Head and neck cancer
Head and neck cancer
What is head and neck cancer?
Head and neck cancer is a general term for a group of different cancers that all start in this same part of the body. They begin in the tissues of the head and neck area, for example in:
- the mouth, which includes the tongue, palate, gums and lips
- the throat (the pharynx), which is divided into the nasopharynx, oropharynx and hypopharynx
- the nose and sinuses, the air filled spaces in the bones of the face
- the salivary glands, which make saliva
- the middle ear, which contains the ear
Around 12,200 people are diagnosed with head and neck cancer in the UK each year, and this figure includes cancer of the larynx (voicebox). In the UK, head and neck cancer is the 4th most common cancer in men.
Macmillan Cancer Support has separate information about cancer of the larynx.
Because there are so many different types, it helps to know exactly which type of head and neck cancer you have, so you can be sure you're reading the right information. If you're ever unsure, it's completely fine to ask your cancer doctor or specialist nurse to explain it to you.
Some other cancers can also develop in the head and neck area, but they are treated as separate conditions and are not classed as head and neck cancers. These include:
- thyroid cancer
- oesophageal cancer
- brain tumours
- tracheal cancer
Types of head and neck cancer
Head and neck cancers are usually named after the exact area where they start, and the type of cell they develop from.
The most common type is squamous cell carcinoma. About 9 out of 10 head and neck cancers, that is 90%, start in squamous cells. These are the cells that line the surfaces inside the head and neck, such as the mouth, nose and throat.
The place head and neck cancer most often spreads to is the lymph nodes in the neck, which can show up as a swollen lymph node. Lymph nodes are part of the lymphatic system, which normally helps protect your body from infection and disease.
Mouth cancer (oral cancer)
Mouth cancer is one of the most common places for head and neck cancer to start. It can develop almost anywhere in the mouth, including:
- on the lip
- inside the cheek
- the gums
- the front part of the tongue
- the floor or roof of the mouth
Tongue cancer
The tongue is made up of 2 parts, and cancer can develop in either one. If it develops in the front part, the part you can see, it's usually called mouth cancer.
The back part of the tongue sits at the base, close to the throat (pharynx). Cancer that develops there is called oropharyngeal cancer instead.
Macmillan Cancer Support has more information about tongue cancer.
Nasopharynx cancer
Nasopharyngeal cancer starts in the upper throat area behind the nose, known as the nasopharynx. This is the passage that allows air to travel from the nose, through the rest of the throat, and down into the lungs.
Often, the very first sign someone notices is a painless swelling or lump in the upper neck.
Oropharyngeal cancer
Oropharyngeal cancers start in the middle part of the pharynx, just behind the mouth, an area called the oropharynx. This is the passageway that air moves through, and it's also where swallowed food passes on its way down. It contains muscles that help push food from the mouth toward the gullet (oesophagus).
The oropharynx includes:
- the soft part of the roof of the mouth (soft palate)
- the base or back of the tongue, the part you cannot see
- the tonsils and the side walls of the throat
Most oropharyngeal cancers develop on the tonsils or at the base of the tongue.
Hypopharyngeal cancer
These cancers begin in the lower part of the pharynx, just behind the voice box (larynx), in an area called the hypopharynx. It contains muscles that move food onward into the gullet (oesophagus), which it connects to, and air also passes along it on the way to the airways and lungs. Cancer here is sometimes treated in much the same way as laryngeal cancer.
Cancer of the larynx (voice box)
The larynx is your voice box, a short passageway sitting just in front of the hypopharynx, and it contains your vocal cords. You can find out more about laryngeal cancer and its treatment separately.
Cancer of the nose and sinuses (paranasal sinuses)
The space inside the nose is called the nasal cavity. The bones surrounding it contain small, hollow spaces known as the paranasal sinuses, which also play a part in shaping the sound and tone of your voice.
