Head and neck cancers

What are head and neck cancers?

Head and neck cancer is a general term for a range of cancers that start in the tissue or lymph nodes in the head and neck area. This region includes the mouth, tongue, palate, gums, salivary glands, tonsils, throat (pharynx), voice box (larynx), nose and sinuses.

Only malignant tumours are cancer. Some tumours in the head and neck are benign (not cancer).

Most head and neck cancers start in the cells that line the moist surfaces of the mouth, nose or throat (squamous cells). These are called squamous cell carcinomas (SCC). Some head and neck cancers start in glandular cells. Many of these are called adenocarcinomas. Squamous cell carcinomas and adenocarcinomas can also occur in other parts of the body.

Learn more about:

• Types of head and neck cancers
• Other cancers in the head and neck area
• Who gets head and neck cancers?
• What causes head and neck cancers?
• What is human papillomavirus (HPV)?

Types of head and neck cancers

Cancers of the head and neck are categorised by the area of the head or neck where they begin.

Mouth (oral cavity)

The mouth, also called the oral cavity, includes the lips, tongue and gums. The muscles of the base of the tongue continue into the upper throat (oropharynx). Cancer that starts in the mouth is called oral cancer.

Cancer can begin in any part of the mouth – the lips, gums, inside lining of the cheeks and lips, front two-thirds of the tongue (oral tongue), floor of the mouth under the tongue, bony roof of the mouth (hard palate), and the small area behind the wisdom teeth. Cancer that starts in the base of the tongue is oropharyngeal cancer.

Nasal cavity and paranasal sinuses

The nasal cavity is the large, hollow space inside the nose. This space warms, moistens and filters the air that you breathe. The bones around the nasal cavity have a group of small, air-filled spaces called the paranasal sinuses. These sinuses affect the sound and tone of your voice.

The are four pairs of paranasal sinuses:

• maxillary sinuses – under the eyes and in the cheek area
• frontal sinuses – behind the forehead
• ethmoid sinuses – above the nose and between the eyes
• sphenoid sinuses – behind the nose and between the eyes.

Salivary glands

The salivary glands make saliva. This keeps the mouth moist, helps you swallow food and protects the mouth against infections. There are three pairs of major salivary glands:

• parotid glands – in front of the ears
• sublingual glands – under the tongue
• submandibular glands – under the jawbone.

There are hundreds of smaller glands throughout the lining of the mouth and throat. These are known as the minor salivary glands. Most salivary gland cancers affect the parotid glands. Less commonly, the submandibular and sublingual glands are affected.

Throat (pharynx)

The throat, also called the pharynx, is a hollow tube that starts behind the nose and leads to the food pipe (oesophagus) and the windpipe (trachea). Cancer can affect the three parts of the pharynx:

• nasopharynx – the upper part, behind the nose and above the soft palate; cancer starting in this area is called nasopharyngeal cancer
• oropharynx – the middle part, the area from the soft palate and base of the tongue to the back of the mouth, including the tonsils; cancer starting in this area is called oropharyngeal cancer
• hypopharynx – the lower part, around the voice box (larynx); cancer starting in this area is called hypopharyngeal cancer.

Voice box (larynx)

The voice box, also called the larynx, is a short passageway that connects the lower part of the throat (hypopharynx) with the windpipe (trachea). The thyroid gland is in front of the trachea under the voice box. Cancer that starts in the larynx is called laryngeal cancer.

The larynx includes the:

• epiglottis – when you swallow, this small flap of tissue moves to cover the larynx to prevent food going into the trachea and lungs
• glottis – the area containing the vocal cords, which vibrate when air passes through them to produce the sound of your voice
• subglottis – located below the vocal cords.

Other cancers in the head and neck area

Cancer can start in the brain, eye, oesophagus, thyroid gland, skin and scalp. It can also start in the bone or muscle of the head and neck. These cancers are not usually classified as head and neck cancer.

Sometimes a cancer first appears as an enlarged lymph node in the neck. This looks like a lump in the side of the neck. Because this may be the first sign of a head and neck cancer, the primary tumour must be looked for in the mouth and throat. Cancer from elsewhere in the body (for example, stomach cancer) can also spread and cause an enlarged lymph node in the neck. This is not a head and neck cancer.

For details about other cancers, call Cancer Council 13 11 20, or see the relevant Cancer types.

Who gets head and neck cancers?

About 4630 people in Australia are diagnosed with a head and neck cancer each year.

This includes about:

• 1460 people diagnosed with cancer in the mouth and tongue
• 935 with lip cancer
• 1055 with pharyngeal cancer
• 640 with laryngeal cancer
• 330 with salivary gland cancer
• 210 with nasal or paranasal sinus cancer.

Men are about three times more likely than women to develop a head and neck cancer.

What causes head and neck cancers?

Head and neck cancers are associated with a number of major risk factors. Two of the main risk factors are alcohol and tobacco, and the combined effect of drinking and smoking is significantly greater than the risk of just drinking or just smoking. Known risk factors include:

• drinking alcohol
• smoking tobacco (including cigarettes, cigars and pipes)
• chewing or smoking areca nut, betel nut, pan or gutka
• infection with the human papillomavirus (HPV), especially HPV 16, or the Epstein-Barr virus (EBV)
• being overweight or obese
• older age (being over 40)
• being male
• having a first-degree relative (parent, child or sibling) with some types of head and neck cancer
• being from southern China or South-East Asia (because of cultural practices such as chewing tobacco or eating salty fish)
• breathing in asbestos fibres, wood dust, dry-cleaning solvents or certain types of paint or chemicals
• having a weakened immune system
• sun exposure (for skin cancer of the lip).

Eating adequate amounts of fruit and vegetables may help lower the risk of getting oral and oropharyngeal cancers. Talk to your doctor if you are worried about any of these risk factors.

What is human papillomavirus (HPV)?

HPV is the name for a group of viruses. It is a very common sexually transmitted infection that affects the surface of different areas of the body, including the cervix and skin. Most people will not know they have HPV.

Some types of HPV are linked with the development of cancer. This includes cancers of the mouth and throat (known as oropharyngeal cancers). HPV in the head and neck area is usually spread through oral sex.

HPV often goes away on its own. If it doesn’t go away, it can take many years to develop into cancer. Most people with HPV don’t develop oropharyngeal or other types of cancer.

HPV vaccination can reduce the risk of developing abnormal cell changes that may lead to cancer.