Head and Neck Cancer: Questions and Answers 

Key Points 

• Most head and neck cancers begin in the squamous cells that line the 

mucosal surfaces in the head and neck. Head and neck cancers are 

identified by the area in which they begin (see Question 2). 

• Tobacco and alcohol use are the most important risk factors for head and 

neck cancers. People who are at risk for this disease should talk with 

their doctor about ways they can reduce their risk and how often to have 

checkups (see Question 4). 

• Typical symptoms of head and neck cancer include a lump or sore (for 

example, in the mouth) that does not heal, a sore throat that does not go 

away, difficulty swallowing, and a change or hoarseness in the voice 

(see Question 5). 

• The treatment plan for an individual patient depends on a number of 

factors, including the exact location of the tumor, the stage of the cancer, 

and the person’s age and general health (see Question 8). 

• Rehabilitation and regular follow-up care are important parts of 

treatment for patients with head and neck cancer (see Questions 10 

and 11). 

1. What is cancer? 

Cancer is a group of many related diseases that begin in cells, the body’s basic unit of 

life. Normally, cells grow and divide to form new cells in an orderly way. They perform 

their functions for a while, and then they die. Sometimes, however, cells do not die. 

Instead, they continue to divide and create new cells that the body does not need. The 

extra cells form a mass of tissue, called a growth or tumor. There are two types of 

tumors: benign and malignant. Benign tumors are not cancer. They do not invade nearby 

tissue or spread to other parts of the body. Malignant tumors are cancer. Their growth 

invades normal structures near the tumor and spreads to other parts of the body. 

Metastasis is the spread of cancer beyond one location in the body.

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2. What kinds of cancers are considered cancers of the head and neck? 

Most head and neck cancers begin in the cells that line the mucosal surfaces in the head 

and neck area, e.g., mouth, nose, and throat. Mucosal surfaces are moist tissues lining 

hollow organs and cavities of the body open to the environment. Normal mucosal cells 

look like scales (squamous) under the microscope, so head and neck cancers are often 

referred to as squamous cell carcinomas. Some head and neck cancers begin in other 

types of cells. For example, cancers that begin in glandular cells are called 

adenocarcinomas. 

Cancers of the head and neck are further identified by the area in which they begin: 

• Oral cavity. The oral cavity includes the lips, the front two-thirds of the tongue, the 

gingiva (gums), the buccal mucosa (lining inside the cheeks and lips), the floor 

(bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and 

the small area behind the wisdom teeth. 

• Salivary glands. The salivary glands produce saliva, the fluid that keeps mucosal 

surfaces in the mouth and throat moist. There are many salivary glands; the major 

ones are in the floor of the mouth, and near the jawbone. 

• Paranasal sinuses and nasal cavity. The paranasal sinuses are small hollow spaces 

in the bones of the head surrounding the nose. The nasal cavity is the hollow space 

inside the nose. 

• Pharynx. The pharynx is a hollow tube about 5 inches long that starts behind the 

nose and leads to the esophagus (the tube that goes to the stomach) and the trachea 

(the tube that goes to the lungs). The pharynx has three parts: 

ο Nasopharynx. The nasopharynx, the upper part of the pharynx, is behind the 

nose. 

ο Oropharynx. The oropharynx is the middle part of the pharynx. The oropharynx 

includes the soft palate (the back of the mouth), the base of the tongue, and the 

tonsils. 

ο Hypopharynx. The hypopharynx is the lower part of the pharynx. 

• Larynx. The larynx, also called the voicebox, is a short passageway formed by 

cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It 

also has a small piece of tissue, called the epiglottis, which moves to cover the larynx 

to prevent food from entering the air passages. 

• Lymph nodes in the upper part of the neck. Sometimes, squamous cancer cells are 

found in the lymph nodes of the upper neck when there is no evidence of cancer in 
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other parts of the head and neck. When this happens, the cancer is called metastatic 

squamous neck cancer with unknown (occult) primary. 

