Head & Neck Cancer 

What is cancer?

Normally, cells grow and divide to form new cells in an orderly way. They perform their functions for a while, and then they die. Sometimes, however, cells do not die. Instead, they continue to divide and create new cells that the body does not need. The extra cells form a mass of tissue, called a growth or tumour.
There are two types of tumours: benign and malignant. Malignant tumours are cancers in which a group of cells display specific behavior:

  • Uncontrolled growth (division beyond the normal limits)
  • Invasion (intrusion on and destruction of adjacent normal tissues)
  • Metastases (spread to other locations in the body via lymph or blood)

These three malignant properties of cancers differentiate them from benign tumours, which are self-limited, and do not invade nearby tissue or spread to other parts of the body.

Which cancers are considered cancers of the head

Most head and neck cancers begin in the cells that line the mucosal surfaces in the head and neck area, such as the mouth, nose, and throat. Mucosal surfaces are moist tissues lining hollow organs and cavities of the body open to the environment. Normal mucosal cells look like scales (squamous) under the microscope, so head and neck cancers originating form these cells are named squamous cell carcinomas. Some head and neck cancers begin in other types of cells. For example, cancers that begin in glandular cells are called adenocarcinomas.
Cancers of the head and neck are identified by the area in which they originate:

Oral cavity
This includes the lips, the front two-thirds of the tongue, the floor (bottom) of the mouth under the tongue, the gingiva (gums), the buccal mucosa (lining inside the cheeks and lips), the hard palate (bony top of the mouth), and the small area behind the wisdom teeth.
This is a hollow tube about 12 centremetres long that starts behind the nose and leads to the oesophagus (the tube that goes to the stomach). The pharynx has three parts: nasopharynx (upper part located behind the nose); oropharynx (middle part includes the soft palate (the back of the mouth), the base of the tongue, and the tonsils;) hypopharynx (lower part of the pharynx).
Also called the voice-box, this is located at top of the windpipe (trachea) and in front of the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.
Salivary glands
These glands produce saliva, the fluid that keeps mucosal surfaces in the mouth and throat moist. There are three pairs of large (major) salivary glands near the jawbone and in the floor of the mouth, and there are hundreds of smaller (minor) salivary glands in the mouth and throat.
Paranasal sinuses and nasal cavity
Sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.
Cancers of the brain, eye, and thyroid as well as those of the scalp, skin, muscles, and bones of the head and neck are not usually grouped with (mucosal) cancers of the head and neck.

How do head & neck cancers spread?

Head and neck cancers have the propensity to spread to lymph nodes in the neck or to the lungs. Rarely they spread to other parts of the body (eg liver, bone, brain).
Occasionally squamous carcinoma cancer cells are found in the lymph nodes of the upper neck when there is no evidence of cancer in other parts of the head and neck. When this happens, the cancer is called metastatic squamous neck cancer with unknown (occult) primary.

How common are head & neck cancers?

Head and neck cancers account for approximately 3 to 5 percent of all cancers in New Zealand. These cancers are more common in men and in people over age 50.

What causes head & neck cancers?

Smoking, tobacco or betel nut chewing and heavy alcohol consumption are risk factors for head and neck cancer. However, there is an increasing trend for patients with none of these risk factors and human papillomavirus exposure to develop these cancers.

What are common symptoms of head & neck cancers?

Symptoms of several head and neck cancer sites include a lump or sore/ulcer that does not heal, a sore throat that does not go away, difficulty breathing, hoarseness or a change in voice change, or difficulty swallowing. Other symptoms may include the following:

