Head and Neck Cancer Awareness

News

Risk Factors

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, smoking is a risk factor for many cancers including cancer of the lung. Exposing skin to strong sunlight is a risk factor for skin cancer.

But risk factors don't tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease. And many people who get the disease may not have had any known risk factors.

Laryngeal and hypopharyngeal cancers are often grouped together with other cancers of the mouth and throat into a group known as head and neck cancers. These cancers have many of the same risk factors, many of which are included below.

Tobacco and alcohol:
Tobacco use is the most important risk factor for head and neck cancers. The risk of developing cancer in these areas is much higher in smokers than in nonsmokers. These cancers are rare in people who have never smoked. Most people with these cancers have a history of smoking or other tobacco exposure. The more you smoke, the greater the risk. Smoke from cigarettes, pipes, and cigars all increase the chance of getting these cancers. Chewing tobacco also increases the risk of mouth (oral cavity) cancer.

Drinking alcohol
Heavy drinkers have a risk that is several times that of nondrinkers.

People who use both tobacco and alcohol have the highest risk of all. Combining these 2 habits doesn't just add both risks together, it actually multiplies them. Some reports have found that people who smoke and drink are up to 100 times more likely to get head and neck cancer than are people with neither habit.

Nutrition:
Poor nutrition may increase the risk of getting head and neck cancer. Vitamin deficiencies often occur in those who abuse alcohol and may be partly responsible for alcohol's role in increased risk of these cancers.

Human papilloma virus:
The human papilloma virus (HPV) is a group of over 100 related viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma, which is more commonly known as a wart. Some types of HPV can cause cancers of the cervix, vagina, anus, vulva, or penis. HPV also seems to be a factor in some cases of throat cancer, such as cancer of the tonsils and cancers of the hypopharynx. It does not seem to be a factor in laryngeal cancer.

Weakened immune system:
Head and neck cancers are more common in people who have a weak immune system. A weak immune system can be caused by certain diseases present at birth, the acquired immunodeficiency syndrome (AIDS), and certain medicines (such as those given after bone marrow and organ transplant).

Genetic syndromes:
People with certain syndromes caused by inherited defects in certain genes have a very high risk of throat cancer, including cancer of the hypopharynx.

Workplace exposures:
Long and intense exposures to wood dust, paint fumes, and certain chemicals used in the metalworking, petroleum, plastics, and textile industries can also increase the risk of head and neck cancers.

Gender:
Cancers of the head and neck are about 4 times more common in men than women. This is because the 2 main risk factors -- smoking and alcohol abuse -- are more common in men. In recent years, however, as these habits have become more common among women, their risks for these cancers have increased as well.

Age:
Cancers of the head and neck usually take many years to develop, so they are not common in young people. Over half of patients with these cancers are older than 65 when the cancers are first found.

Race:
Cancers of the head and neck are more common among African Americans and whites than among Asians and Latinos.

Gastroesophageal reflux disease:
When acid from the stomach comes up into the esophagus it is called gastroesophageal reflux disease (or GERD). GERD can cause heartburn and increase the chance of cancer of the esophagus. Whether or not it increases the risk of laryngeal and hypopharyngeal cancers is currently under study.

Source: American Cancer Society: What are the risk factors for laryngeal and hypopharyngeal cancers?.

Symptoms

What are signs and symptoms?

A sign is also a signal that something is not right in the body. But signs are signals that can be seen by someone else -- maybe a loved one, or a doctor, nurse, or other health care professional. Fever, fast breathing, and abnormal lung sounds heard through a stethoscope may be signs of pneumonia.

A symptom is a signal of disease, illness, injury, or that something is not right in the body. Symptoms are felt or noticed by the person who has them.

What are common symptoms of head and neck cancers?

The signs and symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing, and a change or hoarseness in the voice. These symptoms may also be caused by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms. Other symptoms may include the following:

• Oral cavity.
  A white or red patch on the gums, tongue, or lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.
• Nasal cavity and sinuses.
  Sinuses that are blocked and do not clear, chronic sinus infections that do not respond to treatment with antibiotics, bleeding through the nose, frequent headaches, swelling or other trouble with the eyes, pain in the upper teeth, or problems with dentures.
• Salivary glands.
  Swelling under the chin or around the jawbone; numbness or paralysis of the muscles in the face; or pain that does not go away in the face, chin, or neck.
• Pharyngeal.
  Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.
• Laryngeal.
  Trouble breathing or speaking, frequent headaches, pain or ringing in the ears, or trouble hearing.
• Larynx.
  Pain when swallowing, or ear pain.

These symptoms may be caused by cancer or by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms.

Source: National Cancer Institute (NCI): Head and Neck Cancer information webpage

Screening

There is no simple screening procedure to diagnose these cancers early. They are difficult to diagnose and require complex procedures. Because the cancers are not common, and the tests require specialized doctors, neither the American Cancer Society nor any other group recommends screening for these cancers.

