A risk factor is anything that increases a person’s chance of developing a disease, including cancer. There are risk factors that can be controlled, such as smoking, and risk factors that cannot be controlled, such as age and family history. Although risk factors can influence disease, for many risk factors it is not known whether they actually cause the disease directly. Some people with several risk factors never develop the disease, while others with no known risk factors do. Knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.
Two risk factors greatly increase the risk of head and neck cancer:
Use of tobacco (including cigarettes, cigars, pipes, chewing tobacco, and snuff) is the single, largest risk factor for head and neck cancer
Frequent and heavy consumption of alcohol
Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Using alcohol and tobacco together increases this risk even more. Recent research suggests that people who have used marijuana may be at higher risk for head and neck cancer.
Other factors that can raise a person’s risk of developing head and neck cancer include:
Prolonged sun exposure. This is especially linked to cancer in the lip area (as well as skin cancers of the head and neck and other chronically sun-exposed areas such as the hands).
Gender. Men are two to three times more likely than women to develop head and neck cancer. However, the rate of head and neck cancer in women has been rising for several decades.
Age. People over 40 are at higher risk for head and neck cancer.
Race. Black people are more likely than white people to develop certain types of cancer of the head and neck.
Poor oral hygiene. Poor oral hygiene has been suggested to increase the risk of head and neck cancer.
Occupational inhalant. Exposure to asbestos, wood dust, paint fumes, and certain chemicals may increase a person’s risk of head and neck cancer.
Poor nutrition. A diet low in A and B vitamins can raise a person’s risk of head and neck cancer.
Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD). Reflux of stomach acid into the upper airway and throat may lead to head and neck cancer.
Weakened immune system. A weakened immune system can raise a person’s risk of head and neck cancer.
Human papillomavirus (HPV). Exposure to this virus may be a risk factor for head and neck cancer.
Exposure to second-hand smoke. Exposure to second-hand smoke may be a risk factor for head and neck cancer.
Prevention
Avoiding alcohol
Avoiding marijuana (discuss marijuana as a risk factor with your doctor)
Using sunscreen regularly, including lip balm with an adequate solar protection factor (SPF)
Maintaining proper care of dentures. Poorly fitting dentures can trap tobacco and alcohol's cancer-causing substances. Denture wearers should have their dentures evaluated by a dentist at least every five years to ensure a good fit. Dentures should be removed every night and be cleaned and rinsed thoroughly every day.
People with head and neck cancer often experience the following symptoms. Sometimes, people with head and neck cancer do not show any of these symptoms. Or, these symptoms may be similar to symptoms of other medical conditions. If you are concerned about a symptom on this list, please talk to your doctor.
Swelling or sore that does not heal (the most common symptom)
Red or white patch in the mouth
Painless lump or mass in the neck
Mass or bump in the head and neck area
Persistent sore throat
Foul or fetid mouth odor not explained by hygiene
Hoarseness or change in voice
Nasal obstruction or persistent nasal congestion
Frequent nose bleeds and/or unusual nasal discharge
Difficulty breathing
Double vision
Numbness or weakness of a body part in the head and neck region
Pain or difficulty chewing, swallowing, or moving the jaws or tongue
Ear and/or jaw pain
Blood in the saliva or phlegm
Loosening of teeth
Dentures that no longer fit
Unexplained weight loss
Fatigue
People who notice any warning signs should consult a doctor and/or dentist right away. When detected early, cancers of the head and neck have a much better chance of cure.Because many of these symptoms can be caused by other, noncancerous health conditions as well, it is important to receive regular health and dental screenings; this is particularly important for those people who routinely drink alcohol or currently use tobacco products or have used them in the past.
In fact, people who use alcohol and tobacco should receive a general screening examination at least once a year. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, then the doctor will recommend a more extensive examination using one or more of the diagnostic procedures mentioned below. Smokers should also be enrolled in lung cancer screening programs.
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
If a person shows symptoms and signs of head and neck cancer, the doctor will take a complete medical history, noting all symptoms and risk factors. The doctor may perform any of several types of tests that can help to make a definite diagnosis and determine the stage of the cancer (how far it has progressed).
