Weighing the Role of Stage, Tumor Size, Location, and Treatment Response in Survival Rate

By Maxine Lipner 

Published on August 16, 2023

 Medically reviewed by John Carew, MD

With head and neck cancer, the malignancy (cancer) usually starts in squamous cells.¹ These cells are part of the pink mucosal lining in areas such as the inside of your mouth, your throat, and your voice box.

Head and neck cancers forming squamous cell carcinomas can be found in the oral cavity, throat, voice box, paranasal sinuses, and nasal cavity. Less commonly, head and neck tumors may arise in other types of tissues, such as those of the salivary glands.¹

The size of the tumor and how early it is found can play a pivotal role in the outcome. Detecting the cancer before it has had a chance to spread is likely to give the best prognosis.

In this article, you will learn symptoms to note, treatments that can help, complementary therapies to ease treatment side effects, ways to lower your risk of developing head and neck cancer, and more.

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Symptoms of Head and Neck Cancer

Head and neck cancer symptoms will likely be linked to the type of cancer you have. Here are some of the first warning signs to look out for in each case.²

Laryngeal

Laryngeal cancer affects the voice box. Signs of laryngeal cancer include:³

• Hoarseness or other vocal changes

• Trouble swallowing (dysphagia)

• Trouble breathing

• A lingering sore throat

• A swollen area in the neck

• Ear pain

• Unexplained weight loss

Mouth

The tongue, lips, gums, roof of the mouth, or inside of the cheeks can be affected in mouth (oral) cancer. This form of head and neck cancer is the most common. Symptoms to watch for are:⁴

• Sores or ulcers on the gums, tongue, or inside of the cheeks that won't heal

• Pain or unusual bleeding in the mouth

• A swollen jaw

• Denture issues

 Oral Cancer on Gums

Nasal and Sinus

Any cancer in this area involves the area in your nose, just beyond where the roof of your mouth is, or the sinuses located in the forehead and cheekbones. Signs of nasal and sinus cancer include:²

• Difficulty with sense of smell

• Blocked nose, particularly if just on one side

• Bloody nose for no reason

• Postnasal drip (down the throat from the nose)

Keep in mind that these signs may also simply point to a cold or a common sinusitis infection.

Nasopharynx

This rare type of cancer involves the area that links the mouth to the back of the nose. Signs that can point to nasopharyngeal cancer include:⁵

• Difficulty breathing due to a clogged nose

• Trouble hearing (usually out of one ear)

• Nosebleeds

• Finding a lump in the neck because of cancer spreading to the lymphatic system

• Repeated ear infections

• Headaches

• Pain or numbness in the face

Salivary Gland

Keeping your mouth moist is the job of the salivary glands, which make the needed saliva. You also rely on saliva to make swallowing easier and help digest food.

All salivary glands are not the same. There's a pair between your ears and your cheeks (parotid glands), some situated beneath your tongue (sublingual glands), and some on either side of the jawbone (submandibular glands).

Usually, it's the parotid glands near your cheeks that are affected. The key symptom is swelling around your mouth, neck, or close to your jaw.⁶ The good news is that even if you do find a lump, it is often not malignant.

Other symptoms can include:⁶

• Ongoing pain in the mouth, cheek, ear, jaw, or neck

• Facial numbness

• Dysphagia

• Weak facial muscles on one side

• New differences in the size or shape of one side of your face or neck.

Throat

Throat cancer may be referred to as cancer of the hypopharynx (the lower area of the throat involving the windpipe and gullet), nasopharynx (the area at the back of the mouth, which links to the back of the nose), or the oropharynx (the throat portion at the back of the mouth).

Signs of throat cancer include:³

• Trouble swallowing

• A lingering sore throat

• A lump in the area

Diagnosing Head and Neck Cancer

If head and neck cancer is suspected, your healthcare provider will perform a physical examination coupled with testing. You can expect to undergo the following:⁷

• Endoscopy: A lighted tube with a camera is inserted through the nose or mouth into the area where the tumor is located.

• Biopsy: A sample tissue is removed from the tumor and evaluated under a microscope.

• Human papillomavirus (HPV) testing: HPV infection is a risk factor for some types of cancer. In throat cancer, those who are HPV-positive tend to have better outcomes than those who are not. They may be able to undergo less intensive treatments, with fewer side effects.

• Diagnostic imaging: This can include throat X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), positron-emission tomography (PET) scans, and an X-ray known as a Panorex that shows the full jaw and sinuses.

• Genetic testing of tumor cells: This looks for mutations in the cancer cells to help distinguish the type of cancer and guide treatment options with targeted drugs.

Head and Neck Cancer Staging

To help determine what to do about head and neck cancer, your oncologist (cancer specialist) will likely stage the cancer. Here's how this works:⁸

• The cancer is considered localized if it remains in the same area that it started.

