Head and Neck Cancer

Head and Neck Cancer

Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body).
Head and neck cancer is a term used to describe a range of malignant tumors that can appear in or around the throat, larynx (voice box), nose, sinuses, and mouth.
Most head and neck cancers are squamous cell carcinomas, meaning they begin in the flat, squamous cells that make up the thin, surface layer (called the epithelium) of the structures in the head and neck. Directly beneath this lining, some areas of the head and neck have a layer of moist tissue, called the mucosa. If a cancer is limited to the squamous layer of cells, it is called carcinoma in situ. If the cancer has grown beyond this cell layer and moved into deeper tissue, then it is called invasive squamous cell carcinoma. If the cancer starts in the salivary glands, the tumor will usually be classified as an adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma; each is a rare type of cancer.
Types of head and neck cancer
There are five main types of head and neck cancer, named by the part of the body where they begin. For more information on each type, select a name below.
Laryngeal and Hypopharyngeal Cancer: The larynx (commonly called the voice box) is a tube-shaped organ in the neck that is important for breathing, talking, and swallowing. It is located at the top of the windpipe, or trachea. Meanwhile, the hypopharynx (also called the gullet) is the lower part of the throat that surrounds the larynx.
Nasal Cavity and Paranasal Sinus Cancer: The nasal cavity is the space just behind the nose where air passes on the way to the throat, while the paranasal sinuses are the air-filled areas that surround the nasal cavity.
Nasopharyngeal Cancer: The nasopharynx is the air passageway at the upper part of the throat behind the nose.
Oral and Oropharyngeal Cancer: The oral cavity includes the mouth and tongue, while the oropharynx includes the middle of the throat from the tonsils to the tip of the voice box.
Salivary Gland Cancer: The salivary gland is tissue that produces saliva, which is the fluid that is released into the mouth to keep it moist and that contains enzymes that begin breaking down food.
Other types of cancer may be located in this area of the body, but the diagnosis and treatment are much different, so they are addressed separately on this website. Information on thyroid cancer, parathyroid cancer, and brain tumors is available in separate sections on Cancer.Net.
Find out more about basic cancer terms used in this section.
Statistics

Head and neck cancer accounts for about 3% to 5% of all cancers in the United States. This year, an estimated 52,610 people (38,380 men and 14,230 women) will develop head and neck cancer, and an estimated 11,500 deaths (8,320 men and 3,180 women) will occur.
Cancer statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with head and neck cancer. Learn more about understanding statistics.
Statistics adapted from the American Cancer Society’s publication,Cancer Facts & Figures 2012.
Risk Factors and Prevention

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop the disease, while others with no known risk factors do. However, knowing your risk factors and talking about them with 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), which 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. Recent research suggests that people who have used marijuana may be at higher risk for head and neck cancer. Secondhand smoke may also increase a person’s risk of head and neck cancer.
Other factors that can raise a person’s risk of developing head and neck cancer include the following:
Prolonged sun exposure. This is especially linked to cancer in the lip area (as well as skin cancer of the head and neck and other chronically sun-exposed areas, such as the hands).
Human papillomavirus (HPV). Research indicates that infection with this virus is a risk factor for head and neck cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. Learn more about HPV and cancer.
Epstein-Barr virus (EBV). Exposure to EBV, which is more commonly known as the virus that causes mononucleosis, plays a role in causing nasopharyngeal cancer to develop.
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 as a factor that may increase the risk of head and neck cancer.
Environmental/occupational inhalants. 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.
Prevention
Although some of the risk factors of head and neck cancer cannot be changed, such as age, several can be avoided by making lifestyle changes. Stopping the use of all tobacco products is the most important thing a person can do, even for people who have been smoking for many years. Other steps that can reduce the risk of head and neck cancer include:

• Avoiding alcohol
  
  
• Avoiding marijuana (Discuss marijuana as a risk factor with your doctor.)
  
  
• Using sunscreen regularly, including lip balm with an adequate sun protection factor (SPF)
  
  
• Reducing your risk of HPV infection by limiting the number of sex partners, because having many partners increases the risk of HPV infection. Using a condom cannot fully protect you from HPV during sex.
  