Cancers of the brain, eye, and thyroid as well as those of the scalp, skin, muscles, and 

bones of the head and neck are not usually grouped with cancers of the head and neck. 

3. How common are head and neck cancers? 

Head and neck cancers account for approximately 3 to 5 percent of all cancers in the 

United States. These cancers are more common in men and in people over age 50. It is 

estimated that about 39,000 men and women in this country will develop head and neck 

cancer in 2005. 

4. What causes head and neck cancers? 

Tobacco (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) 

and alcohol use are the most important risk factors for head and neck cancers, particularly 

those of the oral cavity, oropharynx, hypopharynx, and larynx. Eighty-five percent of 

head and neck cancers are linked to tobacco use. People who use both tobacco and 

alcohol are at greater risk for developing these cancers than people who use either 

tobacco or alcohol alone. 

Other risk factors for cancers of the head and neck include the following: 

• Oral cavity. Sun exposure (lip); possibly human papillomavirus (HPV) infection. 

• Salivary glands. Radiation to the head and neck. This exposure can come from 

diagnostic x-rays or from radiation therapy for noncancerous conditions or cancer. 

• Paranasal sinuses and nasal cavity. Certain industrial exposures, such as wood or 

nickel dust inhalation. Tobacco and alcohol use may play less of a role in this type of 

cancer. 

• Nasopharynx. Asian, particularly Chinese, ancestry; Epstein-Barr virus infection; 

occupational exposure to wood dust; and consumption of certain preservatives or 

salted foods. 

• Oropharynx. Poor oral hygiene; HPV infection and the use of mouthwash that has a 

high alcohol content are possible, but not proven, risk factors. 

• Hypopharynx. Plummer-Vinson (also called Paterson-Kelly) syndrome, a rare 

disorder that results from iron and other nutritional deficiencies. This syndrome is 

characterized by severe anemia and leads to difficulty swallowing due to webs of 

tissue that grow across the upper part of the esophagus. 
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• Larynx. Exposure to airborne particles of asbestos, especially in the workplace. 

Immigrants from Southeast Asia who use paan (betel quid) in the mouth should be aware 

that this habit has been strongly associated with an increased risk for oral cancer. Also, 

consumption of mate, a tea-like beverage habitually consumed by South Americans, has 

been associated with an increased risk of cancers of the mouth, throat, esophagus, and 

larynx. 

People who are at risk for head and neck cancers should talk with their doctor about ways 

they can reduce their risk. They should also discuss how often to have checkups. 

5. What are common symptoms of head and neck cancers? 

Symptoms of several head and neck cancer sites include a lump or sore that does not 

heal, a sore throat that does not go away, difficulty swallowing, and a change or 

hoarseness in the voice. 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. 

• Oropharynx and hypopharynx. Ear pain. 

• Nasopharynx. Trouble breathing or speaking, frequent headaches, pain or ringing in 

the ears, or trouble hearing. 

• Larynx. Pain when swallowing, or ear pain. 

• Metastatic squamous neck cancer. Pain in the neck or throat that does not go away. 

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. 
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6. How are head and neck cancers diagnosed? 

To find the cause of symptoms, a doctor evaluates a person’s medical history, performs a 

physical examination, and orders diagnostic tests. The exams and tests conducted may 

vary depending on the symptoms. Examination of a sample of tissue under the 

microscope is always necessary to confirm a diagnosis of cancer. 

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

• Physical examination may include visual inspection of the oral and nasal cavities, 

neck, throat, and tongue using a small mirror and/or lights. The doctor may also feel 

for lumps on the neck, lips, gums, and cheeks. 

• Endoscopy is the use of a thin, lighted tube called an endoscope to examine areas 

inside the body. The type of endoscope the doctor uses depends on the area being 

examined. For example, a laryngoscope is inserted through the mouth to view the 

larynx; an esophagoscope is inserted through the mouth to examine the esophagus; 

and a nasopharyngoscope is inserted through the nose so the doctor can see the nasal 

cavity and nasopharynx. 

