FAQ

• People who have been treated for head and neck cancers have an increased chance of developing new cancer, usually in the head, neck, esophagus, or lungs. The chance of a second primary cancer varies depending on the original cancer site, but it is higher for people who use tobacco and drink alcohol.
• Especially because patients who smoke have a higher risk of a second primary cancer, doctors encourage patients who use tobacco to quit. Information about tobacco cessation is available from NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and in the NCI fact sheet Where To Get Help When You Decide To Quit Smoking. The federal government’s main resource to help people quit using tobacco is BeTobaccoFree.gov.The government also sponsors Smokefree Women, a website to help women quit using tobacco, and Smokefree Teen, which is designed to help teens understand the decisions they make and how those decisions fit into their lives. The toll-free number 1–800–QUIT–NOW (1–800–784–8669) also serves as a single point of access to state-based telephone quitlines.
• Taken from the website of the National Cancer Institute

• The goal of treatment for head and neck cancers is to control the disease, but doctors are also concerned about preserving the function of the affected areas as much as they can and helping the patient return to normal activities as soon as possible after treatment. Rehabilitation is a very important part of this process. The goals of rehabilitation depend on the extent of the disease and the treatment that a patient has received.
• Speech Therapy
  • Speech and swallow therapists are a cornerstone of cancer treatment. They work with patients to rehabilitate speech and swallowing through exercises and therapy sessions.
• Physical Therapy
  • Post-treatment physical therapy is used to stretch and strengthen muscles and tissues affected by cancer treatment. Common therapy includes:
    • Shoulder and neck exercises
    • Jaw opening
    • Mobility
• Lymphedema Therapy
  • Lymphedema specialists provide massage therapy with additional techniques to improve post-treatment swelling.
• Cancer Survivorship Groups
  • There are local and national groups dedicated to post-treatment care. The American Head and Neck Society has an easily accessible website with a number of popular topics, comments, and FAQs.
  • Read more about survivorship.
• Is follow-up care necessary? What does it involve?
  • Regular follow-up care is very important after treatment for head and neck cancer to make sure that 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, if one has been created, and of the mouth, neck, and throat. Regular dental exams may also be necessary.
  • After being treated, it is generally recommended that you have a complete head and neck exam at the following intervals:
    • Year 1: every 1-3 months
    • Year 2: every 2-6 months
    • Years 3-5: every 4-8 months
    • After 5 years: every 12 months
  • From time to time, the doctor may perform a complete physical exam, blood tests, x-rays, computed tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI) scans. The doctor may monitor thyroid and pituitary gland function, especially if the head or neck was treated with radiation. Also, the doctor is likely to recommend smoking cessation. Research has shown that continued smoking by a patient with head and neck cancer may reduce the effectiveness of treatment and increase the chance of a second primary cancer.

• Surgery
  • Surgery for large head and neck cancers often changes the patient’s ability to eat, talk and breathe.  Specific side effects will be based on where the tumor is located and what is removed to get it out.  The surgeon will try and remove the entire cancer while keeping function as much as possible (preserving major nerves and vessels and muscles).
  • There will be scars (these will fade with time), and the face and neck may be swollen.
  • Swelling after surgery usually goes away within a few weeks.  However, when lymph nodes are removed and scar is created from an operation, the flow of lymph in the neck may be slow and can build up in the tissues causing a swelling called lymphedema.  Many people need therapy to help resolve lymphedema.  Lymphedema can be a long-term problem.
  • Another problem after surgery can be skin numbness. This can return with time or may be permanent if nerves are cut.  
  • Shoulder and lower lip weakness can also occur based on the location of your tumor and surgery.
  • Please talk to the surgeon to discuss the expected functional side effects of surgery.
• Radiation Therapy
  • Radiation therapy has side effects such as redness, irritation, thick saliva, loss of taste, and sores in the mouth during treatment.
  • The sores can be painful and limit you from taking in a normal meal.  However, they should resolve within a month of completing therapy.
  • The dry mouth and thickened saliva will likely persist after treatment (can be permanent).  This dry mouth can cause dental issues, and it is important to have a dental evaluation before starting radiation.
  • Other long-term side effects are earaches and changes in hearing, changes in the feeling of the skin, and hardening of the muscles (neck feels “woody” or stiff). Sometimes it is harder to open the mouth as wide as before radiation.