• It is considered regional if it is now found in nearby lymph nodes.

• It is called distant if it has reached other parts of the body.

Such staging will help determine the kind of treatment you receive and also how effective that treatment may ultimately be. For example, with lip cancer, when it is still local, the five-year survival rate is 94%; when it is regional, it is 63%. The earlier head and neck cancer is caught, the better the likely outcome.⁹

Other Forms of Head and Neck Cancer

Also considered head and neck cancer, are any cancerous skin lesions such as scalp cancer and those on the face and neck. Likewise, tumors found on the thyroid and parathyroid are also included here.¹⁰

Treatment Plan for Each Type of Head and Neck Cancer

Treatment will vary somewhat depending on the head and neck cancer type. The good news is that early-stage head and neck cancers are considered highly curable, sometimes even with just one treatment type.¹¹ The five-year survival rate after early treatment is between 70% and 90%.¹²

While your treatment will be tailored to you, here are the approaches typically used.

Laryngeal and Hypopharyngeal Treatment

If you have either laryngeal or hypopharyngeal cancer, you will likely need to undergo one of the following treatments or a combination of these to remove or destroy the cancer cells:¹³

• Surgery (commonly performed)

• Radiation (commonly given): High-energy beams or particles are used to kill cancer

• Chemotherapy or other medication (commonly given)

Mouth Treatment

For cases of mouth or oropharyngeal cancer, your oncologist will likely recommend the following approaches:¹⁴

• Surgical removal of the tumor

• Radiation therapy

• Chemotherapy with one agent or a combination

Nasal and Sinus Treatment

With nasal and sinus cancer treatment, you may undergo the following depending on the amount of progression:¹⁵

• Surgery to remove the tumor is commonly done. Lymph nodes may also be removed to see if the cancer has spread there. If it has, your oncologist may remove lymph nodes on both sides of your neck in what's termed a modified radical or radical neck dissection.

• Radiation therapy may be used to treat small tumors of the nasal cavity, usually if the cancer remains local. This may be used after surgery to mop up lingering cancer cells or combined with chemotherapy to shrink tumors before surgery and make them easier to handle.

• Chemotherapy is given in conjunction with surgery or radiation therapy. Usually, this is used if cancer has spread or returned or it is given together with radiation therapy if the cancer is advanced but still confined locally.

Nasopharyngeal Cancer Treatment

The treatment will vary depending on how early nasopharyngeal cancer is found and where it has spread. You may undergo the following treatments:¹⁶

• Radiation therapy can cure most early nasopharyngeal cancer that has not yet spread elsewhere.

• Chemotherapy may be used in cases where this has spread to the lymph nodes in the neck or to other parts of the body.

• Chemoradiation therapy, where both radiation and chemotherapy are given together, may be recommended if cancer has been detected in the nearby lymph nodes or is found in the tissue around the nasopharynx.

• Surgery is usually not done in this area since it is surrounded by important nerves and blood vessels, and the tumors typically respond well to other treatments. But lymph nodes may be surgically removed.

Salivary Gland Cancer Treatment

The treatment selected for salivary gland cancer will depend on how far it has progressed. You may have the following options:¹⁷

• Surgery alone may be possible. But other treatment may be warranted if the cancer is in a deeper part of the gland where it's harder to get to or if it has spread to the lymph nodes.

• Radiation therapy may be used if the tumor is difficult to reach, the tumor can't be completely surgically removed, or your health is such that it's unsafe to be under anesthesia for a prolonged period.

• Chemotherapy to kill the cancer cells will be used if the tumor has spread to other parts of the body or has returned after other treatment.

Throat Cancer Treatment

The approach to treat your throat cancer will depend on tumor size and how far this has progressed. You may be given the following options:¹⁸

• Surgery may be an option if the tumor is small enough. But if the cancer is advanced, surgical tissue removal may impact your ability to chew, swallow, speak, or breathe, and other options may be tried.

• Radiation therapy may be a primary therapy if the tumor is small enough. This approach may also be used for advanced tumors in combination with surgery or chemotherapy.

• Chemotherapy may be given together with radiation in advanced cases.

Head and Neck Cancer Side Effects

You may contend with side effects while undergoing various head and neck cancer treatments. Here's what may occur for each type of treatment.

