Cancers of the head and neck region are not uncommon, with over 50,000 patients being diagnosed with head and neck (H&N) cancer annually. Research studies have shown a very strong association between tobacco use and developing this form of cancer. Smoking, as well as smokeless tobacco use, is the most significant risk factor for the development of a head and neck cancer. Approximately 90% of patient with H&N cancer have a history of chronic tobacco use.
Within the head and neck, there are many sites where the malignancy may develop. The most common sites include: lips and tongue, tonsils, and larynx (voice box). Depending on the site, the patient will present with different primary symptoms.
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The Most Common Symptoms of H&N Cancer
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A cancer of the lips or tongue most often present as a painful sore, or ulcer, that has been present for more than 2-3 weeks. Tonsil and laryngeal malignancies have many similar symptoms, including trouble swallowing, painful swallowing, a change in voice quality (hoarseness), coughing-up blood (hemoptysis), and persistent ear pain. Many of these same symptoms occur with an acute infection, such as tonsillitis or laryngitis. However, if these symptoms do not resolve in 2-3 weeks, then an evaluation by an ENT physician is indicated.
Another possible and not uncommon sign that a patient has developed H%N cancer is an enlarged lymph node of the neck. H%N cancer spreads to lymph nodes in the neck before it spreads to any other sites within the body. These lymph nodes are typically non-tender and will not respond to other treatments, including antibiotics. If the lymph node has been present for more than 2-3 weeks, then the patient should be evaluated by an ENT physician.
The diagnosis of H&N cancer includes many tests, including biopsies and imaging studies. Patients will need a biopsy, which may require general anesthesia in an operating room. If there is an enlarged lymph node, a needle biopsy will be needed as well. CT scans are often obtained of the neck and chest, with whole-body PET scans needed for some patients. All of this is done to classify, or stage, the cancer.
Once the diagnosis and stage is made, then treatment is planned. In addition to ENT physicians, radiation and medical oncologists play an important role in treating these patients. Treatment options include surgical resection, radiation treatments, and chemotherapy infusions. Early stage disease can often be treated with one form of therapy (ie, radiation or surgery alone), whereas more advanced stages need a combination of treatments (ie, surgery, radiation and/or chemotherapy).
The prognosis of H%N cancer is very dependent upon the stage of disease upon diagnosis. In general, early stage cancers have a very good cure rate (over 75-80%). However, the cure rates drop considerably as the stage progresses in more advanced disease.
Head and neck cancer has the best cure rates if diagnosed and treated early. Therefore, a patient should seek medical evaluation if symptoms are present for more than 2-3 weeks.
Robert Wilson, MD.