When it comes to cancer, many people often think of breast cancer, liver cancer, or lung cancer first. However, another group of cancers that is quite common but often overlooked is head and neck cancer. Some early-stage head and neck cancers in certain locations, such as nasopharyngeal cancer or the base of the tongue, often do not show prominent symptoms. This causes some patients to be diagnosed only when the disease has progressed. Nevertheless, some types of cancer, such as laryngeal or oral cancer, may have warning signs from the early stages, especially persistent hoarseness or oral ulcers that do not heal within 2 weeks. Being aware of warning signs and promptly seeing a doctor when suspicious symptoms appear can help detect the disease early and increase the chances of successful treatment.
What is head and neck cancer and where can it occur?
Head and neck cancer is a group of cancers that occur in the head and neck region. Most arise from squamous epithelial cells (Squamous Cell Carcinoma), which can spread rapidly and metastasize to the lymph nodes in the neck. Knowing the common sites of head and neck cancer helps us recognize even minor symptoms or warning signs. Common locations include:
- Oral cavity such as gums, cheeks, palate, tongue, and floor of the mouth. This is the most common site among head and neck cancers, especially in individuals with risk behaviors such as smoking, alcohol consumption, and betel nut chewing.
- Tongue including both the visible front part and the base of the tongue deep in the throat. The base of the tongue is often associated with HPV infection.
- Pharynx including the nasopharynx, the area around the uvula and tonsils, and the lower part of the throat.
- Larynx which controls the voice, found more commonly in males than females.
- Nasal cavity and sinuses less commonly found than other sites.
- Salivary glands located beside the jaw, under the tongue, or beneath the jawbone, found less frequently.
- Thyroid gland located in the mid-neck below the larynx. Although thyroid cancer is classified as a head and neck cancer, it differs from most head and neck cancers, which are usually squamous cell carcinomas.
Warning signs of head and neck cancer that should not be ignored
Early-stage head and neck cancer often does not show severe symptoms, but the body may send some observable signals. Important symptoms to watch for include:
Chronic sore throat lasting more than 2-3 weeks without a cause such as a cold or infection, especially if the sore throat is on one side or accompanied by other symptoms indicating abnormalities in the larynx or pharynx.
Difficulty or pain when swallowing which may be caused by a mass or lesion spreading in the pharynx, larynx, or base of the tongue.
Hoarseness or voice changes without known cause lasting more than 2 weeks and not due to overuse of the voice, cold, or bronchitis. Such symptoms may be related to laryngeal cancer affecting the vocal cords.
A lump in the neck or enlarged lymph nodes that is painless, immovable, and progressively enlarging, which may result from cancer cells spreading from other head and neck sites.
Blood in saliva or sputum or bleeding in the mouth and nose, which may indicate lesions or abnormal masses in the upper respiratory tract.
Chronic oral or tongue ulcers that do not heal within 2 weeks and do not respond to general treatment, or have a hard, rough texture or bleeding.
Chronic bad breath not related to oral health problems if occurring with chronic ulcers, masses, or other abnormal symptoms, may be a warning sign of cancer in the mouth or pharynx.
Numbness or pain in the face which may be caused by nerve compression related to cancer spreading in the nasal cavity, sinuses, or salivary glands.
If these symptoms persist or worsen, you should promptly consult a doctor for accurate diagnosis.
Diagnostic procedures for head and neck cancer
Diagnosing head and neck cancer requires the expertise of specialists in otolaryngology or head and neck surgery, along with appropriate medical technology to accurately diagnose the disease and plan targeted treatment. Key steps include:
- Physical examination and medical history The doctor will look for visible abnormalities such as chronic oral ulcers, neck masses, or swollen lymph nodes, and inquire about symptoms and risk factors to assess the need for further tests.
- Endoscopy In cases where lesions are in deep locations such as the nasopharynx, pharynx, or larynx, the doctor will use a special scope inserted through the nose or mouth to closely examine internal abnormalities, assessing tissue characteristics, color, movement, and other abnormalities not visible externally.
