Head and Neck Cancer - West Cancer Center

If you or a loved one has been diagnosed with head and neck cancer, West Cancer Center & Research Institute is uniquely prepared to offer the latest treatment options with a skilled team of head and neck cancer medical, surgical, radiology oncologist, speech pathologist and physical therapist.

Types of Head and Neck Cancer

LARYNGEAL CANCER

This is the second most common type of head and neck cancer and affects the larynx (voice box) at the top of the trachea (windpipe) which is comprised of the vocal cords and prevents food from entering the lungs.

MOUTH CANCER

Another name for mouth cancer is oral cavity cancer and it is most likely linked to tobacco and alcohol use.

NASAL CAVITY AND SINUS CANCER

These rare forms of cancer are many times not cancerous, but may become cancerous if not treated. The nasal cavity and sinuses are comprised of layers of cells that produce mucus, affect your voice, and warm the air you breathe.

SALIVARY GLAND CANCER

Approximately 70% of salivary gland tumors are non-cancerous and usually begin in the parotid glands. Tumors are more likely to be cancerous if they form in the minor salivary glands, sublingual gland or the submandibular gland.

THROAT CANCER

Like mouth cancer, tobacco and alcohol use are associated with throat cancer, but now over 70% are linked to HPV (human papillomavirus) according to the Center for Disease Control.

THYROID CANCER

Only 10% of thyroid cancers (thyroid-a small gland below the voice box that is part of your endocrine system) are cancerous and are very hard to diagnose because of lack of symptoms. This cancer type is most common in women between the ages of 20 and 55.

TONGUE CANCER

These cancers can either start at the base of the tongue or oral tongue-the front two-thirds that is visible when you stick out your tongue.

Stages of Head and Neck Cancer

Hypopharyngeal Cancer

Stage 0

Abnormal cells are found in the lining of the hypopharynx and may become cancer and spread into nearby normal tissue (also called carcinoma in situ)

Stage 1

Cancer has formed in one area of the hypopharynx only and/or the tumor is 2 centimeters or smaller.

Stage II

The tumor is either:

larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx (voice box); or
found in more than one area of the hypopharynx or in nearby tissues.

Stage III

The tumor:

is larger than 4 centimeters or has spread to the larynx (voice box) or esophagus. Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller; or
has spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller and cancer is found:
in one area of the hypopharynx and/or is 2 centimeters or smaller; or
in more than one area of the hypopharynx or in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx.

Stage IV-A

has spread to cartilage around the thyroid or trachea, the bone under the tongue, the thyroid, or nearby soft tissue. Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller; or
has spread to one lymph node on the same side of the neck as the tumor (the lymph node is larger than 3 centimeters but not larger than 6 centimeters) or to lymph nodes anywhere in the neck (affected lymph nodes are 6 centimeters or smaller), and one of the following is true:
cancer is found in one area of the hypopharynx and/or is 2 centimeters or smaller; or
cancer is found in more than one area of the hypopharynx or in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx (voice box); or
cancer has spread to the larynx or esophagus and is more than 4 centimeters; or
cancer has spread to cartilage around the thyroid or trachea, the bone under the tongue, the thyroid, or nearby soft tissue.

Stage IV-B

has spread to muscles around the upper part of the spinal column, the carotid artery, or the lining of the chest cavity and may have spread to lymph nodes which can be any size; or
may be any size and has spread to one or more lymph nodes that are larger than 6 centimeters.

Stage IV-C

The tumor may be any size and has spread beyond the hypopharynx to other parts of the body.

Laryngeal Cancer

Stage 0

Abnormal cells are found in the lining of the larynx and may become cancer and spread into nearby normal tissue. (also called carcinoma in situ)

Stage I

Laryngeal cancer depends on where cancer began in the larynx:

Supraglottis: Cancer is in one area of the supraglottis only and the vocal cords can move normally.
Glottis: Cancer is in one or both vocal cords and the vocal cords can move normally.
Subglottis: Cancer is in the subglottis only.

Stage II

Cancer is in the larynx only and depends on where cancer began in the larynx:

Supraglottis: Cancer is in more than one area of the supraglottis or surrounding tissues.
Glottis: Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally.
Subglottis: Cancer has spread to one or both vocal cords, which may not move normally.