• Chemotherapy
  • Chemotherapy also has side effects based on which medicine is given.
  • Most chemotherapy for head and neck cancer does not cause hair loss.  However, chemotherapy does change the body’s ability to fight infection and weakens the immune system, can cause fatigue, nausea, vomiting, loss of appetite, and changes in the sensation in the hands and feet.
  • When chemo is given with radiation, the side effects of both intensify.
• Immunotherapy
  • Immunotherapy can also cause side effects during treatment.  Some of the common side effects are fatigue, nausea, vomiting, diarrhea, as well as skin rashes.
  • Immunotherapy uses the body’s own defenses to fight cancer, and sometimes the immune system can go into overdrive and start to work against the body (including lung, brain, liver, kidney, and intestines).  This is rare but can cause trouble breathing, hepatitis, pancreatitis, and thyroid problems.  Usually, these can be controlled with medications such as steroids and antihistamines.
• Specific Side Effects
  • Patients should report any side effects to their doctor or nurse to discuss how to deal with them.
    • Dry Mouth (Xerostomia)
      • Radiation and chemotherapy can damage the glands in your mouth that produce saliva, reducing or eliminating their ability to keep your mouth moisturized.
      • Learn more at headandneck.org
    • Oral Mucositis
      • Painful sores in your mouth or throat, caused by cancer treatment, can impact your ability to eat, increase your risk of infection, and temporarily reduce your quality of life. 
      • Learn more at headandneck.org
    • Lymphedema
      • When the lymph system is damaged by radiation or surgery, lymph fluid cannot flow back to the heart the way that is should.  It collects under the skin, causing swelling.
      • Learn more at headandneck.org
    • Neuropathy
      • Nerve damage and nerve pain can be caused by cancer treatments, including radiation, surgery, and some chemotherapy drugs. It often doesn’t appear for years following treatment.
      • Learn more at headandneck.org
    • Osteoradionecrosis
      • Bone death is caused when radiation therapy damages the blood vessels that supply the jawbone with nutrients and oxygen, causing it to no longer heal itself when faced with infection or trauma
      • Learn more at headandneck.org
    • Trismus
      • Radiation and/or surgery can cause scarring or damage to the jaw muscle or joint or nerve damage, resulting in decreased range of motion and making it difficult, painful, or impossible to open your mouth.
      • Learn more at headandneck.org
    • Radiation Fibrosis
      • Increased production of a protein called fibrin can accumulate due to radiation treatment and eventually cause tissue damage, resulting in the shortening of tissues.
      • Learn more at headandneck.org
• Other Considerations
  • Cancer surgery may require having a laryngectomy (surgery to remove the voice box).  Adjusting to life after laryngectomy surgery is often a challenge for survivors.
  • The Laryngectomee Guide, available in several languages, can help make the transition easier.
  • Maintaining adequate nutrition before, during, and after cancer treatment is critical to your recovery.

Get tips and recipes designed for head and neck cancer patients here.

• 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. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments.
• People who are diagnosed with HPV-positive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are HPV-negative. Recent research has shown that patients with HPV-positive oropharyngeal tumors have a better prognosis and survival.  They may do just as well with less intense treatment and fewer long-term side effects.  Ongoing clinical trials are investigating this question. 
• More information about treatment for head and neck cancer based on location is available in the following summaries.  These are available for patients and health professionals and are available in Spanish.
  • Lip and Oral Cavity Cancer
  • Oropharyngeal Cancer
  • Laryngeal Cancer
  • Hypopharyngeal Cancer
  • Unknown Primary (Metastatic Squamous Neck Cancer with Occult Primary)
  • Nasopharyngeal Cancer
  • Nasal Cavity and Sinus Cancer
  • Salivary Gland Cancer
• Each treatment regimen has its own set of risks and side effects.  The patient and doctor will discuss treatment options fully, especially how they may change how the patient looks, talks, eats, and breathes.

• As our understanding of cancer evolves, so does the way oncologists stage cancers.  As of January 1, 2018, a new staging methodology was put into place by the American Joint Committee on Cancer (AJCC), and the way head and neck cancers are now staged has changed significantly. The most dramatic changes have been made to staging for mucosal melanoma, oropharyngeal cancer, cancer with an unknown primary, and oral cancer. For example, prior to the changes instituted in 2018, most oropharyngeal cancers were classified as stage IV. Today, many of those would be considered stage I or II. We also now know that oropharyngeal cancers that are HPV positive (also called p16 positive)–that is, they contain DNA from the human papillomavirus (HPV)—have a better prognosis than those that are HPV negative.  Under the recent changes to the TNM system, there are different staging criteria for HPV-positive and HPV-negative oropharyngeal cancer.