The most common symptoms of nasal and sinus cancer are a blocked nose that doesn't clear up, usually only on 1 side, and nosebleeds.
Cancer of the salivary glands
The salivary glands produce saliva, or spit. The largest pair, the parotid glands, sit at the sides of the mouth, just in front of the ears, and this is the most common site for salivary gland cancer to develop. Growths in the salivary glands are sometimes non-cancerous (benign), but some are cancer.
Cancer of the middle ear
It's rare, but cancer can sometimes develop in the middle ear. The middle ear is made up of the eardrum and a cavity called the tympanum, which holds 3 small bones connecting the eardrum to the inner ear. It also links to the nasopharynx through the eustachian tube.
To help you find your way around this topic, this information is organised into these sections: what head and neck cancer is, types of head and neck cancer, symptoms of head and neck cancer, what causes head and neck cancer, diagnosing head and neck cancer, staging and grading of head and neck cancer, treatment for head and neck cancer, and life after head and neck cancer treatment.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
What causes head and neck cancer?
The main risk factors for head and neck cancer are tobacco and alcohol, especially when combined. Risks are associated with all types of tobacco use, including chewing tobacco, not just smoking.
Head and neck cancer is also much more common in men than in women.
Certain risk factors depend on the type of head and neck cancer you have. Many cancers are linked to infections like human papilloma virus (HPV) or Epstein-Barr virus (EBV).
Macmillan Cancer Support have more information about the causes and risk factors for head and neck cancers.
Diagnosis
If your GP or dentist thinks your symptoms could be linked to cancer, they will refer you to see a specialist doctor. This is usually an oral and maxillofacial surgeon, or an ear, nose and throat (ENT) specialist surgeon.
Neck lump clinic
If your only symptom is a lump in your neck, you may be referred to a one-stop neck lump clinic. There you can have all the tests needed to check for cancer in a neck lump.
These may include:
- an ultrasound neck scan
- removing a sample of tissue from the lump (a biopsy)
- nasendoscopy, a test that looks at the back of your mouth, nose and throat
You may get the results of your tests on the same day, or 7 to 10 days later.
At the hospital
Your specialist doctor will ask you about your symptoms and examine your mouth, throat and neck. They may take blood tests to check your general health.
If you have an abnormal looking area that can be seen and is easy to reach, they may remove a small piece of tissue or some cells from the area (biopsy). This will then be checked for cancer cells.
Your doctor and specialist nurse will explain the tests you need.
You may have a test using a thin flexible tube with a light and camera on the end (endoscope). Different types of endoscope can be used to examine the mouth, nose, throat and sometimes the gullet (oesophagus) area.
Some people have a general anaesthetic so the doctor can examine the area more closely using a bigger endoscope. This is sometimes called a panendoscopy.
You may have a biopsy on its own or during some of these tests.
Macmillan Cancer Support have more information and support about tests for head and neck cancer.
Further tests for head and neck cancer
If tests show you have a head and neck cancer, your specialist will arrange further tests. These can help find out more about the size and position of the cancer and whether it has spread. This is called staging. These could include the following tests.
X-rays
You may have an X-ray of your face or neck to see if any bones are affected by the cancer, and to check your teeth.
You may have a chest X-ray to check your general health and to see if there is anything abnormal in the lungs.
CT scan
A CT scan takes a series of X-rays, which build up a three dimensional picture of the inside of your body.
MRI scan
An MRI scan uses magnetism to build up a detailed picture of areas of your body.
PET-CT scan
A PET-CT gives more detailed information about the part of the body being scanned.
Testing for viruses
If you have oropharyngeal cancer, tests are done on the cancer cells to check if it is linked to the human papilloma virus (HPV). The results help your doctor plan the most effective treatments for you. HPV-related head and neck cancers usually have a good outlook.
If you have nasopharyngeal cancer, the cancer cells are tested to see if it is linked to the Epstein-Barr virus (EBV).
