Head or neck cancer refers to the growth of abnormal (malignant or cancerous) cells in the tissues of the head or neck. These cancers frequently start in the squamous cells that are located in the moist membranes (also called mucous membranes) that line the surface of the nose, mouth and throat. They are often called squamous cell carcinomas of the head and neck. The following cancers are included in the group of head and neck cancers.

• Cancers of the mouth (oral cavity) - This includes the front of the tongue, the gums, the lining of the cheeks and lips and the bottom and top of the mouth.
• Cancers of the throat (pharynx) - This tube that begins behind the nose and extends to the food pipe.
• Cancers of the voicebox (larynx) - This short tube is located at the bottom of the pharynx.
• Cancers of the sinuses and nasal cavity - These are hollow spaces inside the head and nose.
• Cancer of the salivary glands - These are the glands in the floor of the mouth that produce saliva. Cancer of the salivary glands is uncommon.

After the diagnosis of a cancer in the head or neck, healthcare providers will look for spread of the head or neck cancer to the lymph nodes in the neck or tissues in other areas of the body. This process is called “staging.” Metastatic head or neck cancer is cancer that started in the mucous membranes of the head or neck and has spread to the lymph nodes or other organs and tissues. Your healthcare provider will need the following clinical information to decide what type of treatment is right for you.

• What does the cancer look like under the microscope? Where is it located?
• How large is the primary cancer?
• Has the cancer spread to lymph glands or anywhere else in the body?

A cervical lymphadenectomy is the removal of lymph nodes and surrounding tissue that may contain cancerous cells. It is usually done through a large curved incision that starts at the ear and goes to the chin. The three main surgeries are a radical neck dissection, a selective neck dissection and a modified neck dissection. The surgery your healthcare provider recommends will depend on your specific circumstances.

• A radical neck dissection is removal of all the lymph nodes, tissue, muscles, nerves, salivary glands and major blood vessel on the side of the neck where the cancer was found.
• A selective neck dissection is removal of some of the lymph nodes on the side of the neck where the cancer was found. It can spare the nerves, blood vessels and muscle. This surgery is an option if the cancer has not spread very far.
• A modified radical neck dissection is removal of the lymph nodes and some surrounding tissue on the side of the neck where the cancer was found. The nerves, blood vessels and muscle may be spared with this type of surgery.

The costs for this care path are for a modified neck dissection, which is the most common surgery.

Head or neck cancers can develop at any age. However, they are more common in men over 50 years of age. The risk factors for cancers of the head and neck include:

• Tobacco and alcohol use (cause about 75% of cancers of the head or neck)
• History of certain viruses, such as Human Papillomavirus (HPV) or Epstein-Barr (EB) infection
• Prior radiation therapy to the head or neck area
• Use of betel quid (a type of chewing tobacco) or mate (a type of tea)
• Poor oral health
• Exposure to certain particles or chemicals in the workplace (wood dust, asbestos)
• Asian ancestry

The primary ways to prevent cancers of the head and neck are by not using tobacco and limiting alcohol intake. Good oral hygiene is also very helpful. In addition, being aware of your risk factors can improve your prognosis by leading to early diagnosis and treatment.

The symptoms of head and throat cancers vary depending on the location of the cancer. These symptoms can be similar to those of other less serious conditions, so medical evaluation is necessary. Some of the symptoms include:

• A sore or lump that does not heal
• A constant sore throat
• Frequent headaches
• Swallowing and eating difficulty
• Changes or hoarseness in voice
• Pain when speaking or swallowing
• Pain in the ears or teeth
• Chronic sinus infections that do not respond to treatment
• Swelling of the jawline or under the chin

Contact your healthcare provider if you have any of the above symptoms. He or she will review your symptoms and do a physical examination. They may also recommend one of the following tests:

• A laryngoscopy, an examination of your mouth and throat using a special instrument
• Removal of abnormal tissue for examination under a microscope (biopsy)

A biopsy is needed to determine if an abnormality is cancer. If your biopsy indicates you do have cancer, additional testing may be needed.

The treatment for head or neck cancer is based on many factors, including:

• Your age and overall health
• The type and stage of the cancer
• Other tests that determine the specific characteristics of the cancer

Treatments for head or neck cancer are either local (only affects the area of the cancer) or systemic (affects all areas of the body). Local treatments include:

• Surgery to remove the cancer
• External radiation to kill the cancer cells

The systemic treatments include:

• Chemotherapy to kill the cancer cells
• Targeted or biologic therapy to interfere with the changes in cells that help the cancer grow

Treatment for head and neck cancer may involve a combination of local and systemic treatments, especially if the cancer has gone to other parts of your body. You may also have more than one type of treatment at a time.

To get a full range of opinions and perspectives, you may want to consider input from a variety of doctors. This group may include:

• Your primary care physician
• A medical oncologist (a doctor who specializes in the treatment of cancer)
• A surgeon with experience in head or neck cancer
• A radiation oncologist (a doctor who specializes in treating cancer with radiation therapy)
• A plastic surgeon

If your healthcare provider recommends a neck dissection prior to the surgery you should tell them about any medications you are taking (including over-the-counter medications and supplements). You should also ask about specific instructions you should follow before and after the surgery. These include:

• Medications you should not take before the surgery, such as blood thinners
• Regular medications you should continue to take on the day of your surgery
• What diet should follow the weeks before surgery
• What medicine or prep you will take to clean out your colon for surgery
• How many hours you should stop eating and drinking before the surgery

If you are a smoker, you should quit smoking, as it can interfere with your recovery.

During your surgery, you will receive anesthesia to keep you comfortable and pain free. General anesthesia is the most common type of anesthesia for this surgery. With this type of anesthesia, you are put into a deep sleep and are unable to see, hear or feel anything.

• Recovery typically takes months and can involve speech therapy, swallowing evaluations and other follow up care.
• You may need pain medication and help at home while you recover.

It is important to remember that the total cost of this care path does not include all possible medications, lab work or imaging studies. Those charges can add up. If your healthcare provider recommends any lab work or imaging studies, you may need to search for their costs separately.

You should contact your healthcare provider if you have symptoms of head or neck cancer. Be prepared to discuss your symptoms and how long you have had them.

• Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
• Make a list of your medications (including over-the-counter).
• Write down any questions, symptoms or concerns you want to talk about.
• If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

What should I ask my healthcare provider before having a removal of the lymph nodes in my neck?

• What is my diagnosis? What type of cancer do I have?
• What tests are you recommending and why? Will the test results change my treatment plan? If not, then why do I need them?
• What is the reason for the surgery? Are there any alternatives to surgery? Why are you choosing one treatment over another?
• What happens if I do not go through with the surgery?
• What kind of sedation will I have? What are the possible side effects?
• How will I feel after the surgery? Will I have to modify my activity?
• Will I need to see a dietician? Will I be able to eat and breathe normally?
• What are the possible complications for this surgery?
• What is your experience in doing this type of surgery? What is your complication rate?
• Will I be receiving other treatments before or after my surgery?

Do not forget to arrange for transportation to and from the facility and for help at home.

Before you go home, make sure you understand all home care instructions (including medications and side effects), what symptoms you should report to your healthcare provider after discharge and follow-up plans. Your surgeon should also communicate with your primary care physician.

Source UHC.com

Also known as:

Throat Cancer

Neck Dissection

Lymphadenectomy

Lymph Node Removal

Head Cancer

Dissection

Cervical Lymphadenectomy

Cancer of the Neck

Cancer of the Mouth

Cancer of Head

Cancer - Neck Lymph Node Removal

Cancer