• More than half of all sexually active people contract one or more types of HPV at one time, making it the most common sexually transmitted disease in the US.
• What is Human Papilloma Virus (HPV)?
  • The human papillomaviruses or HPVs are a group of more than 150 related viruses. The most common types are found on the skin and appear as warts seen on the hand. More than 40 of these viruses can be easily spread through direct skin-to-skin contact during vaginal, anal, and oral sex. HPV can also infect the genital areas of males and females. According to the Centers for Disease Control & Prevention (CDC), genital HPV is the most common sexually transmitted infection. There are at least 40 HPV types that can affect the genital areas. Some of these are low-risk and cause genital warts while high-risk types can cause cervical or other types of genital cancer. The high-risk HPV types may also cause head and neck cancer, also called oropharyngeal cancer, which is becoming more prevalent.
• How is throat cancer linked to HPV?
  • There are high-risk and low-risk types of HPV. The low-risk types can cause genital warts or no symptoms and do not typically cause cancer. High-risk types, especially types 16 and 18, are associated with oropharyngeal cancers (or cancers of the tonsils, base of tongue, and throat). Unfortunately, oropharyngeal cancer associated with HPV infection has increased dramatically over the past 20 years in young men and women without traditional risk factors, like smoking and drinking.
• Why is HPV-derived head and neck cancer becoming more prevalent?
  • The epidemiology of oral HPV infection is not well understood. However, HPV has long been known to be present in the genital area and to be a significant cause of cervical, vulvar, penile, and anogenital carcinoma. It is believed that an increased number of people are engaging in oral sex practices and as a result are contracting HPV in the head and neck region, resulting in a higher rate of head and neck cancers.
• What are signs and symptoms of HPV-related cancer?
  • A lump in the neck
  • Lump or sore in mouth or throat
  • Hoarseness or change in voice
  • Swallowing problems or pain
  • An earache that doesn’t go away
  • Bleeding: nose, mouth, or throat
  • Numbness
• Who is at risk for HPV infection and head and neck cancer?
  • HPV is a sexually transmitted infection, and the number of lifetime sexual partners is an important risk factor for the development of HPV-associated head and neck squamous cell carcinoma. Research has shown that:
    • The odds of HPV-positive head and neck cancer doubled in individuals who reported between one and five lifetime oral sexual partners.
    • The risk increased five-fold in those patients with six or more oral sexual partners compared with those who have not had oral sex.
  • It is important to know that HPV-positive head and neck squamous cell carcinoma has also been reported in individuals who report few or no sexual partners. Aside from high-risk HPV, other traditional risk factors for developing head and neck squamous cell carcinoma include history of tobacco or alcohol use, history of oral lesions, family history of thyroid cancer, and history of radiation therapy.
• If HPV is a sexually transmitted infection, are there other ways to contract the virus?
  • You can get HPV by having vaginal, anal, or oral sex with someone who has HPV. It also spreads through close skin-to-skin touching during sex. A person with HPV can pass the infection to someone even when they have no signs or symptoms. If you are sexually active, you can get HPV, even if you have had sex with only one person. You also can develop symptoms years after having sex with someone who has the infection.
• How should I protect myself?
  • Consistent and correct use of condoms can reduce the transmission of HPVs between sexual partners, but because there are areas not covered by a condom, infection may still occur.
  • It is recommended that girls and women between 9 and 26, and boys and men between 9 and 21 years of age should be vaccinated against HPV. Currently, there are three vaccines approved for the prevention of HPV: Gardasil® VIS*, Gardasil®9, and Cervarix®(exclusively for girls).
  • The vaccines are safe and highly effective in preventing infections with HPV types 16 and 18. Gardasil® VIS* and Gardasil®9 also prevent infection with HPV types 6 and 11, which may cause genital warts, benign tumors, or no symptoms at all. Gardasil®9 also prevents infection with HPV types 19, 31,33, 45, 52, and 58, which cause anal, cervical, vulvar, and vaginal cancers. These vaccines are one of the best ways parents can prevent cancer in their children.
