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Information factsheet on head and neck cancers
Cancers of the Head and Neck
The information in this factsheet has been written to help you understand
cancers of the head and neck. It is an agreed view on this cancer by
medical experts. We hope that it will answer some questions and concerns
you might have. The information here is brief but more details are given in
a booklet called Understanding Cancers of the Head and Neck from the Irish
Cancer Society. It is available free of charge by calling the Helpline on 1800
200 700 (Mon–Fri: 9am–5pm) or email [email protected].
What is cancer?
Malignant tumours are cancerous.
Cancer cells can spread by breaking
away and entering the bloodstream or
lymphatic system. The lymphatic system
drains away excess fluids (called lymph)
from the tissues. As a result, cancer cells
can invade other tissues and organs.
The body is made up of tiny building
blocks called cells that form the organs
and tissues of the body. Cancer can
affect cell growth and cause cells to
grow and divide without order or
control. These groups of abnormal cells
can form a tumour. Tumours can be
benign or malignant. Benign tumours
are not cancerous and can usually be
removed. Benign tumours do not spread
to other parts of the body.
Head and neck cancers
Cancer can occur in any of the tissues or
organs in the head and neck. These
include:
Oral Cavity (Mouth) Cancer
Cancer can occur in the lips or in the
mouth itself, including:
 Inside the mouth, on the tongue.
 In the roof of the mouth (hard palate).
 In the gums, the floor of the mouth.
 In the inner lining of the lips and
cheeks.
Oropharyngeal Cancer
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This cancer develops in the
oropharynx, the part of the throat that
sits directly behind the mouth.
It includes the soft part of the roof of
the mouth, the base of the tongue, the
side walls of the throat and the back
wall of the throat.
Information factsheet on head and neck cancers
Cancer of the Nose
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Cancer can develop in the lining of
the nose and the skin of the
nostril.
A specific cancer called
nasopharyngeal carcinoma can
develop in the nasopharynx, which
is the highest part of the throat,
lying behind the nose.
Cancer can also develop in the
lining of the sinuses or air spaces
that lie alongside the nose in the
bones of the face.
Cancer of the Ear
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Cancers of the ear are rare and
can develop deep inside the ear.
They mostly develop on the skin
of the ear.
Cancer of the Eye
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Cancers are unusual in the eye
itself and are usually a type called
ocular melanoma.
Cancer can also develop in the
skin of the eyelids and
occasionally in the lymph nodes
behind the eye.
Cancer of the Thyroid Gland
The thyroid is a small gland in the front of
the neck just below the voice box. It
produces hormones needed to keep the
body functioning at its normal rate.
 Cancer of the thyroid is a rare
cancer that usually affects middleaged and older people.
 Papillary thyroid cancer can occur
in younger people.
 Thyroid cancer is more common in
women and very rare in children.
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Information factsheet on head and neck cancers
Cancer of the Larynx (voice box)
The larynx or voice box is a small organ
that sits at the entrance to the windpipe
(trachea) at the front part of the neck. It
can be seen or felt as the normal lump in
the front of the neck known as the
‘Adam’s apple’.
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Cancer that develops near the
vocal cords can affect the sound
of the voice.
Cancer of the Salivary Glands
The salivary glands make saliva (spit) that
keeps the mouth moist and helps the
movement of food down the oesophagus
(gullet) to the stomach.
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Salivary gland cancer is a rare
type of cancer. Often benign
tumours are more common in the
glands than malignant tumours.
Risk factors for head and neck cancers
A risk factor is anything that increases a
person’s chance of getting a disease,
such as cancer. Although the exact cause
of head and neck cancers is unknown,
there are certain risk factors that are
linked to it.
either factor alone. Tobacco and alcohol
drinking account for approx. threequarters of all head and neck cancers.
Ultraviolet radiation: Prolonged
exposure to ultraviolet radiation (UV)
from sunlight is linked to increased
occurrence of cancer of the lip.
Tobacco: There is a strong association
between the development of head and
neck cancer and smoking. It is linked to
the amount smoked and the length of
time a person has smoked.
Poor nutrition: A diet low in fruits and
vegetables is associated with an
increased risk of developing cancer of
the oral cavity and oropharynx.
