Head and Neck Cancer

Head and neck cancers can affect a variety of locations. They are usually squamous cell carcinomas arising from the squamous cells of the mucosa. 

 

Locations

The potential areas of head and neck cancers are:

  • Nasal cavity
  • Paranasal sinuses
  • Mouth
  • Salivary glands
  • Pharynx (throat)
  • Larynx (epiglottis, supraglottis, vocal cords, glottis and subglottis)

 

Head and neck cancers usually spread to the lymph nodes first. Squamous cell carcinoma cells may be found in an enlarged, abnormal lymph node (lymphadenopathy), and the original tumour cannot be found. This is called cancer of unknown primary. 

 

Risk Factors

  • Smoking
  • Chewing tobacco
  • Chewing betel quid (a habit in south-east Asia)
  • Alcohol
  • Human papillomavirus (HPV), particularly strain 16
  • Epstein–Barr virus (EBV) infection

 

HPV also causes cervical cancer. The HPV vaccine (Gardasil) protects against strains 6, 11, 16 and 18.

 

Red Flags

Presenting symptoms and signs that may indicate head and neck cancer are:

  • Lump in the mouth or on the lip
  • Unexplained ulceration in the mouth lasting more than 3 weeks
  • Erythroplakia or erythroleukoplakia
  • Persistent neck lump
  • Unexplained hoarseness of voice
  • Unexplained thyroid lump

 

Management

Management will be guided by the multidisciplinary team (MDT). It will be dependent on the location, stage and individual patient factors. 

Staging usually involves the TNM staging system, grading the tumour, node involvement and metastases. 

Treatment may involve any combination of:

  • Chemotherapy
  • Radiotherapy
  • Surgery
  • Targeted cancer drugs (i.e., monoclonal antibodies)
  • Palliative care

 

Cetuximab is an example of a monoclonal antibody used in treating squamous cell carcinomas of the head and neck. It may also be used to treat bowel cancer. It targets epidermal growth factor receptor, blocking the activation of this receptor and inhibiting the growth and metastasis of the tumour.

 

Last updated July 2021
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