Staging and grading of head and neck cancer
The stage of a cancer describes its size and if it has spread from where it started.
Staging is slightly different for each type of head and neck cancer. Oropharyngeal cancers that are HPV positive have a separate staging system.
A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer may develop.
Knowing the stage and grade of head and neck cancer helps you and your doctors decide on the best treatment for you.
Treatment
Treatment for head and neck cancer
As head and neck cancer isn’t common, you’re usually treated in a specialist head and neck unit.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
They’ll also talk to you about preparing for treatment (sometimes called prehabilitation). This may include things like:
- stopping smoking or drinking to make your treatment more effective
- dental checks or dental treatment
- dietary advice to improve your weight
- certain exercises to reduce the risk of side effects
Macmillan Cancer Support have more information about preparing for head and neck cancer treatment.
The aim of treatment is to remove or destroy the cancer and reduce the risk of it coming back.
Your treatment depends on:
- where the cancer is
- the type and stage of the cancer
- the best way to maintain appearance, speech and swallowing
- your general health
- your preferences
Your doctor and nurse will explain the benefits and disadvantages of different treatments. They’ll also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.
You and your doctor can decide together on the best treatment for you.
Doctors plan your treatment so the effect on your appearance, speech, swallowing and eating is as little as possible. If treatment is likely to affect any of these, your doctor and nurse will talk to you about this.
They’ll explain how long this is likely to last and how they can support you. You may see different specialists like a dentist, speech or language therapist (SLT), or dietitian during treatment.
Treatment for head and neck cancers may include the following.
Surgery
Surgery is one of the main treatments for cancers of the head and neck.
Small cancers may be treated with a simple operation or laser surgery. If the cancer is bigger, the surgeon may also remove the lymph nodes in the neck.
Some people might need reconstructive surgery. This is when the surgeon takes tissue from another part of the body to replace tissue taken from the head and neck.
Chemoradiation
Chemoradiation is when you have chemotherapy and radiotherapy together. It’s often the main treatment for locally advanced head and neck cancer.
The chemotherapy helps the radiotherapy to work better. It can also be given after surgery.
Chemoradiation can cause severe side effects so it may not be suitable for everyone.
Radiotherapy
Radiotherapy can be used on its own to treat small cancers or cancers in harder-to-reach areas. But it’s often given in combination with chemotherapy (called chemoradiation).
Chemotherapy
You may have chemotherapy on its own before radiotherapy or surgery to shrink the cancer and make treatment work better.
It’s often given in combination with radiotherapy (chemoradiation). Sometimes chemotherapy can be used to control the symptoms of the cancer.
Targeted therapies and immunotherapies
The targeted therapy drug cetuximab is sometimes used if chemoradiation isn’t suitable for you.
Pembrolizumab and nivolumab are immunotherapy drugs that may sometimes be used if the cancer is advanced or comes back.
Your treatment depends on the stage of the cancer.
Treatment for early-stage cancer
Small cancers that have not spread can usually be treated with surgery. If the operation causes any small changes to speech, chewing or swallowing, you can usually adapt to these quickly.
Your doctors may suggest radiotherapy instead of surgery if the cancer is in a difficult-to-reach area. Or, if surgery may cause major changes to appearance, speech or swallowing.
Treatment for locally advanced cancer
If the cancer is bigger, or has spread to lymph nodes in the neck, you usually need more than one type of treatment.
Chemotherapy and radiotherapy are often used together (called chemoradiation). This may be your main treatment.
If you have surgery to remove the cancer, you may also have the lymph nodes in the neck removed. Some people may need reconstructive surgery. The aim is to cause as little change as possible to appearance and how things like swallowing or speech.
After surgery, some people have chemoradiation or radiotherapy to treat any remaining cancer cells.
Chemotherapy on its own may also be used to shrink a cancer before radiotherapy or surgery. It can also be used to try to control the cancer and improve symptoms.
