuses, nose, mouth and salivary glands down through the throat. Although these cancers are different, they are treated similarly, so are considered as a group.

In 2015, 4633 head and neck cancers were diagnosed in Australia. These figures include cancers of the tongue, gum, mouth, salivary glands, tonsils, pharynx, nasal cavity and larynx, but not cancers of the lip.

In 2016, there were 1080 deaths in Australia due to head and neck cancers.

The five year survival rate is approximately 71%.

Head and neck cancer symptoms

Symptoms depend on the site of the cancer, however you may have one or more of the following symptoms:

• pain
• swelling
• hoarse voice
• difficulty swallowing
• bad breath.

Causes of head and neck cancer

There are a number of risk factors associated with head and neck cancers. The main risk factors are alcohol consumption and tobacco. Risk factors include:

• viruses including the human papillomavirus (HPV) and the Epstein-Barr virus have been linked to head and neck cancers
• age - head and neck cancer is more common in people over 40 years old
• gender - men are three times more likely than women in Australia to develop head and neck cancer
• oral hygiene - poor oral health including gum disease have been linked to cancers of the oral cavity
• exposure to work-related chemicals such as asbestos, dry-cleaning solvents or certain types of paint
• a weakened immunity
• smoking tobacco
• smoking or chewing betel nut, areca nut, gutka or pan
• drinking alcohol
• being from southern China or South-East Asia due to cultural practices such as chewing tobacco or eating salty foods
• sun exposure (skin cancer of the lip)

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Diagnosis for head and neck cancer

Your doctor will physically examine your neck, ears, eyes, nose, mouth or thrat, depending on your symptoms. Other tests will use an endoscope, needle or surgery to take a biopsy.

Treatment for head and neck cancer

The definitive treatment for local disease is surgery to the primary lump and draining the lymph glands. Full dose radiotherapy may be used in sites where functions such as speech can be preserved. Radiotherapy can be given in sequence with chemotherapy (commonly cisplatin, 5 fluorouracil or the taxanes) for more advanced cancer and both can be used for symptom relief with widespread disease.

Immunotherapy , a type of treatment that uses your body’s own immune system to fight cancer, may be used to treat head and neck cancers. 

Treatment for head and neck cancers can affect your teeth, gums and mouth. Some preparations before treatment begins may include: 

• Seeing a dentist 
• Consulting a dietitian to help improve your diet and nutrition as you may lose a lot of weight
• Beginning an exercise program to help build up your strength
• Quitting smoking as you may not respond to treatment as well as someone who doesn’t smoke

Staging

Based on the results of the tests, your doctor will tell you the stage of the cancer. The extent of the tumour is defined by the size of the lump and whether there is spread to lymph nodes or further to the lungs or bones. CT, MRI, bone and PET scans are used. Visual examination using an endoscope may be required.

Treatment team

If you are diagnosed with a head or neck cancer, your treatment team may consist of a number of health professionals including:

• a GP who will arrange for initial tests and may refer to other specialists
• an ear, nose and throat specialist
• a head and neck surgeon
• an oral surgeon who specialises in surgery to the face
• a medical oncologist who coordinates chemotherapy
• a radiation oncologist who coordinates radiotherapy
• a dentist
• a cancer nurse
• other health professionals such as speech pathologist, occupational therapist, counsellor and dietitian.

Palliative care

In some cases of head and neck cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of head and neck cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

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Screening for head and neck cancer

There is currently no screening for head and neck cancer available in Australia.

White plaques or patches in the mouth (leukoplakia) may precede the development of the cancer.

Prognosis for head and neck cancer

Prognosis means the expected outcome of a disease. An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis.

Preventing head and neck cancer

The risk of head and neck cancers can be reduced by not smoking (or quitting) and reducing alcohol consumption.

Source

Understanding Head and Neck Cancers, Cancer Council Australia,  © 2019. Last medical review of source booklet: September 2019.

Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.

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