• Laboratory tests examine samples of blood, urine, or other substances from the 

body. 

• X-rays create images of areas inside the head and neck on film. 

• 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. 

• 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. 

If the diagnosis is cancer, the doctor will want to learn the stage (or extent) of disease. 

Staging is a careful attempt to find out whether the cancer has spread and, if so, to which 

parts of the body. Staging may involve an examination under anesthesia (in the operating 

room), x-rays and other imaging procedures, and laboratory tests. Knowing the stage of 

the disease helps the doctor plan treatment. 
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7. What health professionals treat patients with head and neck cancers? 

Patients with head and neck cancers are best treated by a team of specialists. The 

specialists vary, depending on the location and extent of the cancer. The medical team 

may include oral surgeons; ear, nose, and throat surgeons (also called otolaryngologists); 

pathologists; medical oncologists; radiation oncologists; prosthodontists; dentists; plastic 

surgeons; dietitians; social workers; nurses; physical therapists; and speech-language 

pathologists (sometimes called speech therapists). 

8. How are head and neck cancers treated? 

The treatment plan for an individual patient depends on a number of factors, including 

the exact location of the tumor, the stage of the cancer, and the person’s age and general 

health. The patient and the doctor should consider treatment options carefully. They 

should discuss each type of treatment and how it might change the way the patient looks, 

talks, eats, or breathes. 

• Surgery. The surgeon may remove the cancer and some of the healthy tissue around 

it. Lymph nodes in the neck may also be removed (lymph node dissection), if the 

doctor suspects that the cancer has spread. Surgery may be followed by radiation 

treatment. 

Head and neck surgery often changes the patient’s ability to chew, swallow, or talk. 

The patient may look different after surgery, and the face and neck may be swollen. 

The swelling usually goes away within a few weeks. However, lymph node 

dissection can slow the flow of lymph, which may collect in the tissues; this swelling 

may last for a long time. After a laryngectomy (surgery to remove the larynx), parts 

of the neck and throat may feel numb because nerves have been cut. If lymph nodes 

in the neck were removed, the shoulder and neck may be weak and stiff. Patients 

should report any side effects to their doctor or nurse, and discuss what approach to 

take. Information about rehabilitation can be found in question 10. 

• Radiation therapy, also called radiotherapy. This treatment involves the use of 

high-energy x-rays to kill cancer cells. Radiation may come from a machine outside 

the body (external radiation therapy). It can also come from radioactive materials 

placed directly into or near the area where the cancer cells are found (internal 

radiation therapy or radiation implant). 

In addition to its desired effect on cancer cells, radiation therapy often causes 

unwanted effects. Patients who receive radiation to the head and neck may 

experience redness, irritation, and sores in the mouth; a dry mouth or thickened 

saliva; difficulty in swallowing; changes in taste; or nausea. Other problems that may 

occur during treatment are loss of taste, which may decrease appetite and affect 

nutrition, and earaches (caused by hardening of the ear wax). Patients may also 

notice some swelling or drooping of the skin under the chin and changes in the 

texture of the skin. The jaw may feel stiff and patients may not be able to open their 
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mouth as wide as before treatment. Patients should report any side effects to their 

doctor or nurse and ask how to manage these effects. 

More information about radiation therapy is available in the NCI booklet Radiation 

Therapy and You: Support for People With Cancer. NCI publications and materials 

are available by calling the Cancer Information Service (CIS) at 

1–800–4–CANCER (1–800–422–6237), or through the NCI Publications Locator 

Web site at http://www.cancer.gov/publications on the Internet. 