Alcohol: People who drink alcohol have
a higher risk of these cancers. The more
a person drinks, the higher the risk.
Gender: Cancers of the head and neck
are more common in men than women.
Tobacco and alcohol combined: The
combined effect of the two risk factors
is significantly greater than the risk from
Age: These cancers are also more
common in older people.
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Information factsheet on head and neck cancers
Occupational exposure: Some
workplaces may put people at an
increased risk of cancer of the nose and
sinuses. These include exposure to dusts
from wood, textiles and leather. Other
substances linked to these types of
cancer are glues, formaldehyde, solvents
used in furniture and shoe production,
nickel and chromium dust, mustard gas,
isopropyl alcohol and radium.
3. Eat a healthy diet rich in fruit
and vegetables. It is
recommended that you eat five
or more portions of fruit and
vegetables per day. Eat foods
that are low in fat and high in
fibre.
4. Exposure to UV radiation is an
important and avoidable risk
factor for cancer of the lips and
indeed skin cancer in general. If
you cannot avoid exposure to
UV radiation, use protective
measures. These include a
sunscreen with SPF 15+. Use lip
balms containing sunscreen SPF
15+ also. Avoid using sunbeds.
Medical conditions: A viral infection
known as Epstein–Barr virus may be
connected with nasopharyngeal cancer.
For reasons unknown, this virus can
cause a simple infection in some people
and cancer in others. Another virus
called human papilloma virus (HPV),
which is sexually transmitted, has also
been linked to head and neck cancers.
5. Take protective measures to
reduce your risk of exposure to
dust and other chemicals in the
workplace. Wear a protective
mask that covers your nose and
mouth and prevents dust
entering your nose.
How can I reduce my risk of
developing head and neck
cancers?
Nobody knows the exact cause of head
and neck cancer but there are steps you
can take to reduce your risk of
developing it.
What are the warning
signs/symptoms for head and
neck cancers?
1. If you smoke, set a date to quit.
Do not smoke in the presence of
others. Advice and support on
quitting is available: you can call
the National Smokers Quitline at
Callsave 1850 201 203.
The symptoms caused by cancers of the
head and neck depend on where the
cancer is located. An important
common symptom is:
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2. Alcohol use is not
recommended but if you do
drink alcohol, cut down on the
amount you take. Men should
not drink any more than 2
standard drinks per day. Women
should not drink any more than
1 standard drink per day. One
standard drink is equal to a ½
pint of beer, or 1 small glass of
wine, or 1 pub measure of
spirits. Aim to have some
alcohol-free days in the week.
A persistent lump or swelling in
the neck.
This is due usually to an enlargement of
the lymph glands. The lymph glands
are part of the body’s natural defence
against infection, and cancer at any site
in the body can spread into nearby
lymph glands. This is quite common in
head and neck cancers because of the
location of the lymph glands in the neck.
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Information factsheet on head and neck cancers
Other common symptoms are:
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about your symptoms as well as your
medical history and what medications
you are taking, if any. The doctor will
then examine your mouth, throat and
neck.
Difficulty moving or pain
around the teeth, tongue or jaw
Difficulty or pain while chewing
or swallowing
A persistent red or white patch
on the gums, tongue, tonsil or
lining of the mouth
A sore or ulcer that does not
heal
Numbness in the mouth
A persistent lump or thickening
in the cheek
A feeling that something is
blocking the throat that doesn’t
go away or a persistent sore
throat
Breathing or speaking
difficulties, including noisy
breathing, slurred speech, hoarse
voice or other voice changes
Persistent blocked nose or nose
bleeds
Persistent earache, ringing in the
ear, or difficulty in hearing
Blurred vision or shadows over
the eye
Flashing lights or misting of the
lens of the eye
Persistent bad breath
Weight loss.
Tests that are commonly carried out are:
During endoscopy of the nose and
throat, your doctor will pass a
nasendoscope to examine the area.
This is a very thin flexible tube with a
light at the end that is passed into your
nose to look at the inside of your nose,
the back of your throat and mouth.
These tests can be uncomfortable for
you, but will only last a few minutes.
You may be given a local anaesthetic
lozenge to suck, which numbs the
mouth for a few minutes. Or the area
may be sprayed with an anaesthetic
spray that numbs the back of your
throat.