  • Regularly visit your dentist or physician. Ask that they perform an oral, head, and neck exam at each visit.
  • HPV-induced head and neck cancer has been well demonstrated to respond to almost all forms of therapy, including surgery, external beam radiotherapy, and chemotherapy. New technologies have been developed that greatly improve treatment response. The use of robotic surgery can help avoid the need for radiation or chemotherapy altogether. Many large trials have also shown promise in using lower doses of radiation after robotic surgery to effectively treat this cancer, with survival rates over 90%.
• How does the robotic procedure work? What are the benefits?
  • Robotic surgery is far less invasive than non-robotic tumor surgeries, greatly minimizing complications, minimizing recovery time, and maximizing quality of life after surgery. Many studies have shown that patients treated with transoral robotic surgery may have improved quality of life, improved swallowing function, and less long-term toxicity.
• How prevalent is HPV-derived head and neck cancer?
  • In the US, HPV-associated oropharyngeal squamous cell carcinoma is one of very few cancer types that has been increasing in prevalence of the last several decades. Studies have shown that this incidence may continue to increase until the benefits of widespread HPV vaccination (in both men and women) has been reached.
• What is the long-term prognosis for people with HPV-derived head and neck cancer?
  • While the prevalence of head and neck cancer derived from HPV is steadily increasing, data suggest that it is easily treated. Patients with HPV-induced oropharyngeal cancer have a disease-free survival rate of 85-90% over five years. This is in contrast to the traditional patient population of excessive smokers and drinkers with advanced disease who have a five-year survival rate of approximately 25-40%.
• My significant other is genital HPV positive yet has no history of cervical cancer, can I get oropharyngeal cancer by kissing her or having oral sex with her?
  • Oropharyngeal cancer is only caused by certain strains of HPV. Certain low-risk strains lead to genital warts and only very specific strains (typically 16 and 18) can lead to oropharyngeal cancer. Intimacy and oral sex can cause transmission of the HPV strain that your partner has. If this is a high-risk strain, this can be a risk factor for future development of oropharyngeal cancer unless you are vaccinated.
• Do men or women get this more frequently?
  • Cases of this cancer are more frequent in men. In both the US and the UK, the incidence of oropharyngeal cancer in men has also surpassed the incidence of cervical cancer in women. However, this increased incidence can be decreased through the widespread adoption of HPV vaccination in men at a young age.
• Why are men at higher risk for this cancer?
  • Although we do not fully know why, this may be true due to differences in infection susceptibility and transmissibility. A gender disparity between the number of reported lifetime sexual partners may also be a contributing factor.
• Is there a way to determine if I am oral HPV positive?
  • Currently, there is no widespread or commonly recommended screening tool for oropharyngeal HPV.
• Who should get screened?
  • People with a history of tobacco or alcohol use, a history of oral lesions or exposure to radiation therapy, and those with 5 or more sexual partners should be screened. Symptoms to be aware of include hoarseness, pain on swallowing, difficulty swallowing, pain on chewing, a lump in the neck, or non-healing sores.
• How do I get screened for HPV- related throat cancer?
  • People who have a persistent sore throat or enlarged lymph nodes should be examined. Getting screened is quick and painless. Doctors place a very thin, flexible telescope, the size of a piece of spaghetti, with a miniature camera on its tip, into the nose to examine the throat structures, including the vocal cords.
• Where did I get HPV from?
  • It is difficult without specific DNA viral typing to determine who transmitted the virus or where the virus was acquired.
• Can the vaccine be used as treatment if I already have HPV-induced oropharyngeal cancer?
  • No. Patients with known HPV-induced oropharyngeal cancer do not appear to benefit from vaccination, as the vaccination is used for prevention, not treatment.
• What new research is ongoing to better understand and prevent HPV-derived head and neck cancer?
  • One promising area of research has been developing a “liquid biopsy” that can identify circulating tumor DNA. Clinical studies have shown that this may be able to predict treatment response for patients with oropharyngeal cancer or predict cancer recurrence. Its utility as a screening tool to identify patients at high risk for developing HPV-associated head and neck cancer is still being investigated.
• Where should I go if I want to learn more about HPV-derived head and neck cancer?
  • If you would like to learn more, please refer to the many resources below. If you think you or a loved one may be at risk, please consult your doctor.