- Imaging studies to check the extent of lesions, spread to adjacent structures, or metastasis to lymph nodes or other organs, such as:
- Computed Tomography (CT Scan) used to evaluate the size and extent of the tumor, spread to adjacent structures, and suspicious enlarged lymph nodes in the neck, providing detailed images of bone and surrounding tissues.
- Magnetic Resonance Imaging (MRI) used to clearly assess soft tissue details such as muscles, nerves, bone marrow, tongue, base of the tongue, larynx, or brain involvement.
- Positron Emission Tomography (PET Scan) helps detect abnormal metabolic activity of cancer cells and assess overall disease spread.
- Biopsy to confirm cell type and abnormalities by collecting tissue samples from suspicious areas for pathological examination. This may be done directly if the lesion is in the oral cavity or via endoscopy for deeper locations. For suspicious neck masses or masses in the thyroid or salivary glands, fine needle aspiration (FNA) may be used to detect cancer cells.
- Virus testing Although not a direct test for malignancy, certain viruses are associated with specific head and neck cancers. Virus testing helps guide treatment planning and more accurately predict long-term outcomes, such as:
- HPV is often associated with base of tongue and tonsil cancers.
- EBV is a major cause of nasopharyngeal cancer.
Stages of head and neck cancer and chances of cure
Staging of head and neck cancer is crucial for treatment planning and prognosis. The disease can be classified from stage 0 to stage 4 as follows:
Stage 0: Abnormal cells confined to the epithelial layer such as in the oral cavity, pharynx, or larynx, without invasion into deeper tissues. The chance of cure is very high.
Stage 1: Tumor size is small, not exceeding 2 centimeters and has not spread to lymph nodes or other organs. There is a good chance of cure.
Stage 2: Tumor size approximately 2-4 centimeters confined to the original site and not yet spread to lymph nodes. The chance of cure is still fairly good but becomes more complex.
Stage 3: Tumor larger than 4 centimeters or beginning to invade adjacent structures such as muscles, tongue tissue, or larynx, or spreading to lymph nodes on one side of the neck not exceeding 6 centimeters. The chance of cure decreases as the cancer progresses.
Stage 4: Advanced cancer which may spread to multiple lymph nodes or distant organs such as lungs, liver, or bones. The chance of cure is low, but combined treatments can help control the disease and improve quality of life.
Treatment approaches for head and neck cancer
Treatment of head and neck cancer depends on various factors such as the location of the disease, cancer stage, overall patient condition, and response to treatment. Doctors will consider using single or combined treatment methods to achieve the best therapeutic outcomes. The main treatment approaches include:
- Surgery suitable for early-stage cancer or cases where the tumor can be completely removed, including removal of lymph nodes in the neck if necessary.
- Radiation therapy to destroy cancer cells, often used in combination with surgery or chemotherapy, or to eliminate residual cancer cells after surgery.
- Chemotherapy usually used when cancer has spread to lymph nodes or other organs, and often combined with radiation therapy to enhance treatment effectiveness. Chemotherapy drugs destroy cancer cells throughout the body and may cause side effects such as nausea, fatigue, or low blood counts.
- Targeted therapy and immunotherapy for patients whose cancer has specific mutations or is associated with HPV or EBV infection. These treatments stimulate the immune system to destroy cancer cells.
Additionally, rehabilitation and long-term care may be necessary because head and neck cancer affects speech, swallowing, breathing, and appearance. Patients should receive rehabilitation from a multidisciplinary team including rehabilitation physicians, occupational therapists, speech therapists, nutritionists, and psychiatrists to help them return to daily life with quality. Doctors may also use combined treatment methods to increase the chance of cure and reduce potential side effects.
Head and neck cancer is a common disease and often does not show clear symptoms in the early stages. If you experience abnormal symptoms such as chronic sore throat, voice changes, or a persistent neck lump for more than 2-3 weeks, you should promptly consult a doctor for diagnosis. At Phyathai Phaholyothin Hospital, we have a team of specialists in otolaryngology, head and neck cancer surgeons, and a multidisciplinary team, along with advanced diagnostic and treatment technologies, to provide comprehensive care for patients at all stages of the disease with dedication, aiming to restore quality of life to full health and strength.
Dr. Jakkrit Worakulpanich
Otolaryngology Specialist
Phyathai Phaholyothin Hospital