You should not eat or drink anything
for about an hour afterwards if you have
had a local anaesthetic in your throat.
Otherwise there is a risk of whatever
you swallow going into your windpipe.
Be careful of hot drinks as the
numbness may prevent you feeling the
heat in your mouth and you might get
scalded.
These symptoms do not always mean
cancer and could be due to other
conditions such as an infection.
However, if you have any of these
symptoms, get your doctor to check
them to be sure.
The doctor can only make a definite
diagnosis by taking a sample of cells
from the abnormal area to examine
under a microscope. This procedure is
called a biopsy. Sometimes the biopsy
can be taken in an outpatient clinic of
the hospital. The affected area is first
numbed with some local anaesthetic. A
small piece of the suspected cancer is
then removed using a very fine needle.
How are cancers of the head
and neck diagnosed?
Cancers of the head and neck are mostly
diagnosed in hospital. Your GP or your
dentist will refer you to hospital for tests
and for specialist advice. At the hospital,
you will see a specialist doctor such as
an ENT surgeon or a maxillofacial
surgeon. The specialist will ask you
Usually a biopsy is taken while you are
asleep under a general anaesthetic. This
allows the specialist to examine the
mouth and throat area closely and take
biopsies from any other suspicious
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Information factsheet on head and neck cancers
areas. This usually does not require an
overnight stay in hospital.
The results of the biopsy will indicate if
cancer cells are present. The results will
also show the type of cancer. For
example, if it has begun in the cells
lining the mouth and throat, it might be
squamous cell cancer.
Staging and further tests
MRI scan: This scan uses magnetic
fields to build up a picture of the inside
of your head and neck. It is painless but
can be very noisy. Some people find it
claustrophobic, but it is possible to
bring someone in with you while having
it done. During the test you will be
asked to lie very still on a couch inside
the machine for about 30 minutes. If
you have a pacemaker or any type of
metal device placed in your body, you
must tell the person doing the scan, as
the test cannot be done in this case.
The next step is to find out the extent of
the cancer. This is called staging and
involves further tests. This is very
important as it will help your doctor to
make the right decision regarding your
treatment. Your doctor will decide
which tests are necessary in your case.
These may include some of the
following:
X-ray: This test is often carried out as it
can show any abnormalities of the bone
structure. An X-ray known as an
orthopantomogram (OPG) may be
taken to look at your jaw and to check
your teeth. A chest X-ray will also be
done to check your general physical
health.
Ultrasound
This test is carried out in the X-ray
department of the hospital. A picture is
built up of the head and neck using
sound waves. You will be asked to lie on
your back and gel will be spread over
the area to be scanned. A small device
like a microphone, which produces
sound waves, is used to take the scan
which is converted into a picture by a
computer. This test is painless and only
takes about 10 minutes to do.
CT scan (CAT scan): This is a special
type of X-ray. A series of X-rays are
taken that build a detailed picture of the
inside of your body. It can take up to 30
minutes. Sometimes you are given a
drink or an injection to help show a
particular part of your body. Before
having the injection or drink, it is
important to tell your doctor and the
person doing the test if you are allergic
to iodine or have asthma.
PET scan
This is a new type of test called
positron emission tomography. PET
uses a low dose of radioactive sugar to
measure activity in your cells. This sugar
is injected into your arm and travels to
all the cells in your body. Cancer cells
absorb large amounts of the sugar, so
more radioactivity will appear where the
cancer cells are located. After an hour
the scan is taken and can show if the
cancer has spread to other tissues and
organs.
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Information factsheet on head and neck cancers
Treatment for head and neck
cancers
Before the test you may have to fast for
a few hours. The scan itself may take up
to an hour. PET is safe to use and there
are no side-effects. Because it is a
relatively new type of scanning it may
not be available in the hospital in your
area.
The aim of treatment is to remove as
much of the tumour as possible and
prevent it from coming back. There are
three main types of treatment for head
and neck cancers:
Bone scan: Cancers of the mouth and
throat can spread to the lymph nodes in
the head and neck. But they do not
usually spread beyond this area to other
parts of the body. A bone scan may be
required to find out if the cancer has
spread into nearby bones such as the
jawbone.