Staging is a way of describing cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until the doctor performs a biopsy. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis (chance of recovery). There are different stage descriptions for different types of cancers.One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
There are three main treatment options for head and neck cancer: surgery, radiation therapy, and chemotherapy. One of these therapies, or a combination of them, may be used to treat the cancer.
Surgery
During surgery, the doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it (called a margin). The goal of surgery is to remove all of the tumor and leave negative margins (no trace of cancer in the healthy tissue). If the doctor suspects that the cancer has spread, then the doctor may remove lymph nodes in the neck, possibly causing stiffness in the shoulders afterward. Sometimes, it is not possible to completely remove the cancer; additional therapies might be necessary.Depending on the location, stage, and the type of the cancer, some people may need more than one operation to remove the cancer and to help restore the appearance and function of the tissues affected. If the surgery requires major tissue removal (for example, jaw, skin, pharynx, or tongue), plastic surgery may be used to replace the missing tissue. A prosthodontist may be able to make an artificial dental or facial part to restore the ability to swallow and speak. A speech pathologist may then be needed to assist the patient to swallow and communicate using new techniques or special equipment.Sometimes, surgery is followed by radiation treatment to destroy cancer cells not removed during surgery. Chemotherapy may or may not be given.Side effects of surgery depend on the type and location of the surgery, and may include:
Swelling of the mouth and throat area, making it difficult to breathe. Some patients may receive a temporary tracheostomy (a hole in the windpipe) to make breathing easier.
Temporary or permanent loss of normal voice or impaired speech
Difficulty chewing or swallowing. A tube may be inserted in the stomach for feeding purposes.
Facial disfigurement. Reconstructive surgery may be required to maintain appearance or body functions, such as chewing, swallowing, or breathing.
Hearing loss
Decreased functioning of the thyroid gland, especially after a total laryngectomy and/or radiation therapy
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Radiation can be administered in two ways: externally and internally. External-beam radiation therapy is conducted with a radiation beam aimed at the tumor.
A new method of external radiation therapy, known as intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells and causing fewer side effects.Radiation therapy can be the main treatment for head and neck cancer, or used after surgery to destroy small pockets of cancer that cannot be removed surgically.Before beginning radiation treatment for any head and neck cancer, patients should receive a thorough examination from an oncologic dentist (a dentist with experience in treating people with head and neck cancer). Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning treatment. People should also receive an evaluation from a speech pathologist who has experience treating people with head and neck cancer. Since radiation therapy can cause throat swelling and scarring, voice and swallowing are often affected.Radiation therapy to the head and neck may cause the following side effects:
Redness or skin irritation to the treated area
Swelling
Dry mouth or thickened saliva, from damage to salivary glands
Bone pain
Nausea
Fatigue
Mouth sores and/or sore throat
Dental problems (usually preventable)
Painful or difficulty swallowing (short and long-term)
Changes in voice because of swelling or scarring
Loss of appetite, due to a change in sense of taste
Hearing loss, due to buildup of fluid in the middle ear
Buildup of earwax that dries out because of the radiation therapy’s effect on the ear canal
Fibrosis (scarring)
Radiation therapy also may cause a condition called hypothyroidism, in which the thyroid gland (located in the neck) slows down and causes the patient to feel tired and sluggish. Every patient who receives radiation therapy to the neck area should have his or her thyroid checked regularly.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given orally (by mouth); given intravenously (in a vein); injected either into a muscle, under the skin, or directly into the cancerous tumor; or applied onto the surface of the skin.Chemotherapy can be used in the initial treatment either neoadjuvant (before) or adjuvant (after) surgery, radiation therapy, or both.Many combined treatments (chemotherapy and radiation therapy) are performed as part of a clinical trial, which are research studies to find new treatments.Each drug or combination of drugs can cause specific side effects, and some can be permanent. In general, chemotherapy may cause the following side effects:
Fatigue
Nausea
Vomiting
Hair loss
Dry mouth
Loss of appetite, due to a change in sense of taste
Weakened immune system
Diarrhea and/or constipation
Open sores in the mouth; this condition coupled with a low immunity can lead to infections