• Chemotherapy, also called anticancer drugs. This treatment is used to kill cancer 

cells throughout the body. The side effects of chemotherapy depend on the drugs that 

are given. In general, anticancer drugs affect rapidly growing cells, including blood 

cells that fight infection, cells that line the mouth and the digestive tract, and cells in 

hair follicles. As a result, patients may have side effects such as lower resistance to 

infection, sores in the mouth and on the lips, loss of appetite, nausea, vomiting, 

diarrhea, and hair loss. They may also feel unusually tired and experience skin rash 

and itching, joint pain, loss of balance, and swelling of the feet or lower legs. Patients 

should talk with their doctor or nurse about the side effects they are experiencing, and 

how to handle them. The NCI booklet Chemotherapy and You: Support for People 

With Cancer has more information about this type of treatment. 

Additional information on treatment for head and neck cancers can be found in the 

following PDQ® cancer treatment summaries, available in patient and health professional 

versions, at http://www.cancer.gov/cancertopics/pdq/adulttreatment on the Internet: 

• Hypopharyngeal Cancer 

• Laryngeal Cancer 

• Lip and Oral Cavity Cancer 

• Nasopharyngeal Cancer 

• Oropharyngeal Cancer 

• Paranasal Sinus and Nasal Cavity Cancer 

• Salivary Gland Cancer 

9. Are clinical trials (research studies) available for patients with head and neck 

cancers? 

Clinical trials are research studies conducted with people who volunteer to take part. 

Participation in clinical trials is an option for many patients with head and neck cancers. 

Treatment trials are designed to find more effective cancer treatments and better ways to 

use current treatments. In some studies, all patients receive the new treatment. In others, 

doctors compare different therapies by giving the new treatment to one group of patients 

and standard therapy to another group. Doctors are studying new types and schedules for 

delivering radiation therapy, new anticancer drugs, new drug combinations, and new 

ways of combining treatments. They are also studying ways to treat head and neck 
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cancers using biological therapy (a type of treatment that stimulates the immune system 

to fight cancer) by itself or in combination with anticancer drugs or radiation therapy. 

Scientists are also conducting clinical trials to find better ways to reduce the side effects 

of chemotherapy and radiation therapy for head and neck cancers. These clinical trials, 

called supportive care trials, explore ways to improve the comfort and quality of life of 

cancer patients and cancer survivors. 

People interested in taking part in a clinical trial should talk with their doctor. 

Information about clinical trials is available from the CIS (see below) and the NCI 

booklet Taking Part in Cancer Treatment Research Studies. This booklet describes how 

research studies are carried out and explains their possible benefits and risks. In addition, 

the NCI’s Web site, http://www.cancer.gov on the Internet, provides information about 

clinical trials. It also offers detailed information about specific ongoing studies by 

linking to PDQ, a cancer information database developed by NCI. The CIS also provides 

information from PDQ. 

10. What rehabilitation or support options are available for patients with head and 

neck cancers? 

Rehabilitation is a very important part of treatment for patients with head and neck 

cancer. The goals of rehabilitation depend on the extent of the disease and the treatment 

a patient has received. The health care team makes every effort to help the patient return 

to normal activities as soon as possible. 

Depending on the location of the cancer and the type of treatment, rehabilitation may 

include physical therapy, dietary counseling, speech therapy, and/or learning how to care 

for a stoma after a laryngectomy. A stoma is an opening into the windpipe through 

which a patient breathes after a laryngectomy. 

Sometimes, especially with cancer of the oral cavity, a patient may need reconstructive 

and plastic surgery to rebuild the bones or tissues of the mouth. If this is not possible, a 

prosthodontist may be able to make a prosthesis (an artificial dental and/or facial part) to 

restore satisfactory swallowing and speech. Patients will receive special training to use 

the device. 

Patients who have trouble speaking after treatment, or who have lost their ability to 

speak, may need speech therapy. Often, a speech-language pathologist will visit the 

patient in the hospital to plan therapy and teach speech exercises or alternative methods 

of speaking. Speech therapy usually continues after the patient returns home. 

