Mouth, Head, and Neck Cancers

Cancer of the mouth (oral cancer) and cancers of the head and neck area are common, and they are among the most deadly cancers known. The great majority of oral, head, and neck cancers occur in people over the age of 50. Unfortunately, these cancers tend to spread early, so many people are diagnosed at late stages when the outlook for responding to treatment is poor.

Causes

Oral, head, and neck cancers have three major risk factors: older age, tobacco use, and alcohol consumption. Tobacco is responsible for the large majority of these cancers. Several other factors may play a role, including heredity, exposure to certain chemicals that can cause cancer, and viruses. Sun exposure can cause lip cancer. A diet low in fruits and vegetables increases a person's risk of developing oral cancer.

Symptoms and Diagnosis

Early cancers frequently produce no symptoms. Cancers in the larynx and throat may cause hoarseness and a feeling of fullness, as if something is stuck in the throat.

Many early oral cancers appear as white, red, or a mixture of red and white sores or ulcers. Sores or ulcers that do not disappear after 3 to 4 weeks should be examined by a dentist or doctor. Cancers can occur as lumps in the mouth, on the tongue, in the back of the throat, and in the neck. Pain does not occur until cancers become larger, and the neck may not swell until oral cancers have spread to lymph nodes in the neck.

Diagnosis is made by tissue biopsy. CT or MRI scanning is then done to determine the exact location of the cancer and to determine if the cancer has spread.

Treatment

Doctors treat small oral, head, and neck cancers with surgery. If the entire cancer is removed and there is no evidence of spread, no further treatment may be needed other than careful follow-up by a doctor for many years. Because recurrence is much more likely with continued tobacco use and alcohol consumption, these should be discontinued.

With large oral, head, and neck cancers, surgery is required to remove the tumor as well as nearby lymph nodes. Since these lymph nodes are located in the neck, surgery involves removing extensive portions of one or both sides of the neck. About 4 weeks after surgery, the person then undergoes radiation therapy. Radiation therapy is usually given 5 times per week for 5 to 7 weeks. Doctors direct the radiation to the areas from which cancerous tissue was removed, as well as to other areas in the head and neck that are at risk for cancer spread. Radiation therapy is commonly combined with chemotherapy. Chemotherapy may help improve survival, but only if the cancer has not spread (metastasized) to other parts of the body. Chemotherapy may help if the cancer has already metastasized. In such instances, the chemotherapy is used without radiation therapy, to help slow the cancer's growth while preserving the function of structures such as the vocal cords, which can be damaged by radiation therapy.

Outlook

The outcomes for oral, head, and neck cancer depend on the severity of the disease and the type of treatment. In general, more than 80% of people with small cancers and no lymph node involvement live 5 years or longer. But fewer than 20% of people with large cancers that have spread to nearby lymph nodes live more than 5 years.

Surgery for oral, head, and neck cancer can cause significant problems. People may experience numbness; pain; and difficulty eating, chewing, speaking, swallowing, and tasting, depending on which parts of the mouth, head, and neck were removed in the surgery. If surgery involves the face or neck, disfigurement can be expected.

Radiation therapy can cause oral sores and ulcers (mucositis) to develop during and immediately after therapy. Permanent mouth dryness also develops because the radiation frequently destroys salivary glands. Problems associated with a dry mouth develop, putting people at high risk for dental cavities and oral infections (particularly fungal infections). Radiation to the face and neck can lead to difficulty opening the jaw, moving the neck, and swallowing.

Before and after treatment for oral, head, or neck cancer, the person should be examined by a dentist. Any problems such as tooth decay or periodontal disease should be treated, and a program of careful oral hygiene should be begun under the dentist's direction.