Head and neck cancer

What are head and neck cancers?

Head and neck cancers include cancers in:

the mouth (oral cavity or oral cancers)
the tongue
part of the throat (cancers of the oropharynx and tonsils, nasopharynx and hypopharynx)
the nose or sinuses (nasal and sinus cancer)
the salivary glands
the middle ear.

People may use the word throat to describe different parts of the neck. When doctors talk about the throat, they mean the pharynx and larynx (voice box).

It is important to know what type of head and neck cancer you have to make sure you have the right information. Ask your doctor or specialist nurse if you are unsure.

The following cancers that are in the head and neck area, are treated differently and not explained on this page.

We have other information about:

Head and neck cancers and cell type

Head and neck cancers are also described based on the type of cell the cancer started in.

Squamous cell carcinoma

The most common type of head and neck cancer is squamous cell carcinoma (squamous cell cancer). About 9 out of 10 head and neck cancers (90%) start in squamous cells. Squamous cells line the mouth, nose and throat.

Other cell types

A small number of head and neck cancers develop from other types of cells. These include lymphomas, adenocarcinomas (cancers that start in the mucous glands) and sarcomas.

Symptoms of head and neck cancers

The symptoms depend on where the cancer is in the head or neck. Some symptoms can include a sore throat, earache, nose bleeds, a lump or ulcer in the mouth that does not heal, and swelling under the jawbone. If you are worried about head and neck cancer, we have more information about the signs and symptoms.

Causes of head and neck cancers

Doctors do not know the exact causes of head and neck cancers. But there are risk factors that can increase your chance of developing it.

The main risk factors for head and neck cancers are tobacco and alcohol. It is thought that about 3 out of 4 head and neck cancers (75%) are linked to tobacco or alcohol use.

Many cancers at the back of the tongue and in the tonsils (cancers of the oropharynx) are linked to infection with a type of virus called human papilloma virus (HPV).

Having one or more risk factors does not mean you will get a head and neck cancer. Also, having no risk factors does not mean you will not develop a head and neck cancer.

We have more information about the causes and risk factors for head and neck cancers.

Diagnosis of head and neck cancers

If you have symptoms, you usually begin by seeing your GP or dentist. If they think that your symptoms could be caused by cancer, or they are not sure what the problem is, they will refer to a specialist doctor at the hospital. If your only symptom is a lump in your neck, you may be referred to a hospital that has a neck lump clinic. You are likely to see an oral and maxillofacial surgeon or an ear, nose and throat (ENT) specialist surgeon.

At the hospital, you may have some of the following tests:

Ultrasound scan of the neck

An ultrasound scan of the neck uses soundwaves to produce a picture of your neck and lymph nodes on a computer screen.
Nasendoscopy

A nasendoscopy is used to look at the back of your mouth, nose, pharynx and larynx.
Examination under anaesthetic (EUA)

An EUA is when you have a general anaesthetic, to allow the doctor to look at the area more closely using an endoscope. An endoscope is a thin, flexible tube with a camera and a light at the end.
Trans-nasal flexible laryngo-oesophagoscopy (TNFLO)

A TNFLO can be used instead of an endoscopy if you are not fit enough to have a general anaesthetic. It allows the doctor to look at your nose, throat, voice box and gullet (oesophagus).
Biopsy

The doctor collects a sample (biopsy) of cells or tissue from the area that looks abnormal. A doctor who specialises in analysing cells (called a pathologist) looks at the sample under a microscope for cancer cells. There are different ways of taking a biopsy from the head and neck area.

Waiting for test results can be a difficult time, we have more information that can help.

Further tests for head and neck cancers

If tests show you have a head and neck cancer, your specialist will arrange further tests. These can help find out more about the size and position of the cancer and whether it has spread. This is called staging. These tests could include:

X-rays

You may have an x-ray to check the bones in your face and neck and the health of your teeth. You may have a chest x-ray to check your general health and to see whether the cancer has spread to the lungs (although this is rare).
CT scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body.
MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body.
PET-CT scan

A PET-CT scan gives more detailed information about the part of the body being scanned.