  
• 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 cleaned and rinsed thoroughly every day.

Symptoms and Signs

People with head and neck cancer often experience the following symptoms or signs. Sometimes, people with head and neck cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.

• Swelling or sore that does not heal (the most common symptom)
  
  
• Red or white patch in the mouth
  
  
• Lump, bump, or mass in the head or neck area (with or without pain)
  
  
• Persistent sore throat
  
  
• Foul 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 (mucus discharged in mouth from respiratory passages)
  
  
• 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. Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. 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 people who routinely drink alcohol or currently use tobacco products or have used them in the past.
In fact, people who use alcohol or 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, the doctor will recommend a more extensive examination using one or more of the procedures mentioned in Diagnosis.
If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.
Diagnosis

Doctors use many tests to diagnose cancer and find out 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
  
  
• Type of cancer suspected
  
  
• Severity of symptoms
  
  
• Previous test results

If a person has symptoms and signs of head and neck cancer, the doctor will take a complete medical history, noting all symptoms and risk factors. In addition, the following tests may be used to diagnose head and neck cancer:
Physical examination/blood and urine tests. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. Also, the doctor will inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and a mirror for a clearer view. Blood and urine tests may be performed to help diagnose cancer. Testing for viral infections, including HPV, may also be done.
Endoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is inserted through the mouth and down the esophagus to examine the head and neck areas. The examination has different names depending on the area of the body that is examined, such as laryngoscopy (larynx), pharyngoscopy (pharynx), or a nasopharyngoscopy (nasopharynx). When these procedures are combined, they are sometimes referred to as a panendoscopy.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
Fine needle aspiration. In this type of biopsy, cells are withdrawn using a thin needle inserted directly into the tumor. The cells are examined under a microscope for cancer cells (called cytologic examination).
X-ray. An x-ray is a way to create a picture of the structures inside of your body, using a small amount of radiation. A barium swallow may be required to identify abnormalities along the swallowing passage. A special type of barium swallow called a modified barium swallow may be needed to evaluate difficulties. A dentist may also take x-rays of the teeth and mandible and maxilla, including a panorex (panoramic view). If there are signs of cancer, the doctor may recommend a computed tomography (CT) scan.
Panorex. This is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect cancer or to evaluate teeth before radiation therapy or chemotherapy.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. A contrast medium may be injected into a patient’s vein to create a clearer picture.
Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.
Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. This test may be done to see if cancer has spread to the bones.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
Learn more about what to expect when having common tests, procedures, and scans.
After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer.
Staging

Staging is a way of describing cancer, such as where it is located, if or where it has spread, and whether 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 all of the tests are finished. 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 cancer.
One tool that doctors use to describe the stage is the TNM system. This system judges three factors: 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 is a different staging system for each type of head and neck cancer; detailed information about staging for each head and neck cancer can be found in the specific cancer type section (see Overview.)
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.
Treatment

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current Research sections.
Treatment overview