  • HPV-related Oral, Head, and Neck Cancer Resources

• During the process of diagnosing your cancer, the cancer will be staged. Cancer staging is a way of describing the cancer. Diagnosis and staging tell us several things, including where in the body the cancer is located, the severity of the cancer (for example, by indicating the size of the primary tumor), and how far the cancer may have spread from its original location. Staging helps your medical team determine your prognosis (the predicted outcome of the disease) and identify the best treatment option for your particular cancer.
• Cancer may be staged at multiple points during the processes of diagnosis and treatment.  Your medical team may use one or more of the following types of staging:
  • Clinical Staging – This method of staging uses physical examinations, imaging (x-rays, CT scans, MRI, PET scans, etc.), and biopsies to determine the severity and extent of your cancer.
  • Pathologic Staging – This method combines the findings used in clinical staging with findings from surgery (for example, if you have a tumor removed or if your medical team does an exploratory surgery).
  • Post-Therapy Staging – This type of staging describes the severity and extent of any remaining cancer following an initial course of treatment, such as chemotherapy or radiation.
  • Re-staging – Re-staging occurs if your cancer returns following treatment.
• Staging describes four characteristics of the cancer:
  • Location of the primary tumor
  • Size or extent of the tumor
  • Whether or not the cancer has spread to lymph nodes near the tumor (e.g., in your neck)
  • Whether or not the cancer has spread to distant parts of the body (e.g., in your lungs)
• To be effective and useful, cancer staging relies on a set of standardized criteria that allow all medical professionals to have the same understanding of a particular cancer. The staging system used most often in the U.S. and around the world is the TNM Staging System developed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC).
• This system describes a patient’s cancer according to 3 categories, each with multiple grades:
  • T – This category describes the extent of the tumor
    • TX: Primary tumor cannot be evaluated
    • T0: No evidence of primary tumor
    • Tis: Carcinoma in situ (early cancer that has not spread to neighboring tissue)
    • T1-T4: Size and/or extent of the primary tumor
  • N – This category describes whether or not nearby lymph nodes are involved
    • NX: Regional lymph nodes cannot be evaluated
    • N0: No regional lymph node involvement (no cancer found in the lymph nodes)
    • N1-N3: Involvement of regional lymph nodes (number and/or extent of spread)
  • M – This category indicates whether the cancer has spread to distant parts of the body
    • M0: No distant metastasis (cancer has not spread to other parts of the body)
    • M1: Distant metastasis (cancer has spread to distant parts of the body)
• It is important to note that each type of cancer has its own classification system. Within head and neck cancer, the numbers and letters for one type do not mean the same as those for another type.  For example, in salivary gland cancer a T1 classification means the tumor is smaller than 2cm and does not involve the soft tissues. In sinus cancers a T1 classification means the tumor is confined to one site with no destruction of bone. To better understand your specific cancer stage, ask your doctor to explain it you in terms you and your family understand.
• The T, N, and M classifications are then combined to determine a stage of 0, I, II, III, or IV. While stage 0 and I cancers are the least advanced and often easiest to treat, it is important to note that higher-stage cancers can often be successfully treated as well.
• As our understanding of cancer evolves, so does the way oncologists stage cancers.  As of January 1, 2018, a new staging methodology was put into place by the American Joint Committee on Cancer (AJCC), and the way head and neck cancers are now staged has changed significantly. The most dramatic changes have been made to staging for mucosal melanoma, oropharyngeal cancer, cancer with an unknown primary, and oral cancer. For example, prior to the changes instituted in 2018, most oropharyngeal cancers were classified as stage IV. Today, many of those would be considered stage I or II. We also now know that oropharyngeal cancers that are HPV positive (also called p16 positive)–that is, they contain DNA from the human papillomavirus (HPV)—have a better prognosis than those that are HPV negative.  Under the recent changes to the TNM system, there are different staging criteria for HPV-positive and HPV-negative oropharyngeal cancer.

• Head and neck cancers may be discovered in multiple ways. A doctor or dentist may find the first evidence during a routine exam or oral, head and neck screening. For example, a swollen lymph node in the neck or an unexplainable red or white patch in the mouth may be seen. Most often, however, head and neck cancers are discovered only after a patient has sought treatment for symptoms that have become problematic. 
