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Approximately 110,000 people are diagnosed with oral, head and neck cancer every year in the United States. Worldwide, over 550,000 new cases are diagnosed each year. Oral cancers will be found as late stage three and four diseases 66% of the time. However, most head and neck cancers can be prevented with early detection and treatment.

Most head and neck cancers begin in the cells that line the mucosal surfaces in the head and neck area, which include the mouth, nose and throat. Mucosal surfaces are moist tissues lining hollow organs and cavities of the body open to the environment. Normal mucosal cells look like scales, or squamous, under the microscope. Therefore, head and neck cancers are often referred to as squamous cell carcinomas. Some head and neck cancers begin in other types of cells. Cancers that begin in gland cells such as the salivary glands are called adenocarcinomas. Cancers of the head and neck are further identified by the area in which they begin, including oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, nasopharynx, oropharynx, hypopharynx, larynx and upper neck lymph nodes.

Early detection

Successful treatment of head and neck cancer depends on early detection. Fortunately, most head and neck cancers produce early symptoms. Recognizing these signs and symptoms can save you or your loved ones’ life.  It is important to know the potential warning signs so you can be seen by your doctor as soon as possible.  

Signs & Symptoms

A mouth growth
Most cancers of the mouth or tongue cause a sore or swelling that doesn’t go away. These may be painless sores, which can be misleading. Bleeding may occur, but often not until late in the disease. If an ulcer or swelling is accompanied by lumps in the neck, you should be seen by your doctor. Any sore or swelling in the mouth that does not go away after a week should be evaluated by a physician. Your doctor can determine if a biopsy is needed and can refer you to a head and neck surgeon who can perform this procedure.

Skin Changes
Basal cell cancer of the skin is the most common head and neck cancer. Fortunately, this is rarely serious if treated early. Basal cell cancers usually occur on sun-exposed areas like the forehead, face and ears, but can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, and eventually becomes an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. Some basal cell cancers show color changes.

Squamous cell cancer and malignant melanoma are different types of cancer that also occur on the head and neck. Many squamous cell cancers occur on the lower lip and ear. They may look like basal cell cancers, and if caught early and properly treated, usually are not dangerous. Call your physician if there is a sore on your lip, lower face or ear that does not heal. Malignant melanoma typically produces a blue-black or black discoloration of the skin. However, any mole that changes size, color or begins to bleed could be cause for concern. A black or blue-black spot on the face or neck, particularly if it changes size or shape, should be taken seriously and evaluated by your physician.

A lump found on the neck
Not all lumps are cancerous. However, a lump in the neck may be the first sign of cancer of the mouth, voice-box, throat, thyroid gland, blood cancer or lymphomas.  Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible.   

Recurring earache
Constant pain in or around the ear when you swallow can be a sign of infection or tumor growth in the throat. If it is associated with difficulty in swallowing, hoarseness or a lump in the neck, it can be even more serious. These symptoms should be evaluated by an ear, nose and throat physician as soon as possible.

Voice changes
Voice changes can occur with most cancers in the larynx. A head and neck specialist can examine your vocal cords for diagnosis. If you are hoarse or notice voice changes for more than two weeks, see your physician right away.
Blood in the saliva or phlegm
Tumors in the nose, mouth, throat or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, see your physician.

Trouble swallowing
Cancer of the throat or esophagus may make swallowing solid foods and liquids difficult. If you have trouble almost every time you try to swallow something, you should be examined by a physician. A barium swallow x-ray or an esophagoscopy will be performed to diagnose the cause of swallowing issues.

Risks of head and neck cancer

Cigarette smoking increases your risk of head and neck cancer by 15 times compared to a non-smoker. Tobacco use is the most preventable cause of cancer. Up to 200,000 people die each year in the US from smoking-related diseases. This number has decreased due to the increasing number of Americans who have quit smoking. However, some of these smokers switched to smokeless or spit tobacco, assuming it is a safe alternative, but it is not.  Doing so switches the site of the cancer risk from their lungs to their mouths. While lung cancer cases are decreasing, cancers in the head and neck are increasing, but they are curable if caught early.

Cancer of the throat can also occur as a result of infection with the human papilloma virus (HPV). Annually in the US, over 10,000 new cases of oral, head and neck cancer can be attributed to a particular strain of HPV. Prolonged exposure to sunlight is a factor in cancer of the lip and is also a major cause of skin cancer.

Evaluation and Treatment

The symptoms and signs described here can occur with no cancer present. Many times, complaints of this type are due to another condition. However, it is always better to check with your physician if any of these symptoms are present. If you notice warning signs of head and neck cancer, see your doctor immediately. With early detection, most cancers in the head and neck can be cured. Cure rates for these cancers are greatly improved when people seek medical advice as soon as possible.

The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person's age and general health. The patient and the doctor should consider treatment options carefully, discussing each type of treatment and how it might affect the patient and their quality of life.

Surgery and radiation therapy are the most common treatments designed to stop the spread of cancer by killing and/or removing the cancerous cells. Chemotherapy may be added in certain situations for advanced disease. Regular follow-up care is very important after treatment for head and neck cancer to make sure the cancer has not returned, or that a second primary cancer has not developed. Medical checkups could include exams of the mouth, neck and throat, depending on the type of cancer.

Midwest Ear, Nose & Throat
2315 West 57th Street  •  Sioux Falls, South Dakota 57108  •  605-336-3503  •  Toll-free 888-336-3503  •  Fax 605-336-6010