Many cancers of the head and neck can be cured, especially if they are found early.
Although curing the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When they plan treatment, doctors consider how treatment might affect a person’s quality of life, such as how a person feels, looks, talks, eats, and breathes.
Head and neck cancer specialists often form a multidisciplinary team to care for each patient, and an evaluation should be done by each doctor or the team before any treatment begins. The team may include medical and radiation oncologists; surgeons; otolaryngologists (ear, nose, and throat doctors); plastic (reconstruction) surgeons; maxillofacial prosthodontists (specialists who perform restorative surgery in the head and neck areas); dentists; physical therapists; speech pathologists; audiologists (hearing experts); psychiatrists; nurses; dietitians; and social workers. It is extremely important to create comprehensive treatment plan before treatment begins, and people may need to be seen by multiple specialists before a treatment plan is fully developed.
In addition, evaluation may include testing for HPV infection. As outlined in the Risk Factors section, HPV has been linked to a higher risk of head and neck cancer. In some cases, whether a person has HPV can also be a factor in determining which treatments are likely to be most effective.
Descriptions of the most common treatment options for head and neck cancer are listed below.
There are three main treatment options: surgery, radiation therapy, and chemotherapy. One of these therapies, or a combination of them, may be part of a person’s treatment plan. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Learn more about making treatment decisions.
Surgery
During surgery, the doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it (called a margin). A surgical oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is to remove all of the tumor and leave negative margins (no trace of cancer in the healthy tissue). Laser technology may be used to treat early-stage tumors, especially in larynx cancer. If the doctor suspects that the cancer has spread, 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 treatments might be necessary. For example, surgery may be followed by radiation treatment and/or chemotherapy to destroy cancer cells that cannot be removed during surgery.
Depending on the location, stage, and 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 affected tissues. If the surgery requires major tissue removal (for example, removing the jaw, skin, pharynx, or tongue), reconstructive or 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 help the patient relearn how to swallow and communicate using new techniques or special equipment. Learn more about rehabilitation.
Side effects of surgery depend on the type and location of the surgery, and each patient is encouraged to talk with their doctor about side effects expected from the specific surgery and how long the side effects are likely to last. Common side effects from head and neck surgery include temporary or permanent loss of normal voice or impaired speech; difficulty chewing or swallowing, which may require a tube inserted in the stomach for feeding purposes; hearing loss; or decreased functioning of the thyroid gland, especially after a total laryngectomy (the removal of the larynx) and/or radiation therapy. Another potential side effect is swelling of the mouth and throat area, making it difficult to breathe. In such cases, patients may receive a temporary tracheostomy (a hole in the windpipe) to make breathing easier. Meanwhile, some people experience facial disfigurement from surgery. Reconstructive surgery may be required to maintain appearance or body functions, such as chewing, swallowing, or breathing. Talking with your doctor about what to expect and how recovery will be handled can help you cope with side effects.
Learn more about cancer surgery.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. It can be the main treatment for head and neck cancer, or it can be used after surgery to destroy small pockets of cancer that cannot be removed surgically. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.
Specific types of external-beam radiation therapy include intensity-modulated radiation therapy (IMRT), which allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells and causing fewer side effects. Proton therapy (also called proton beam therapy) is another type of external-beam radiation therapy, using protons rather than x-rays. At this time, however, proton therapy is not a standard treatment option for most head and neck cancers.
When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
Before beginning radiation treatment for any head and neck cancer, patients should receive a thorough examination from an oncologic dentist (a dentist experienced 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. Learn more about dental health during cancer 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.
In addition to dental problems, radiation therapy to the head and neck may cause redness or skin irritation in the treated area, swelling, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, and/or sore throat. Other side effects may include short- and long-term pain or difficulty swallowing; 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, and 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. This may be treated with hormone therapy. Every patient who receives radiation therapy to the neck area should have his or her thyroid checked regularly. Patients are encouraged to talk with their health care teams about what to expect from side effects of radiation therapy before treatment begins, including how these side effects can be prevented or managed.
Learn more about radiation therapy.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.
Targeted therapy
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells, usually leading to fewer side effects than other cancer medications.
Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. For head and neck cancers, targeted therapies against a tumor protein called epidermal growth factor receptor (EGFR) may be used. Learn more about targeted treatments.
Recurrent head and neck cancer
Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear.
If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.
People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.
Metastatic head and neck cancer
If cancer has spread to another location in the body, it is called metastatic cancer.
Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.
Your health care team may recommend a treatment plan that includes a combination of surgery, radiation therapy, chemotherapy, and targeted therapy.
In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time.
If disease-directed treatment is not successful, this may also be called advanced cancer. This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Learn more about advanced cancer care planning.
Find out more about common terms used during cancer treatment.
About Clinical Trials

Doctors and scientists are always looking for better ways to treat patients with head and neck cancer. To make scientific advances, doctors create research studies involving people, called clinical trials.
Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments, such as new chemotherapy, before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating head and neck cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with head and neck cancer.
Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.
To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
For specific topics being studied for head and neck cancer, learn more in the Current Research section.
Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trials ends, and/or if the patient chooses to leave the clinical trial before it ends.
Side Effects

Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur.
Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section.
Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them.
Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with head and neck cancer. Learn more about caregiving.
In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. For many patients, a diagnosis of head and neck cancer is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team, who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your medical care.
A side effect that occurs more than five years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor.
After Treatment

After treatment for head and neck cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. If radiation therapy was used, your doctor may recommend regular thyroid gland checkups, through blood tests.
Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may receive physical therapy to maintain movement and the range of movements and speech therapy to regain skills, such as talking and swallowing. Proper evaluation and treatment may often prevent long-term speech and swallowing problems. Supportive care to manage symptoms and maintain nutrition during and after treatment may be recommended. Some people may need to learn new ways to eat or to have foods prepared differently.
People may look different, feel tired, and be unable to talk or eat the way they used to. Many people experience depression. The health care team can help people adjust and connect them with support services. Support groups may help people cope with changes following treatment.
ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.
People recovering from head and neck cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.
Find out more about common terms used after cancer treatment is complete.
Current Research

Doctors are working to learn more about head and neck cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.
New medications. Many studies are underway investigating new types of cancer medications to treat head and neck cancers.
Combined therapies. Most research for head and neck cancers focuses on combining different types of treatments to improve the effectiveness and the patient’s quality of life.
Radiofrequency thermal ablation (RFA). Used on a localized tumor that cannot be removed by surgery, RFA is a minimally invasive treatment option that applies heat to the tumor.
Gene therapy. Gene therapy is a targeted form of treatment that uses biologic gene manipulation to change bits of genetic code in a person’s cells. Although gene therapy is relatively new, it appears to show promising potential for treating head and neck cancer.
Photodynamic therapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor that stays longer in cancer cells than in normal cells. A laser is directed at the tumor, which destroys the cancer cells. Photodynamic therapy is currently used to relieve swallowing problems for a brief period; it is not a curative therapy.
Proton therapy. Proton radiation therapy can be used as a boost (part of treatment) to reduce normal tissue toxicity. It can be used as part of the treatment for some skull-base tumors—including nasopharynx; chordoma, a rare tumor that usually occurs in the spine and base of the skull; and chondrosarcoma, a cartilage-based tumor—to further limit the radiation dose to normal structures, such as the optic (eye) nerves and brainstem.
HPV. Research continues regarding the link between HPV and head and neck cancers, evaluating both why this virus raises the risk for the disease and why it may affect treatment results in some cases. Investigation is also underway about whether the HPV vaccine, currently used to prevent cervical, vaginal, vulvar, and anal cancers is effective in preventing head and neck cancers, as well.
Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current head and neck cancer treatments in order to improve patients’ comfort and quality of life.
Learn more about common statistical terms used in cancer research.
Looking for More about Current Research?
If you would like additional information about the latest areas of research regarding head and neck cancer, explore these related items:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.
  
  
• Read ASCO’s latest Clinical Cancer Advances report (PDF), which highlights top research findings over the past year.

Or, choose “Next” (below, right) to continue reading this detailed section.
Questions to Ask the Doctor

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you.

• What is the exact type of head and neck cancer that I have?
  
  
• Where is the tumor located?
  
  
• Can you explain my pathology report (laboratory test results) to me?
  
  
• Is it important to determine if I have HPV? Why?
  
  
• What are the treatment options?
  
  
• What clinical trials are open to me?
  
  
• What treatment plan do you recommend? Why?
  
  
• If surgery is needed, will it be necessary to have a reconstruction done to replace lost tissue (mandible)?
  
  
• If surgery is needed, will there be a need for a neck dissection (removing lymph nodes)? If so, what type of dissection will be done? What does this mean?
  
  
• Should I get an additional consultation or second opinion?
  
  
• Who will be part of my health care team, and what does each member do?
  
  
• Can you recommend an oncologic dentist?
  
  
• Should I see a speech pathologist prior to treatment?
  
  
• Who will be coordinating my overall treatment and follow-up care?
  
  
• What are the possible side effects of this treatment, both in the short term and the long term?
  
  
• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  
  
• If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  
  
• What follow-up tests will I need, and how often will I need them?
  
  
• What support services are available to me? To my family?

Patient Information Resources

In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease.
View organizations that offer information on this specific type of cancer.