• When you see your primary care doctor, you should discuss any past medical history as well as risk factors you have for head and neck cancer, such as tobacco or regular alcohol use, and the specific symptoms that you’re experiencing. Your doctor will examine your mouth, head, and neck for lumps, bumps, changes to your mouth or throat, or any problems with the nerves in and around these areas. If he or she feels you need further evaluation, you will likely be referred to an ear, nose, and throat specialist (also called an otolaryngologist) or head and neck surgeon.
• The ear, nose, and throat specialist (ENT) will perform a thorough head and neck exam. Because some parts of your throat are difficult to see, he or she may perform a pharyngoscopy. This procedure can be done in the office and does not require anesthesia. The ENT may use small, long-handled mirrors to see the deeper portions of your throat, the base of your tongue, and portions of the voice box. Alternatively, a tiny, flexible fiber-optic scope may be passed through your nose to examine areas that cannot be seen by eyes or mirrors, including the area behind the nose or the rest of your throat and voice box.
• If further investigation is required, your ENT will perform additional tests, which may include:
  • Panendoscopy – This procedure is done under general anesthesia. The doctor will use scopes to thoroughly examine the throat, voice box, esophagus (tube leading to the stomach), trachea (windpipe), and bronchi (airways leading from the trachea into the lungs).
  • Biopsy – In a biopsy, a sample of tissue is removed from the suspected tumor. The tissue is then examined for the presence of cancer or dysplasia (precancerous changes). Biopsies are examined in a lab by a pathologist who is specialized in cancer diagnosis. He or she is trained to distinguish between cancer cells and normal cells, as well as the type of cancer, based on the cells’ appearance. Depending on the specific situation, one or more types of biopsy may be used.
    • Exfoliative cytology – The doctor collects cells from the area of the suspected cancer by scraping it with a small tool. The cells are spread onto a glass slide and examined under a microscope to look for abnormalities.
    • Incisional biopsy – A piece of tissue is cut from the area of the suspected cancer. Depending on where the suspected cancer is located, this procedure may be done in the doctor’s office (the area will be numbed first) or in the operating room while you are asleep.
    • Fine needle aspiration (FNA) – The doctor uses a thin, hollow needle and syringe to remove cells from the suspected tumor. The cells are then examined under a microscope. This type of biopsy is typically used to examine lymph nodes or lumps in the neck.
  • HPV Testing – Tissues from a biopsy that are shown to be squamous cell carcinoma, especially when taken from the tonsil or the base of the tongue, are often tested for a genomic marker called p16, which is a sign that the cancer may be related to an HPV infection. HPV-related (p16+) cancers have been found to be significantly more responsive to treatment than those lacking p16.
  • Imaging Tests – Your doctor may order imaging tests at different times during your diagnosis and treatment to look for a suspect tumor, to see if cancer has spread, to see if treatment is working, or to look for recurrence of cancer after treatment. Many different types of imaging can be used, including:
    • Chest x-rays – These images are used to see if cancer has spread to the lungs.
    • CT Scan – These images provide a detailed view of your organs and soft tissue. They allow your doctor to see the location of any tumors, whether a tumor is growing into nearby tissue or whether the cancer has spread to lymph nodes, lungs, or other organs. CT images also provide a detailed assessment of facial bones to see if they are affected by cancer.
    • MRI – These images are useful in examining the neck and brain, as well as the extent that a tumor extends into soft tissue, such as muscle and fat or along nerves.
    • PET Scan – PET scans are useful when cancer has already been diagnosed. They can help doctors see if cancer has spread to lymph nodes or other areas of the body, and it is especially useful if your doctor suspects the cancer may have spread but isn’t sure where. During a PET scan, sugar that contains a low level of radiation will be injected into your blood. Cancer cells will absorb more of this sugar than normal cells, making them more apparent on the images.

• The term “head and neck cancer” describes malignant (cancer) tumors that develop in or around the throat, voice box, nose, sinuses, and mouth. It generally does not include other malignant tumors that can occur in the head and neck area but comes from the skin or thyroid gland. The most common type of head and neck cancer is squamous cell carcinoma (around 90%). 
• Worldwide, head and neck cancers account for approximately 900,000 cases and over 400,000 deaths annually. In the United States, head and neck cancer accounts for 4% percent of all malignancies, with approximately 66,000 cases annually and 15,000 deaths yearly. Head and neck cancers are nearly twice as common among men as they are among women. Head and neck cancers are more often diagnosed in people over age 50.