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Surgery
Radiotherapy
Chemotherapy.
It is important to find out from your
doctor or nurse how the different
treatments work, how long they will last
and what side-effects to expect.
Sometimes there may be a choice
between treatments. When talking about
treatments, find out about taking part in
a type of research study called clinical
trials. This may be available for your
type of cancer.
A bone scan can detect cancer cells
before they show up on X-ray. Before
the scan is taken, a small amount of a
mildly radioactive liquid is injected into a
vein, usually in your arm. The abnormal
bone absorbs more of the radioactive
liquid than normal bone, and after a few
hours any abnormality can be seen on
the scan.
Normally before treatment, you will
need a dental check-up to see if any gum
disease or infection is present, so it can
be treated first.
The level of radioactivity used in bone
scans is very low and will disappear
from your body within a few hours.
Surgery is an important treatment for
most head and neck cancers. There are
many different types of surgery that will
depend on the following:
When head and neck cancer is
diagnosed
After cancer is diagnosed, shock,
disbelief and anxiety are natural
reactions. This can often result in
confusion. You may find it hard to think
of what you want to ask the doctor.
Sometimes there is a lot of information
to take in, which might be difficult to
remember later. It helps to make a list of
questions and write down what the
doctor says. It is also a good idea to take
a family member or friend along when
meeting the doctor and for further
appointments.
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The type of tumour
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Its location in the body
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The size of the tumour
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If it has spread to other parts of
the body.
Specialist surgeons such as an ear, nose
and throat (ENT) surgeon or a
maxillofacial surgeon will carry out the
surgery depending on the location of the
tumour. They form part of the hospital
multidisciplinary team. The Irish Cancer
Society has a booklet called Understanding
Cancers of the Head and Neck that provides
further information on surgery.
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Information factsheet on head and neck cancers
Radiotherapy is the use of powerful
rays to treat cancer. It is commonly used
to treat cancers of the head and neck.
Sometimes it is used on its own or can
be given in conjunction with surgery and
can help to prevent a recurrence of the
cancer. Before having radiotherapy, you
will be seen by a radiation oncologist
(radiotherapy specialist) who will plan
your treatment.
call the National Cancer Helpline on
1800 200 700 for more advice.
Further information
If you or someone you know is
diagnosed with a cancer of the head and
neck, more detailed information about
its symptoms, diagnosis and treatment is
available in a booklet called Understanding
Cancers of the Head and Neck. This booklet
can help you understand the feelings
and distress that can arise with a cancer
diagnosis. It is available free of charge
by calling the National Cancer Helpline
on 1800 200 700.
Radiotherapy can cause side-effects that
occur during or after treatment. The
side-effects depend on the dose given
and can vary from person to person.
Nowadays there are more ways to
relieve side-effects. So it is important to
find out from your doctor or nurse
about any side-effects that could occur
during or after treatment.
For more information about head
and neck cancers, or about cancer
in general, call the National Cancer
Helpline on Freefone
1800 200 700
(Monday–Friday, 9 am–5 pm) or
email [email protected]
for confidential advice from our
cancer nurse specialists.
More information on radiotherapy and
its side-effects is available from the Irish
Cancer Society in a booklet called
Understanding Radiotherapy. You can also
call the National Cancer Helpline on
1800 200 700.
Chemotherapy can be used to treat
cancers of the head and neck. This type
of treatment involves the use of drugs to
kill cancer cells and can often be given
after surgery in an effort to prevent the
cancer coming back. This is called
adjuvant chemotherapy. Usually it is
given in conjunction with radiotherapy.
Chemotherapy is also given to treat
cancers of the head and neck when
surgery is of no benefit or when the
cancer has spread.
Irish Cancer Society
43–45 Northumberland Road
Dublin 4
Tel: (01) 231 0500
Fax: (01) 231 0555
Email: [email protected]
Website: www.cancer.ie
© Irish Cancer Society, 2005
There are side-effects from
chemotherapy and these will depend on
the drugs that are used. Nowadays there
are many ways to relieve side-effects and
give you help and support. So do talk to
your doctor or nurse about side-effects.
More information on chemotherapy and
its side-effects is available from the Irish
Cancer Society in a booklet called
Understanding Chemotherapy. You can also
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