A targeted therapy drug called cetuximab is sometimes given with radiotherapy if you can’t have chemoradiation. Sometimes immunotherapy drugs may be given on their own. This is usually if the cancer is advanced, or if it comes back after treatment.
Treatment to control the cancer
If the cancer can’t be cured, you may be given treatment to control the cancer for as long as possible, and to manage the symptoms.
You’ll usually have chemotherapy, or targeted therapy or immunotherapy.
Your doctor and specialist nurse will help to make sure your symptoms are controlled. This is called supportive or palliative care.
You may see a specialist palliative care doctor or nurse for expert help with your symptoms.
You may have some treatments as part of a clinical trial.
After head and neck cancer treatment
After your treatment, you’ll have regular follow-up appointments for several years. Your specialist will regularly examine your head and neck. This is the most important part of your follow-up. You may sometimes have scans.
It can take several months for the side effects of the treatment to improve. Always tell your specialist about:
- ongoing side effects or symptoms that aren’t improving
- any new symptoms that don’t get better within 2 weeks
Your nurse can tell you what to look out for after treatment. For example, this might be:
- a new ulcer or a lump in your neck
- pain
- difficulty swallowing or speaking
Contact your doctor or nurse as soon as possible if you notice any symptoms or side effects. You don’t need to wait until your next appointment.
Late effects
Treatment side effects may affect how you eat and drink, or your speech. These changes may return to normal, or near normal, as the area recovers from surgery or radiotherapy.
Your speech and language therapist (SLT) and dietitian will assess you. They help you learn to cope with any changes.
Late effects are side effects that don’t improve, or that develop years after treatment has finished. Your doctor or nurse will explain any likely late effects of your treatment. Not everyone gets late effects. It depends on the treatment you had.
Macmillan Cancer Support have more information about managing late effects of head and neck cancer treatments.
Sex life
Head and neck cancer and its treatment can sometimes have an effect on your sex life.
If you’re worried about this, talk to your doctor or nurse.
Macmillan Cancer Support have more advice about cancer and sex.
Fertility
Some cancer treatments can also affect whether you can get pregnant or get someone pregnant. If you’re worried about this, it’s important to talk with your doctor before you start treatment.
Macmillan Cancer Support have more information on:
- fertility in women after treatment
- fertility in men after treatment
- LGBTQ+ people and cancer treatment
Body image
If treatment has changed your appearance, voice or how you eat and drink it can also affect your body image. Talk to your nurse if this is a concern for you.
There are different things that can help to improve body image changes. There are also organisations below that can help to support you.
Complications
After treatment, even someone who already lives a healthy life may find it worth making a few more positive changes. If you smoke or drink alcohol, this is a good time to cut back or quit.
Eating well and staying active can lift your overall health and wellbeing, and it also helps your body heal. If eating becomes difficult after treatment, a dietitian can guide you through it.
Getting support
Recovery from treatment can take several months. It is often hard when treatment has changed how you look, how you eat or drink, or how your voice sounds, and this can affect how you feel about your body too. There are ways to help you manage these changes over time.
You may still be working through difficult emotions, and that is completely normal. Talking openly with family, friends, or health professionals about how you feel helps them understand how best to support you.
Several support groups exist for people going through this:
- The Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
- Changing Faces offers advice and information to anyone affected by a change in appearance.
- The Swallows runs a 24 hour support line for anyone affected by head and neck cancer.
- Salivary Gland Cancer UK supports people with rare salivary gland cancers, such as adenoid cystic carcinoma (ACC) and unknown carcinoma.
Macmillan Cancer Support also offers further help. You can phone the Macmillan Support Line on 0808 808 00 00, chat with Macmillan specialists online, or join the Macmillan head and neck cancer forum, where you can talk to others affected by the condition, ask questions, and share your experience. When posting there, avoid sharing personal information such as your name, location, or details of your health conditions.