• Read more at the National Cancer Institute
• What causes cancers of the head and neck?
  • Alcohol and tobacco use (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx. At least 75 percent of head and neck cancers are caused by tobacco and alcohol use. People who use both tobacco and alcohol are at greater risk of developing these cancers than those who use tobacco or alcohol alone. Tobacco and alcohol use are not risk factors for salivary gland cancers.
  • Infection with cancer-causing types of human papillomavirus (HPV), especially HPV-16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue. In the United States, the incidence of oropharyngeal cancers caused by HPV infection is increasing, while the incidence of oropharyngeal cancers related to other causes is falling.
  • Learn more with the HNCA infographic on head and neck cancer risk factors

• Specific Risk Factors
  • Paan (betel quid)
    • 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 of oral cancer.
  • Maté
    • Consumption of maté, 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.
  • Preserved or Salted Foods
    • Consumption of certain preserved or salted foods during childhood is a risk factor for nasopharyngeal cancer.
  • Oral Health
    • Poor oral hygiene and missing teeth may be weak risk factors for cancers of the oral cavity. Use of mouthwash that has a high alcohol content is a possible but not proven risk factor for cancers of the oral cavity.
  • Occupational Exposure
    • Occupational exposure to wood dust is a risk factor for nasopharyngeal cancer. Specific industrial exposures, including exposures to asbestos and synthetic fibers, have been associated with cancer of the larynx, but the increase in risk remains controversial. People working in certain jobs in the construction, metal, textile, ceramic, logging, and food industries may have an increased risk of cancer of the larynx. Industrial exposure to wood or nickel dust or formaldehyde is a risk factor for cancers of the paranasal sinuses and nasal cavity.
  • Radiation Exposure
    • Radiation to the head and neck, for noncancerous conditions or cancer, is a risk factor for cancer of the salivary glands.
  • Epstein-Barr Virus Infection
    • Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.
  • Ancestry
    • Asian ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer.

The signs and symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat or ear pain that does not go away (especially if just on one side), difficulty in swallowing, and a change or hoarseness in the voice. These symptoms may also be caused by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms. Symptoms that may affect specific areas of the head and neck include the following:

• Mouth – Signs and symptoms of mouth or oral cavity cancer can include any of the following
  • A white or red patch on the gums, tongue, or lining of the mouth
  • A sore or ulcer that does not heal within 1-2 weeks
  • Swelling of the jaw or roof of mouth
  • Loose teeth
  • Changes in how your dentures fit 
  • Bleeding 
  • Persistent pain in the mouth
  • Numbness of the tongue or the skin of the chin 
  • Changes in speech or swallowing 
  • Foul smell in the mouth or persistent bad breath 
  • Weight loss
  • Neck mass 
  • Trismus or difficulty opening your mouth
• Back of throat – Signs and symptoms of throat cancer can include any of the following
  • Throat pain, especially pain that is just on one side
  • Ear pain, especially pain that is just on one side
  • Difficulty swallowing or painful swallowing
  • Changes in speech
  • Weight loss
  • Bleeding
  • Neck mass 
  • Difficulty breathing
  • Voice box
  • Nose and sinuses
  • Spit glands
• Voice Box – Signs and symptoms of throat cancer can include any of the following
  • Hoarseness or voice changes 
  • Coughing or choking when eating 
  • Difficulty swallowing or painful swallowing 
  • Difficulty breathing or noisy breathing 
  • Coughing up blood  
  • Ear pain, especially pain that is just on one side 
  • Weight loss
  • Neck mass
• Nose and Sinuses – Signs and symptoms of nose and sinus cancer can include any of the following
  • Nasal obstruction/difficulty breathing through your nose
  • Facial pressure or pain 
  • Nose bleeds 
  • Face or cheek numbness
  • Vision changes, especially new blurry or double vision or eye swelling 
  • Difficulty hearing, especially just on one side 
  • Swelling of the cheek or the roof of the mouth, pain in the upper teeth 
  • Foul smell in the nose
  • Weight loss
  • Neck mass
• Spit Glands – Signs and symptoms of spit gland cancer can include any of the following
  • Swelling or a mass under the jaw or around the ear (typically in front of the ear or just under the earlobe) 
  • Facial weakness on one side 
  • Facial numbness on one side 
  • Pain, especially one-sided ear, jaw, or neck pain
  • Weight loss