The diagnosis depends on where the cancer starts.
Head and neck cancer is an umbrella term for the different types of cancers that can start in the mouth, nose, and throat. Usually, though not always, this cancer affects the flat squamous cells that line these mucosal surfaces (this is called squamous cell carcinoma of the head and neck).
“The great majority of head and neck cancers occur within the upper air or digestive tract,” says Mark Persky, MD, otolaryngologist and surgeon at NYU Langone Health in New York City. “There are other areas, too, that are not quite as common, such as the salivary glands and the skin of the head and neck.”
Cancers in the head and neck are primarily categorized by where in the head and neck the cancer starts. For example, even if the head and neck cancer spreads (or metastasizes) to the lungs—which is common—it won’t be diagnosed as lung cancer. This is reserved for cancer that starts in the lungs.
When making a diagnosis of head and neck cancer, doctors may refer to one of the following types:
Hypopharyngeal cancer: Cancer starts in the hypopharynx, which sits behind and next to the voice box in the lower section of the throat. The hypopharynx connects the throat with the esophagus.
Laryngeal cancer: Cancer starts in the larynx, which is the voice box. The larynx sits in the throat above the opening of the trachea, or windpipe.
Nasal cavity cancer: Cancer starts in the space above the roof of the mouth and downward toward the throat. The nasal cavity helps filter and moisten air while breathing.
Nasopharyngeal cancer: Cancer starts in the nasopharynx—the passageway for air from the nose to the throat. The nasopharynx is at the upper part of the throat directly behind the nose and just above the soft palate (the squishy part in the back of the roof of the mouth).
“The Asian population especially is predisposed to developing” this type of cancer, says Dr. Persky. “It’s directly associated with what’s called EBV, or Epstein-Barr virus.” Nasopharynx cancers in the Asian population (such as first and second generation Asian Americans) tend to have high levels of the virus in the tumors and the blood stream, according to Dr. Persky.
Oral cavity cancer: Cancer starts in the oral cavity—i.e., the mouth. This includes the lips, inside of the lips and cheeks, teeth, gums, the front of the tongue, and the hard palate (roof of the mouth). This is the most common type of head and neck cancer.
Oropharyngeal cancer: Cancer starts in the oropharynx, which is the part of the throat that’s right behind the mouth (or oral cavity). It includes the tonsils, the base of the tongue, the soft palate (the back of the roof of the mouth), and the top part of the throat.
Paranasal sinus cancer: Cancer starts in the small cavities around or near the nose (the sinuses). There are sinuses in the cheek below the eyes (maxillary sinuses), above the eyebrows (frontal sinuses), behind the nose (sphenoid sinuses), and at the bridge of the nose (ethmoid sinuses).
The type of head and neck cancer someone is diagnosed with may affect treatment options. For example, some of these locations are challenging to operate on, so surgery isn’t always an ideal option. In some cases, the cancerous part may need to be removed altogether (such as the voice box, part of the tongue, or the jaw bone). Luckily, new and improved treatment options for cancer, such as immunotherapy and targeted therapy, can be very effective at treating different types of head and neck cancer.
Dr. Persky is an otolaryngologist and surgeon at NYU Langone Health in New York City.
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Head and neck cancer is a tumor that
occurs anywhere in the head and neck.
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And the great majority of the head and
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neck cancers occur within
the upper aerodigestive tract.
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Meaning the mouth, the throat,
the nose, the larynx, and
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that is basic referral for
head and neck cancer.
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There are other areas, too, that are not
quite as common such as the salivary
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glands and the skin of the head and neck.
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But by and large, when one refers head and
neck cancer, we're basically referring to
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the area of upper air digestive
tract as I just defined.
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Well over 90% of head and neck cancers
are what we call squamous cell carcinomas.
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Which are cancers,
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malignant tumors, that develop from the
lining of the upper air digestive tract.
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That involves the areas of the tongue, the
cheek, the lips, the floor of the mouth
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and the palate, as well as the gums
where the teeth are inserted.
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There are other areas where head and
neck cancer can occur.
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And there is an increasing
amount of head and
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neck cancer that's occurring now in
something called the oral pharyngeal,
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which is where the tonsils in
the back of the throat are.
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So these are the most common areas
that we develop head and neck cancer.
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Also, there's a cancer of the nasopharynx
that the Asian population
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especially is predisposed to developing.
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It's directly associated with what's
called EBV or Epstein-Barr virus which,
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in the great majority of the nasopharynx
cancers that Asians develop,
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have high titers of that virus within the
tumor itself and within the blood stream.
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And they are predisposed
to developing that.
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Even first- and second-generation Asians
within the United States have a bit higher
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chance of developing that type of tumor as
compared to the rest of the population.
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There are other areas that can
be involved such as the sinuses,
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which are the air cavities
that connect with the nose.
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And they can develop cancers, too.
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As well as other areas in the head and
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not nearly as frequently as
the areas that I've just described.
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Head and neck cancers. Bethesda, MD: National Cancer Institute. (Accessed on March 19, 2019 at https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet.)
If you have head or neck cancer. Atlanta, GA: American Cancer Society, 2018. (Accessed on March 19, 2019 at https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/if-you-have-head-or-neck-cancer.html.)
What are laryngeal and hypopharyngeal cancers? Atlanta, GA: American Cancer Society, 2017. (Accessed on March 19, 2019 at https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer/about/what-is-laryngealand-hypopharyngeal.html.)
What are nasal cavity and paranasal sinus cancers? Atlanta, GA: American Cancer Society, 2017. (Accessed on March 19, 2019 at https://www.cancer.org/cancer/nasal-cavity-and-paranasal-sinus-cancer/about/what-is-nasal-paranasal.html.)
What are oral cavity and oropharyngeal cancers? Atlanta, GA: American Cancer Society, 2018. (Accessed on March 19, 2019 at https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.html.)What is nasopharyngeal cancer? Atlanta, GA: American Cancer Society, 2018. (Accessed on March 19, 2019 at https://www.cancer.org/cancer/nasopharyngeal-cancer/about/what-is-nasopharyngeal-cancer.html.)