What are head and neck cancers?
Head and neck cancer is a general term used for a range of cancers that start in the head and neck of the body. This region includes the mouth, tongue, palate, jaw, salivary glands, tonsils, throat (pharynx), voice box (larynx), nose and sinuses.
Head and neck cancers occur when malignant tumours grow in any of the tissue or lymph nodes in the head or neck area. Not all tumours in the head and neck are malignant.
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.
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 head and neck cancer.
CUP, or cancer of unknown primary, is a metastatic cancer (cancer that has spread) with an unknown starting point. If CUP first shows up in the head or neck, doctors may call it metastatic head and neck cancer and treat it like a head and neck cancer.
See details about other cancers call Cancer Council 13 11 20.
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, gums and tongue. 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, floor of the mouth under the tongue, bony roof of the mouth (hard palate), and the small area of gum behind the wisdom teeth.
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 tongue base to the back of the mouth, including the tonsils; cancer starting in this area is called oropharyngeal cancer
- hypopharynx – the lower part, behind 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). Cancer that starts in the larynx is called laryngeal cancer.
The larynx contains the vocal cords (glottis), which vibrate when air passes through them to produce the sound of your voice. When you swallow, a small flap of tissue called the epiglottis moves to cover the larynx to prevent food going into the trachea. Below the vocal cords is the subglottis. Under the voice box, in front of the trachea, is the thyroid gland.
The salivary glands make saliva. This keeps the mouth moist, helps you swallow food and protects the mouth against infections. There are three major salivary glands:
- parotid gland – in front of the ears
- sublingual gland – under the tongue
- submandibular gland – 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.
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.
How common are head and neck cancers?
About 4400 people in Australia (approximately 3170 men and 1230 women) are diagnosed with a head and neck cancer each year. 4 This includes about 1370 people diagnosed with cancer in the mouth and tongue; 1000 with lip cancer; 890 with pharyngeal cancer; 590 with laryngeal cancer; 320 with salivary gland cancer; and 170 with nasal or paranasal sinus cancer.
What are the risk factors?
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. Research shows that the risk is 35 times higher for people who are both heavy smokers and heavy drinkers. 5 The main risk factors include:
- drinking alcohol – compared to non-drinkers, drinkers have about 6 times the risk
- smoking tobacco (including cigarettes, cigars and pipes) – compared to nonsmokers, smokers have about 7 times the risk
- viruses – the human papillomavirus (HPV), especially HPV 16, has been linked to cancers of the oropharynx, and may play a role in other head and neck cancers. Exposure to the Epstein-Barr virus (EBV) may also be linked to the development of some head and neck cancers.
Other risk factors include:
- older age – head and neck cancers are more common in people aged 40 years and older
- being male – men are about three times more likely than women to develop head and neck cancer
- family history – people with a parent, brother, sister or child with head and neck cancer have double the risk of developing some types of head and neck cancer
- being from southern China or South-East Asia – people from some cultural backgrounds may be more likely to develop some types of head and neck cancers. This is because of cultural practices such as chewing tobacco or eating salty fish (salty fish is high in nitrates that react with protein to form chemicals that damage DNA)
- chemical exposure at work – breathing in asbestos fibres, wood dust, dry-cleaning solvents or certain types of paint or chemicals is associated with an increased risk of some types of head and neck cancer 6
- low immunity – people with low immunity conditions, such as those who have had a kidney transplant, have a higher risk of developing oral and oropharyngeal cancers
- sun exposure – ultraviolet (UV) radiation may cause skin cancer on the lip
- areca nut, betel nut, pan or gutka – chewing or smoking these products may cause oral cancer.
Eating adequate amounts of fruit and vegetables may help decrease the risk of oral and oropharyngeal cancers. Talk to your doctor if you are worried about any of these risk factors.
What are the symptoms?
There are many possible symptoms of head and neck cancer. However, these symptoms can also occur with other illnesses, so they don't necessarily mean you have cancer – only tests can confirm the diagnosis. If you are concerned about any of these symptoms, make an appointment with your general practitioner (GP) without delay.
Mouth (oral) cancer
- mouth pain or pain when swallowing
- a persistent sore or swelling in the mouth
- unusual bleeding or numbness in the mouth
- red or white patches on the gums, tongue or mouth
- bad breath changes in speech or difficulty pronouncing words
- difficulty chewing or swallowing food, difficulty moving the tongue or limited chewing
- weight loss a lump in the neck loose teeth, or dentures that no longer fit
- earache, or ringing in the ears
- throat pain or difficulty swallowing
- a persistent sore throat or cough
- coughing up bloody phlegm bad breath weight loss voice changes or hoarseness dull pain around the breastbone
- a lump in the neck pain in the ear or frequent ear infections
- feeling that your air supply is blocked
- numbness of the face
- nasal congestion
- hearing loss
- swelling or a lump in the neck or throat
- a persistent sore throat
- a persistent change in the sound of your voice, including hoarseness
- difficulty swallowing or pain when swallowing
- constant coughing
- difficulty breathing
- weight loss
Salivary gland cancer
- swelling or a lump near the ear, jaw, lip, or inside the mouth
- different appearance on each side of the face or neck
- difficulty swallowing or opening mouth widely
- drooping, numbness or muscle weakness on one side of the face (palsy)
Nasal or paranasal sinus cancer
- decreased sense of smell a persistent blocked nose, particularly in one nostril
- frequent nosebleeds excess mucus in the throat or back of the nose
- frequent headaches or sinus pressure
- difficulty swallowing
- loose or painful upper teeth
- a lump on/in the face, nose or mouth
- numbness of the face, upper lip, or within the mouth or upper teeth
- pressure or pain in the ears
- a bulging or watery eye
- double vision
- complete or partial loss of eyesight
Expert content reviewers:
A/Prof Ardalan Ebrahimi, Head and Neck Surgeon, Liverpool, Macquarie, St George Private and Sydney Southwest Private Hospitals, NSW; Jenne Farrant, Senior Physiotherapist, Intensive and Critical Care Unit, Flinders Medical Centre, SA; Merran Findlay AdvAPD Executive Research Lead – Cancer Nutrition, and Oncology Specialist Dietitian, Royal Prince Alfred Hospital, NSW; Dr Tsien Fua, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Dr Craig Gedye, Medical Oncologist, Calvary Mater Hospital, Newcastle, and Conjoint Senior Lecturer, School of Biomedical Sciences and Pharmacy, The University of Newcastle, NSW; Jenny Holland, Head and Neck Oncology Nurse Consultant, Monash Health at Moorabbin Hospital, VIC; Dr Steven Kao, Medical Oncologist, Chris O’Brien Lifehouse, NSW; Cindy Lyons, Social Worker (Radiology), Gosford Hospital, NSW; Dr Elishka Marvan, Dental Oncologist, Peter MacCallum Cancer Centre, VIC; Dr Julia McLean, Speech Pathologist, St George Swallow Centre, St George Hospital, NSW; Rohan Miguel, Senior Physiotherapist, Community Services, Disability SA; Tracey Nicholls, Nurse Practitioner Ear Nose and Throat, Department of ENT Otolaryngology Head and Neck Surgery, Flinders Medical Centre, SA; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Gail Williams, Consumer.
4. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: Head and neck including lip, AIHW, Canberra, 2017.
5. WJ Blot, “Alcohol and cancer”, Cancer Research, vol. 52 (suppl. 7), 1992, 2119s-2123s.
6. S Langevin et al., “Occupational dust exposure and head and neck squamous cell carcinoma risk in a population-based case-control study conducted in the greater Boston area”, Cancer Medicine, vol. 2, no. 6, 2013, pp. 978–86.