Eating may be difficult after treatment for head and neck cancer. Some patients receive 

nutrients directly into a vein (IV) after surgery, or need a feeding tube until they can eat 

on their own. A feeding tube is a flexible plastic tube that is passed into the stomach 

through the nose or an incision (cut) in the abdomen. A nurse or speech-language 

pathologist can help patients learn how to swallow again after surgery. The NCI booklet 
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Eating Hints for Cancer Patients: Before, During, and After Treatment contains many 

useful suggestions and recipes. 

11. Is follow-up treatment necessary? What does it involve? 

Regular follow-up care is very important after treatment for head and neck cancer to 

make sure the cancer has not returned, or that a second primary (new) cancer has not 

developed. Depending on the type of cancer, medical checkups could include exams of 

the stoma, mouth, neck, and throat. Regular dental exams may also be necessary. From 

time to time, the doctor may perform a complete physical exam, blood tests, x-rays, and 

CT, PET, or MRI scans. The doctor may continue to monitor thyroid and pituitary gland 

function, especially if the head or neck was treated with radiation. Also, the doctor is 

likely to counsel patients to stop smoking. Research has shown that continued smoking 

may reduce the effectiveness of treatment and increase the chance of a second primary 

cancer (see question 12). The NCI fact sheet Follow-up Care After Cancer Treatment: 

Questions and Answers has more information about this topic. 

12. What can people who have had head and neck cancer do to reduce the risk of 

developing a second primary (new) cancer? 

People who have been treated for head and neck cancer have an increased chance of 

developing a new cancer, usually in the head and neck, esophagus, or lungs. The chance 

of a second primary cancer varies depending on the original diagnosis, but is higher for 

people who smoke and drink alcohol. Patients who do not smoke should never start. 

Those who smoke should do their best to quit. Studies have shown that continuing to 

smoke or drink (or both) increases the chance of a second primary cancer for up to 

20 years after the original diagnosis. Information about smoking cessation is available 

from the CIS (see below) and in the NCI fact sheet Quitting Smoking: Why To Quit and 

How To Get Help. 

Some research has shown that isotretinoin (13-cis-retinoic acid), a substance related to 

vitamin A, may reduce the risk of the tumor recurring (coming back) in patients who 

have been successfully treated for cancers of the oral cavity, oropharynx, and larynx. 

However, treatment with isotretinoin has not yet been shown to improve survival or to 

prevent future cancers. 

# # # 

Related NCI materials and Web pages: 

• National Cancer Institute Fact Sheet 7.48, Follow-up Care After Cancer Treatment: 

Questions and Answers

(http://www.cancer.gov/cancertopics/factsheet/Therapy/followup)

• National Cancer Institute Fact Sheet 10.19, Quitting Smoking: Why To Quit and How 

To Get Help (http://www.cancer.gov/cancertopics/factsheet/Tobacco/cessation)
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• Chemotherapy and You: Support for People With Cancer

(http://www.cancer.gov/cancertopics/chemotherapy-and-you)

• Eating Hints for Cancer Patients: Before, During, and After Treatment

(http://www.cancer.gov/cancertopics/eatinghints)

• Radiation Therapy and You: Support for People With Cancer 

(http://www.cancer.gov/cancertopics/radiation-therapy-and-you)

• Taking Part in Cancer Treatment Research Studies 

(http://www.cancer.gov/clinicaltrials/Taking-Part-in-Cancer-Treatment-ResearchStudies)

• What You Need To Know AboutTM Cancer of the Larynx 

(http://www.cancer.gov/cancertopics/wyntk/larynx)

• What You Need To Know AboutTM Oral Cancer

(http://www.cancer.gov/cancertopics/wyntk/oral)

For more help, contact: 

NCI’s Cancer Information Service 

Telephone (toll-free): 1–800–4–CANCER (1–800–422–6237) 

TTY (toll-free): 1–800–332–8615

LiveHelp® online chat: https://cissecure.nci.nih.gov/livehelp/welcome.asp

This fact sheet was reviewed on 3/9/05