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What is head and neck cancers?

Head and neck cancers occur inside the sinuses, nose, mouth and salivary glands down through the throat. Although these cancers are different, they are treated similarly, so are considered as a group.

In 2016, 3737 head and neck cancers were diagnosed in Australia. These figures include cancers of the tongue, gum, mouth, salivary glands, tonsils, pharynx, nasal cavity and larynx, but not cancers of the lip.

In 2018, there were 1109 deaths in Australia due to head and neck cancers.

The five year survival rate is approximately 64.7%.



Head and neck cancer symptoms

Symptoms depend on the site of the cancer,,  however you may have one or more of the following symptoms:

  • pain

  • swelling

  • a hoarse voice

  • difficulties swallowing

  • bad breath.



Causes of head and neck cancers

There are a number of risk factors associated with head and neck cancers. The main risk factors are alcohol consumption and tobacco. Other risk factors include:

  • viruses including the human papillomavirus (HPV) and the Epstein-Barr virus have been linked to head and neck cancers

  • age - head and neck cancer is more common in people over 40 years old

  • gender - men are three times more likely than women in Australia to develop head and neck cancer

  • oral hygiene - poor oral health including gum disease have been linked to cancers of the oral cavity

  • exposure to work-related chemicals such as asbestos, dry-cleaning solvents or certain types of paint

  • smoking

  • a weakened immune system

  • smoking or chewing betel nut, areca nut, gutka or pan

  • drinking alcohol

  • being from southern China or South-East Asia due to cultural practices such as chewing tobacco or eating salty foods

  • sun exposure (skin cancer of the lip).



Diagnosis of head and neck cancers

Your doctor will physically examine your neck, ears, eyes, nose, mouth or throat, depending on your symptoms. Other tests will use an endoscope, needle or surgery to take a biopsy.

Nasendoscopy

Your doctor will examine your nose and throat using a thin flexible tube with a light and camera on the end called a nasendoscope. The nasendoscope will look at your nasal cavity, larynx, nasopharynx and oropharynx. This is done under local anaesthetic.

Laryngoscopy

Your doctor will look at your voice box and throat using a tube with a light and camera on the end (laryngoscope) and take a biopsy (tissue sample). This is done under general anaesthetic.

Biopsy

Your doctor will remove tissue samples or cells from the affected area and these will be examined under a microscope by a pathologist to check for any cancer cells.

X-rays

You may have x-rays to check for tumours or damage to the bones. 

CT scan

A computerised tomography (CT) scan uses x-ray beams to created detailed cross-section images of the inside of your body.

MRI scan

A magnetic resonance imaging (MRI) scan uses powerful magnet and radio waves to create detailed cross-section images of inside your body. Thjs test usually takes between 30 and 90 minutes.

PET-CT scan

A positron emission tomography (PET) scan combined with a CT scan helps pinpoint the location of any abnormalities. It is recommended to help diagnose laryngeal, pharyngeal or oral cancers or to see if cancer has spread.

Ultrasound

You may have an ultrasound to look at the salivary glands, the thyroid and lymph glands in the neck.



Treatment of head and neck cancers

Treatment for head and neck cancers can affect your teeth, gums and mouth. Some preparations before treatment begins may include:

  • seeing a dentist
  • consulting a dietitian to help improve your diet and nutrition as you may lose a lot of weight
  • beginning an exercise program to help build up your strength
  • quitting smoking as you may not respond to treatment as well as someone who doesn’t smoke.

Surgery

Surgery is used to remove the cancerous tissue while preserving as much of the functions of the head and neck area as possible including breathing, swallowing and talking. The type of surgery you have will depend on the type of head and neck cancer you have.

Radiation therapy (radiotherapy)

Radiation therapy (radiotherapy) uses a controlled dose of radiation to damage or kill cancer cells. It can be used on its own as the main treatment for laryngeal and pharyngeal cancers.

Radiation therapy can be used after surgery (adjuvant treatment) and is sometimes used with chemotherapy.

Chemotherapy

Chemotherapy uses specific drugs to kill cancer cells or slow their growth. The drugs are usually administered by injection into a vein (intraveneously).

Targeted therapies

Targeted therapy drugs affect specific features of cancer cells to stop their growth.

Immunotherapy

Immunotherapy, a type of treatment that uses your body’s own immune system to fight cancer, may be used to treat head and neck cancers.

Palliative care

In some cases of head and neck cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of head and neck cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
  • Ear, nose and throat (ENT) specialist- treats disorders of the ear, nose and throat
  • Head and neck surgeon- diagnoses and treats cancers of the head and neck.
  • Oral surgeon- treats disorders of the mouth, face and jaws.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Dentist- evaluates and treats the mouth and teeth
  • Oncology nurse- cares for people who are diagnosed with cancer throughout treatment.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.


Screening for head and neck cancers

There is currently no national screening program for head and neck cancer available in Australia. 

White plaques or patches in the mouth (leukoplakia) may precede the development of the cancer. 



Preventing head and neck cancers

The risk of head and neck cancers can be reduced by not smoking (or quitting) and reducing alcohol consumption. 



Prognosis for head and neck cancers

Prognosis means the expected outcome of a disease. Your prognosis depends your test results, the type of head and neck cancer, the tumour's HPV status, the rate and depth of tumour growth and other factors such as your age and general health at the time of diagnosis. 

The earlier a head and neck cancer is diagnosed the better the outcomes. 



Sources

Understanding Head and Neck Cancers, Cancer Council Australia, © 2019. Last medical review of source booklet: September 2019. 

Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW. 

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