Radiation therapy may damage normal cells in addition to killing the cancer. While the normal cells may eventually recover, in the meantime, you may find yourself dealing with side effects such as the following:¹⁹

• Mouth sores

• Dryness

• Thickened saliva

• Taste issues, including possible metallic taste or reduction or loss of tasting ability

• Large amounts of mucus

• Cavities in teeth

• Infections affecting the gums, teeth, or tongue

• Jaw problems

• Pain in the mouth or throat

• Skin issues like peeling

Chemotherapy may produce the following side effects:²⁰

• Diminished appetite

• Fatigue

• Hearing issues

• Neuropathy (nerve damage)

When surgery is used to remove a head or neck tumor, any side effects will depend on the location and the extent of the surgery. Here are the potential issues you may encounter:²¹

• Trouble chewing or swallowing, and possibly need a feeding tube inserted

• Temporary or permanent changes in your voice

• Shoulder stiffness from lymph node removal

• Fluid buildup from lymphedema

• Diminished thyroid gland function if the larynx is removed

• Difficulty breathing

• Hearing loss

• Potential facial disfigurement (depending on where the tumor is located), which may be remedied with reconstructive surgery.

Recurrent Head and Neck Cancer

In some cases, treatment may initially appear successful, with no signs of the cancer remaining. This is known as remission. But the cancer may return, and if it does so in the same area as before, it's known as recurrent cancer. It may involve many of the same treatment options as before, or your oncologist may recommend entering a clinical trial.²¹

Complementary Head and Neck Cancer Therapies

If you are undergoing treatment for head and neck cancer, keep in mind that other approaches may help you better manage side effects and improve your mood. Some therapies that you may want to consider include:²²

• Relaxation techniques or meditation

• Undergoing massage

• Receiving acupuncture

What Causes Head and Neck Cancer

While anyone can get head and neck cancer, usually, the occurrence is linked to other factors. Tobacco and alcohol use are key risk factors for developing this type of cancer.⁴ That includes tobacco that's either chewed or smoked.

Also, in about 70% of cases, cancer of the oropharynx has been associated with having contracted the human papillomavirus.⁴ Likewise, the Epstein-Barr virus has been linked to an increased risk for cancer in the nose, behind the nose, or in the salivary glands.

Ultraviolet (UV) rays—whether from the sun, a tanning bed, or a sunlamp—can increase the risk of lip cancer. Also, anyone who has undergone radiation treatment targeting either the head or the neck is at increased risk of head and neck cancer.⁴

Where you work may also matter. If you are exposed to substances such as formaldehyde, asbestos, wood dust, or nickel, among other things, you are at heightened risk.⁴

Head and neck cancer is diagnosed in men twice as often as in women.⁴ (Note that the terms for sex or gender used in this article come from the cited source.) Also, anyone over age 50 is in a higher risk category.

Lowering Head and Neck Cancer Risk

Taking the following measures may help you lower your risk of head and neck cancers:⁴

• Avoid tobacco use (in any form).

• Keep any alcoholic beverage drinking to a minimum.

• Do not use tanning beds.

• Consider getting an HPV vaccination if you are eligible.

Self-Care With Head and Neck Cancer

You will experience many emotions when diagnosed with head and neck cancer. It's not unusual to feel as if you are at the mercy of the healthcare providers and the disease. But some self-care options can ease stress and help put you back in control. Here are 10 things to try:²³

• Prioritize quiet time.

• Explore your emotions with journaling.

• Ask about aromatherapy. A nurse may be able to bring you dispensers with scents such as lavender, peppermint, or ginger during a treatment.

• Prioritize eating nourishing foods.

• Get moving. Light exercise, approved by your healthcare provider, may help reduce stress.

• Enjoy a massage.

• Get enough rest.

• Do things that fulfill you, like reading a good book or engaging in a craft project.

• Spend time with those who fill you up, like those closest to you.

• Don't be afraid to say no to things you'd rather not do.

Support for People With Head and Neck Cancer

In addition to getting the right treatment to fight the disease, it's important to assemble other support. Here are some organizations that can assist you or your family members to get needed help:²⁴

• Support for People with Oral and Head and Neck Cancer (SPOHNC): This offers information on the latest clinical trials and will match you with a survivor volunteer who knows what you're going through.

• The Oral Cancer Foundation (OCF): Among other resources, the OCF has the largest oral cancer patient support group available, with over 13,000 members. It also offers valuable information, including podcasts, frequently asked questions, coping tips, and advice for family members who have lost a loved one.

• Cancer Care: This offers everything from support groups and counseling to educational workshops and financial assistance.

• American Cancer Society: Here, you can connect with other cancer survivors and potentially receive free rides to treatment, as well as free lodging, among other services.

Summary

Head and neck cancer includes those of the mouth, throat, voice box, nasal cavity, sinuses, and salivary glands. Swelling or a lump in the area is a common symptom. It's important to be alert for symptoms and to catch this in the early stages to stop the cancer.

Head and neck cancer risk can be elevated due to alcohol and tobacco use and some infections. Treatment typically involves surgery, radiation, and chemotherapy. Head and neck cancer is highly curable if treatment is done early enough.