How to Spot, Prevent Head and Neck Cancers -- Including Skin Cancer

Head and neck cancers are the seventh most common cancers in the world, with the American Society of Clinical Oncology reporting 1.1 million new cases diagnosed globally each year. In the United States alone, it is estimated more than 68,000 men and women will be diagnosed with head and neck cancers each year – mostly cancer of the mouth, throat or voice box.

These cancers, which occur anywhere above the collarbone and outside the brain, can include skin cancers and squamous cell carcinoma in the tongue, throat, thyroid, salivary gland and upper digestive tract, says Geoffrey Young, M.D., head and neck oncologist at Baptist Health Miami Cancer Institute. Cancers of the brain, eye and esophagus are not usually classified as head and neck cancers, he adds.

Geoffrey Young, M.D., head and neck oncologist at Miami Cancer Institute.

According to the National Cancer Institute (NCI), head and neck cancers usually begin in the squamous cells that line the mucosal surfaces of the head and neck, such as those found inside the mouth, throat and voice box. These cancers are referred to as squamous cell carcinomas of the head and neck.

The NCI says that head and neck cancers can also begin in the salivary glands, sinuses, or muscles or nerves in the head and neck, but it says that these types of cancer “are much less common than squamous cell carcinomas.”

Causes of Head and Neck Cancer

The human papillomavirus (HPV), especially HPV type 16, is a major risk factor for oropharyngeal cancers, which involve the tonsils or the base of the tongue. The NCI states that roughly three-quarters of all head and neck cancers are caused by chronic HPV infection. Of concern to oncologists like Dr. Young is that the number of new diagnoses is increasing.

Head and neck cancers are more than twice as common among men as they are among women, the NCI says, and they are diagnosed more often among people over age 50 than among younger people. 

Oral sex is a known risk factor for HPV-related head and neck cancers in men, as men are more likely to perform oral sex on their female partners. “Avoiding oral HPV infection can reduce the risk of these types of cancers,” Dr. Young says.

If there was any doubt about the effectiveness of the HPV vaccine, Dr. Young points to statistics showing that the number of HPV-related cancers in vaccinated people is declining. “Yet among unvaccinated individuals, the number of HPV cancers in 50-80 years old has been increasing dramatically.

By far the biggest risk factor for head and neck cancer, says Dr. Young, is tobacco and alcohol use. Dr. Young advises anyone who is at risk for head and neck cancer – particularly those who use tobacco – to talk with their doctor about ways to stop using tobacco in order to reduce their risk. 

Other Known Risk Factors

The NCI states that there are a number of other known risk factors for specific cancers of the head and neck. These include occupational exposure to wood dust and certain other industrial materials, and radiation exposure to the head and neck – for treatment of non-cancerous conditions or for cancer – which can cause cancer of the salivary glands.

A prior infection of the Epstein-Barr virus is also a risk factor for nasopharyngeal cancer and cancer of the salivary glands. In addition, ancestry seems to play a role, the NCI notes, as Asian populations – particularly Chinese – have an elevated risk for nasopharyngeal cancer.

Symptoms to Watch For

How can you know if you have head and neck cancer? According to the NCI, symptoms may include a lump in the neck or a sore in the mouth or the throat that does not heal and may be painful; a sore throat that does not go away; difficulty in swallowing, and a change or hoarseness in the voice. These may also be caused by other, less serious conditions so it is important to check with your doctor or dentist if you experience any of these symptoms.

According to the NCI, symptoms of head and neck cancers to watch for in specific areas include:

Oral cavity: A white or red patch on the gums, the tongue, or the lining of the mouth; a growth or swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.

Throat (pharynx): Pain when swallowing; pain in the neck or the throat that does not go away; pain or ringing in the ears; or trouble hearing.

   Voice box (larynx):  Trouble breathing or speaking, pain when swallowing or ear pain.

Paranasal sinuses and nasal cavity: 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: Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away.

Treating Head and Neck Cancers

The good news, Dr. Young stresses, is that there have been significant advances in surgery, radiation therapy and systemic therapy, and head and neck cancers are more treatable today than ever before. “Our head and neck cancer specialists combine world-recognized medical expertise, innovation and compassionate care to detect and treat your specific cancer,” he says.

Multidisciplinary evaluation such as is provided at Miami Cancer Institute is extremely important, Dr. Young notes. Dr. Young and his team regularly work with skin cancer specialists, led by  Naiara Braghiroli, M.D., Ph.D., chief of Dermatology Oncology at Miami Cancer Institute.

“Working together, we design the best, most effective treatment plan for each patient,” adds Dr. Young. Moreover, treatment for head and neck cancers depends on a number of factors. “We take into account a number of factors, including the tumor’s location and stage as well as the person’s age and general health.”

Trans-oral robotic surgery, or removing tumors through the mouth, has opened up new options for surgical oncologists like Dr. Young, who predicts that new types of robotic surgery and instruments will continue to revolutionize treatment and allow for even more individualized treatments.

Preventing Head and Neck Cancers

Dr. Young emphasizes that cancers of the head and neck are among the most preventable. Although there is no standard or routine screening test for head and neck cancers, he says your dentist should be checking for signs of cancer during your routine cleanings, which usually are recommended twice per year.

HPV vaccination: In June 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval of the HPV vaccine Gardasil 9 for the prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58 in persons aged 9 through 45 years.

Eliminating tobacco, limiting alcohol: “Most head and neck squamous cell carcinomas, particularly of the mouth and voice box, could be prevented by eliminating tobacco entirely, in any form or device, and limiting your alcohol consumption,” Dr. Young says.

Noting that oral pharyngeal cancers are expected to increase and become more common in women than cervical cancer, Dr. Young emphasizes the importance of dental appointment check-ups.

“The majority of our patients had something spotted on a dental exam or had a small swelling with no other symptoms,” he notes. “By the time they get to me, somebody has already found something.”