Head & Neck Cancer: Comprehensive Overview
Overview
Head and neck cancers (HNC) include malignancies of the **oral cavity, oropharynx (tonsil/base of tongue), hypopharynx, larynx**, **nasopharynx**, **salivary glands**, and **paranasal sinuses/sinonasal tract**. Most are **squamous cell carcinomas (HNSCC)** arising from the mucosal epithelium; others include adenocarcinomas (salivary), lymphomas, and sarcomas. Etiology varies by subsite: **tobacco/betel quid** and alcohol drive many HNSCCs; **HPV** (p16+) drives oropharyngeal cancers; **EBV** is linked to nasopharyngeal carcinoma.
Head and neck cancers (HNC) include malignancies of the **oral cavity, oropharynx (tonsil/base of tongue), hypopharynx, larynx**, **nasopharynx**, **salivary glands**, and **paranasal sinuses/sinonasal tract**. Most are **squamous cell carcinomas (HNSCC)** arising from the mucosal epithelium; others include adenocarcinomas (salivary), lymphomas, and sarcomas. Etiology varies by subsite: **tobacco/betel quid** and alcohol drive many HNSCCs; **HPV** (p16+) drives oropharyngeal cancers; **EBV** is linked to nasopharyngeal carcinoma
Causes & Risk Factors
Known Causes
Malignant transformation is driven by genetic/epigenetic changes from chronic exposures and oncogenic infections: - **Tobacco** smoke/chew and **alcohol** (synergistic) - **Betel quid/areca nut** chewing (common in South/Southeast Asia) - **Human papillomavirus (HPV-16)** for oropharyngeal SCC (p16+) - **Epstein–Barr virus (EBV)** for nasopharyngeal carcinoma - Occupational exposures (wood dust, nickel, chromium) and chronic irritation - Poor oral hygiene, chronic inflammation; prior radiation - Genetic susceptibility
Risk Factors
Symptoms & Early Signs
Early Warning Signs
Often subtle or absent; red flags include: - Non-healing mouth ulcer >3 weeks - Persistent sore throat, unilateral ear pain (referred otalgia) - Hoarseness >3 weeks (larynx) - Progressive difficulty swallowing (dysphagia) or painful swallowing (odynophagia) - Nasal obstruction/epistaxis (sinonasal) - Neck mass (cervical lymphadenopathy) - Unexplained weight loss, fatigue
Common Symptoms
Diagnosis
- **Detailed head & neck examination** with mirror/fiberoptic nasopharyngolaryngoscopy - **Imaging**: Contrast-enhanced **CT** and/or **MRI** of head/neck; **PET-CT** for staging in advanced disease - **Biopsy** of primary lesion and/or fine-needle aspiration (FNA) of neck node - **Pathology & biomarkers**: p16 IHC (HPV surrogate) for oropharynx; EBV-encoded RNA (EBER) in situ hybridization for nasopharynx - **Dental evaluation** and nutrition assessment pre-therapy - **Baseline labs**; audiometry if cisplatin planned
Staging Information
AJCC **TNM** staging is site-specific. - **Oropharynx** has distinct staging for **p16/HPV-positive** vs HPV-negative disease (HPV+ generally downstaged due to better prognosis). - **Nasopharynx**: Nodal disease is common (retropharyngeal, cervical nodes); EBV DNA load may aid prognosis. - **Larynx/Hypopharynx/Oral cavity**: T stage based on size and depth/invasion; N stage on nodal number/size/extranodal extension; M0/M1 for metastasis. Grouped stages: **I–II (early)**, **III–IVA (locally advanced)**, **IVB–IVC (advanced/metastatic)**.
Treatment Information
Treatment Overview
Multidisciplinary, aiming for cure with organ function preservation when possible. - **Early-stage (I–II)**: Single-modality **surgery** (transoral laser/TORS) or **radiotherapy** (IMRT). - **Locally advanced (III–IVA)**: **Concurrent chemoradiotherapy** (cisplatin-based) or **surgery** (resection + neck dissection) followed by **adjuvant RT/CRT** for high-risk features (positive margins, extranodal extension). - **Nasopharynx**: Definitive **IMRT + concurrent cisplatin**, ± adjuvant chemotherapy. - **Larynx preservation**: Organ-preserving **CRT** for selected T3; total laryngectomy for non-responders or T4. - **Systemic therapy (recurrent/metastatic)**: - **Immunotherapy**: PD-1 inhibitors (**pembrolizumab**, **nivolumab**) ± chemotherapy (KEYNOTE-048) for platinum-sensitive/naïve settings. - **Targeted therapy**: **Cetuximab** (anti-EGFR) with RT in select cases or with chemo in R/M disease. - Cytotoxic regimens: platinum/5-FU, taxanes. - **Re-irradiation**: Selected recurrent cases at specialized centers. - **Supportive & rehab**: Speech/swallow therapy, dental care (fluoride trays), nutritional support (PEG when needed), pain control, lymphedema therapy, tracheostomy/stoma care.
5-Year Survival Rate
N/A
Available Treatments
0
Treatment Options
Prognosis & Outlook
Prognosis varies by subsite, stage, HPV/EBV status, and treatment. - **HPV-positive oropharyngeal** cancer has significantly better outcomes than HPV-negative. - Early-stage disease is highly curable; advanced disease may be controlled with multimodality therapy. - Recurrent/metastatic HNSCC prognosis has improved with **PD-1 inhibitors**, though long-term remission remains uncommon.
Prevention & Early Detection
- **Avoid tobacco** (smoked and smokeless) and **limit alcohol**. - **Eliminate betel quid/areca nut** use. - **HPV vaccination** (both sexes) to reduce HPV-driven oropharyngeal cancer. - **Maintain oral hygiene**, regular dental check-ups; promptly evaluate non-healing oral lesions. - **Protective equipment** to limit occupational exposures (wood dust, fumes). - **Sun protection** for lip cancers (UV exposure).
Support & Resources
- **Healthcare team**: ENT/head & neck surgeons, medical and radiation oncologists, dentists, speech/swallow therapists, dietitians, palliative care. - **Patient support**: Head and Neck Cancer Alliance, Macmillan Cancer Support, CancerCare, local hospital groups. - **Rehabilitation**: Speech-language therapy, nutritional rehab, lymphedema and shoulder rehab post-neck dissection, stoma care training. - **Psychosocial/financial**: Social workers, counseling, survivorship programs, return-to-work services.
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