  • Oral cavity: an ulcer or a white (leukoplakia) or red (erythroplasia) patch on the gums, tongue, or lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth. As a rule any lesion persisting beyond 3 weeks should be assessed by a specialist, who regularly deals with oral disease to confirm / exclude serious disorders such as oral cancer or other serious disease. Most of these lesions are benign and your surgeon will be able to reassure you following examination. In most cases your surgeon will be able to reassure you following examination. Sometimes your surgeon may recommend performing a biopsy under local anaesthesia (see mouth ulcer)
  • Oropharynx and hypopharynx: difficulty breathing and swallowing or ear pain
  • Nasopharynx: blocked nose, frequent headaches, pain or ringing in the ears, or trouble hearing
  • Larynx: voice change, difficulty breathing, painful swallowing, or ear pain
  • Nasal cavity and sinuses: sinuses that are blocked and do not clear, chronic sinus infections that do not respond to treatment with antibiotics, bleeding through the nose, frequent headaches, swelling or other trouble with the eyes, pain in the upper teeth, or problems with dentures
  • Salivary glands: lump or pain under the chin or around the jawbone; numbness or paralysis of the muscles in the face
  • Metastatic squamous neck cancer: pain in the neck or throat that does not go away.
If you are worried about any of these symptoms, talk to your GP or family doctor and ask for a referral to the MercyAscot Head and Neck Service.

How are head & neck cancers diagnosed?

Because of the complexity and wide variety of potential diagnoses, your assessment is best performed by a specialist head and neck surgeon who is familiar with the diagnostic possibilities and who is able to assess, recognise and safely take samples (known as biopsies) of abnormalities in the mouth, throat, voice box and sinuses.
Your surgeon’s priority is to determine whether or not you have a cancer by performing the following:

  • Medical history
  • Examination including inspection of the oral and nasal cavities, throat, voice box, and neck, using a small mirror and/or lights. Your surgeon may also feel for lumps in the mouth, lips, neck, and face
  • Endoscopy of the nasal cavity, throat, and voice box. Endoscopy involves assessment of the inside surfaces of the body using a very thin, lighted tube called an endoscope
  • Ultrasound scan of the neck. This scan uses high-frequency sound waves to obtain a picture of the thyroid and assess the size and nature of the nodule(s). Some ultrasound findings of a nodule (growth) are more frequent in thyroid cancer than in non-cancerous nodules. Even so, the thyroid ultrasound alone is rarely able to determine if a nodule is a thyroid cancer
  • Biopsy is a sample taken of any abnormality found during the examination and may be taken following administration of local anaesthesia. A pathologist studies the tissue under a microscope to make a diagnosis. A biopsy is the only sure way to tell whether a person has cancer
  • Fine needle aspirate biopsy (FNA) of the neck lump. This simple procedure is a routine test and can be very useful for diagnosis. A small needle passed into the neck lump through the overlying skin sucks a small amount of cells out from the lump. This sample is examined by a pathologist and the biopsy result is usually ready after 48 hours. Local anaesthesia can be used and the needle is very small. You can go straight back to work after the test
  • Laboratory tests of blood, urine, or other substances from the body
  • X-rays to create images of your bones and internal organs
  • Ultrasound scan — your surgeon can perform this during your consultation
  • CT (or CAT) scan — detailed pictures of areas inside the head and neck created by a computer linked to an x-ray machine
  • MRI (Magnetic Resonance Imaging) uses a powerful magnet linked to a computer to create detailed pictures of areas inside the head and neck
  • PET scan uses sugar that is modified in a specific way so it is absorbed by cancer cells and appears as dark areas on the scan

What happens when I am diagnosed with head & neck cancer at MercyAscot Head and Neck Service?

Although cancers in the head and neck are relatively rare compared to other cancers occurring in other parts of the body, such as breast, lung and colon, there are many different types of head and neck cancer making correct diagnosis and treatment decisions complex. Many head and neck cancers, if treated correctly, are curable.
Your surgeon will want to assess the stage (or extent) of the cancer. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia (in the operating room), biopsy, x-rays, CT scans, and laboratory tests. Knowing the stage of the disease helps the doctor plan treatment.

A multi-disciplinary cancer team assesses all our patients with a new head and neck cancer diagnosis. Dependent on your surgery requirements, you may see a variety of specialist doctors and a specialist support team before your surgery. The team includes head and neck specialist surgeons, nurse specialist, dietitian and swallow and dental specialists, aiming to offer you an expert opinion and treatment choice. Your surgeon is an integral member of the multi-disciplinary head and neck cancer teams based at Mercy Hospital in Epsom, Auckland. The team is internationally recognised for its expertise in treating head and neck cancer patients from all over New Zealand and overseas.

If you are worried about any symptoms, talk to your GP or family doctor and ask for a referral to the MercyAscot Head and Neck Service.