Staging and grading of head and neck cancers

The stage of the cancer describes the size and position of the cancer and whether it has spread. The staging is slightly different for each type of head and neck cancer.

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer may develop.

Knowing the stage and grade helps your doctors plan the best treatment for you.

Treatment for head and neck cancers

Cancers affecting the head and neck are not common. People with this type of cancer are usually treated in specialist centres by a team of healthcare professionals.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your doctor or cancer specialist or nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.

Treatment for head and neck cancers may include:

Surgery

Surgery is one of the main treatments for cancers of the head and neck. Sometimes surgery to the mouth or throat can cause swelling around the throat. If the surgery your having might cause this, the surgeon will create a temporary small opening in your wind pipe for you to breathe through. This is called a tracheostomy or stoma.
Radiotherapy

Radiotherapy uses high-energy rays to destroy the cancer cells. It can be used on its own, but is often given in combination with chemotherapy. This is called chemoradiation.
Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usually given in combination with radiotherapy to treat locally advanced head and neck cancers.
Chemoradiation

Chemoradiation is when you have chemotherapy and radiotherapy together. Chemotherapy can make the cancer cells more sensitive to radiotherapy treatment.
Targeted therapies

Targeted therapy drugs work by targeting something in or around the cancer cell that is helping it grow and survive. The most commonly used targeted therapy to treat head and neck cancers is cetuximab (Erbitux®).
Immunotherapy

Immunotherapy drugs are sometimes used to treat head and neck cancer. These drugs use the immune system to find and attack cancer cells.

We have more information about:

how different treatments are used to treat head and neck cancers
what will happen before your treatment and how to prepare.

You may have some treatments as part of a clinical trial.

After head and neck cancer treatment

You have regular follow-up appointments after treatment.

For the first two years, you will have follow-up appointments more often. Your specialist will regularly examine your head and neck area. You may also have scans from time to time.

Tell your specialist about any ongoing side effects or symptoms that are not improving. You should also tell them about any new symptoms that do not get better within 2 weeks. Symptoms could include new ulcers or lumps in your neck, pain, or difficulty swallowing or speaking.

Sex life and fertility

Head and neck cancer and its treatment can sometimes affect your sex life and fertility.

If you are worried about this, it is important to talk with your doctor before you start treatment.

We have more information about:

Late effects

Some side effects that develop during treatment may take a long time to improve, or may sometimes become permanent. These are called long-term effects. Other effects can develop many years after treatment has finished. These are known as late effects. We have more information about long-term and late effects of head and neck cancer treatment.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes to the way you live such as eating well and keeping active can improve your health and well-being and help your body recover.

It can be difficult to eat well after treatment for head and neck cancer, but your dietitian can help you.

Your feelings after head and neck cancer treatment

For some people, it takes several months to recover from treatment. It can be hard to cope if treatment has changed your appearance, voice or how you eat and drink. It is common to feel overwhelmed by different feelings.

There are national support groups that you may find helpful:

The Mouth Cancer Foundation

The Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
Changing Faces

Changing Faces offers advice and information to anyone who is affected by a change in their appearance.
Let's Face It

Let's Face It provides information and support for people with facial disfigurements.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our head and neck cancer forum to talk with people who have been affected by head and neck cancer, share your experience, and ask an expert your questions.

About our information

References

Below is a sample of the sources used in our head and neck cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

British Association of Head and Neck Oncologists. Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines. 2016. Available from: https://www.bahno.org.uk/_userfiles/pages/files/ukheadandcancerguidelines2016.pdf (accessed September 2018).

Brockstein BE, Stenson KM, Song S. Overview of treatment for head and neck cancer. UpToDate https://www.uptodate.com/contents/overview-of-treatment-for-head-and-neck-cancer (accessed Spetember 2018).

National Institute for Health and Care Excellence (NICE). Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. 2016. Available from: https://www.nice.org.uk/guidance/ng36 (accessed September 2018).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.