Talk to your doctor if you have any of these symptoms (as described in the "Symptoms" section). Many of these signs and symptoms may be caused by other cancers or by less serious, benign (non-cancerous) problems.

For a complete evaluation, a person may need to be referred to an ear, nose, and throat (ENT) specialist. These doctors are also known as otolaryngologists or as head and neck surgeons.

The specialist will also examine the larynx and hypopharynx (known as laryngoscopy). It can be done in 2 ways:

Direct (flexible) laryngoscopy:
For this exam, the doctor inserts a fiber-opticlaryngoscope - a thin, flexible, lighted tube - through the mouth or nose to look at the larynx and nearby areas.

Indirect laryngoscopy:
In this exam, the doctor uses special small mirrors to view the larynx and nearby areas.

Both types of exams can be done in the doctor's office. For either type of exam, the doctor may spray the back of your throat with numbing medicine to help make the exam easier.

Some exams and tests that may be useful are described below:

• Medical history and physical examination:
  The first step in any medical evaluation is for your doctor to gather information about your symptoms, risk factors, family history, and other medical conditions . A thorough physical exam can help uncover any signs of possible cancer or other diseases. In particular, your doctor will pay close attention to your head and neck, looking for abnormal areas in your mouth or throat, as well as enlarged lymph nodes in your neck.
• Panendoscopy:
  Panendoscopy is a procedure that combines laryngoscopy, esophagoscopy, and (at times) bronchoscopy. This lets the doctor thoroughly examine the entire area around the larynx and hypopharynx, including the esophagus and trachea (windpipe).
• Laboratory tests examine samples of blood, urine, or other substances from the body. Other types of tests may be done as part of a workup if a patient has been diagnosed with laryngeal or hypopharyngeal cancer. These tests are not used to diagnose the cancer, but they may be done to see if a person is healthy enough for other treatments, such as surgery or chemotherapy.
• Chest x-ray:
  A chest x-ray may be done to see if laryngeal or hypopharyngeal cancer has spread to the lungs.
• CT (or CAT) scan is a series of detailed pictures of areas inside the head and neck created by a computer linked to an x-ray machine.
• Magnetic resonance imaging (or MRI) uses a powerful magnet linked to a computer to create detailed pictures of areas inside the head and neck. MRI scans use radio waves and strong magnets instead of x-rays.
• PET scan uses sugar that is modified in a specific way so it is absorbed by cancer cells and appears as dark areas on the scan.
• Biopsy is the removal of tissue. A pathologist studies the tissue under a microscope to make a diagnosis. A biopsy is the only sure way to tell whether a person has cancer. The doctor may order an Endoscopic biopsy or a Fine needle aspiration (FNA) biopsy.

Source: American Cancer Society: Laryngeal and Hypopharyngeal Cancer [PDF].

Prevention

Different ways to prevent cancer are being studied, including:

• Changing lifestyle or eating habits.
• Avoiding things known to cause cancer.
• Taking medicines to treat a precancerous condition or to keep cancer from starting.

Source: NCI Prevention and Cessation of Cigarette Smoking: Control of Tobacco Use

U-M Comprehensive Cancer Center Prevention Resources

• Reducing Head and Neck Cancer Risk
• Smoking
• Breaking the Habits that are Beating Us

National Prevention Resources

Smokefree.gov

American Cancer Society:

• Great American Smokeout
• Tobacco and Cancer

Take Action

Multidisciplinary Head and Neck Oncology Clinic

Head and Neck SPORE Program

Stem Cells in Head and Neck Cancer

University of Michigan Clinical Trials

Attend a Throat Cancer Screening. Find a screening near you courtesy of the Head and Neck Cancer Alliance web site's screening web page.

Resources

National Cancer Institute

• Larnygeal Cancer General Information
  Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx.
• Lip and Oral Cavity General Information
  Most lip and oral cavity cancers start in squamous cells, the thin, flat cells that line the lips and oral cavity. These are called squamous cell carcinomas.
• Head and Neck Cancer General Information
• Oropharnygeal General Information
  Oropharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the oropharynx
• Metastatic Squamous Neck Cancer with Occult Primary General Information
  Metastatic squamous neck cancer with occult primary is a disease in which squamous cell cancer spreads to lymph nodes in the neck and it is not known where the cancer first formed in the body.

National Cancer Institute

• Laryngeal and Hypopharnygeal Cancers
  Cancers that start in the larynx are called laryngeal cancers; cancers of the hypopharynx are called hypopharyngeal cancers.
• Oral Cavity and Oropharyngeal Cancer Oral cancer starts in the mouth, also called the oral cavity. The oral cavity includes the lips, the inside lining of the lips and cheeks, the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth below the tongue, the bony roof of the mouth, and the area behind the wisdom teeth.

Head and Neck Cancer Alliance

Medline Plus: Head and Neck Cancer

ASCO Cancer Foundation - Cancer.net: Head and Neck Cancer Information

Web Whispers

Support for People with Oral and Head and Neck cancer (SPOHNC) is a self-help nonprofit organization involved in the development of programs of support.

The American Head and Neck Society