Stage III

Depending on whether cancer has spread from the supraglottis, glottis, or subglottis.

Supraglottis:

cancer is in the larynx only and the vocal cords cannot move, and/or cancer is in tissues next to the larynx. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
cancer is in one area of the supraglottis and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller and the vocal cords can move normally; or
cancer is in more than one area of the supraglottis or surrounding tissues and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller.

Glottis:

cancer is in the larynx only and the vocal cords cannot move, and/or cancer is in tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
cancer is in one or both vocal cords and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller and the vocal cords can move normally; or
cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally.

*cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller.
Subglottis:

cancer is in the larynx and the vocal cords cannot move; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
cancer is in the subglottis and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller; or
cancer has spread to one or both vocal cords, which may not move normally. Cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller.

Stage IV-A

cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
cancer has spread to one lymph node on the same side of the neck as the original tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters, or has spread to more than one lymph node anywhere in the neck with none larger than 6 centimeters. Cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. The vocal cords may not move normally.

Stage IV-B

cancer has spread to the space in front of the spinal column, surrounds the carotid artery, or has spread to parts of the chest. Cancer may have spread to one or more lymph nodes anywhere in the neck and the lymph nodes may be any size; or
cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery, or to parts of the chest. The vocal cords may not move normally.

Stage IV-C

Cancer has spread to other parts of the body, such as the lungs, liver, or bone.

Lip and Oral Cavity

Stage 0

Abnormal cells are found in the lining of the lips and oral cavity and may become cancer and spread into nearby normal tissue. (also called carcinoma in situ)

Stage I

Cancer has formed and the tumor is 2 centimeters or smaller. Cancer has not spread to the lymph nodes.

Stage II

The tumor is larger than 2 centimeters but not larger than 4 centimeters, and cancer has not spread to the lymph nodes.

Stage III

The tumor:

may be any size and has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the tumor; or
is larger than 4 centimeters.

Stage IV-A

has spread through tissue in the lip or oral cavity into nearby tissue and/or bone (jaw, tongue, floor of mouth, maxillary sinus, or skin on the chin or nose); cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the tumor; or
is any size or has spread through tissue in the lip or oral cavity into nearby tissue and/or bone (jaw, tongue, floor of mouth, maxillary sinus, or skin on the chin or nose), and cancer has spread:

to one lymph node on the same side of the neck as the tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
to more than one lymph node on the same side of the neck as the tumor and the lymph nodes are not larger than 6 centimeters; or
to lymph nodes on the opposite side of the neck as the tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.

Stage IV-B

may be any size and has spread to one or more lymph nodes that are larger than 6 centimeters; or
has spread further into the muscles or bones in the oral cavity, or to the base of the skull and/or the carotid artery. Cancer may have spread to one or more lymph nodes anywhere in the neck.

Stage IV-C

The tumor has spread beyond the lip or oral cavity to distant parts of the body, such as the lungs. The tumor may be any size and may have spread to the lymph nodes.

Metastatic Neck Cancer

There is no standard staging system for metastatic squamous neck cancer with occult primary. The tumors are described as untreated or recurrent. Untreated metastatic squamous neck cancer with occult primary is cancer that is newly diagnosed and has not been treated, except to relieve signs and symptoms caused by the cancer.

Nasopharyngeal Cancer

Stage 0

Abnormal cells are found in the lining of the nasopharynx and may become cancer and spread into nearby normal tissue. (also called carcinoma in situ)

Stage I

The cancer:

is found in the nasopharynx only; or
has spread from the nasopharynx to the oropharynx and/or to the nasal cavity.

Stage II

The cancer:

• is found in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity. Cancer has spread to one or more lymph nodes on one side of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller; or is found in the parapharyngeal space. Cancer may have spread to one or more lymph nodes on one side of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller.

Stage III

is found in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity. Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller; or
is found in the parapharyngeal space. Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller; or
has spread to nearby bones or sinuses. Cancer may have spread to one or more lymph nodes on one or both sides of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller.

Stage IV-A

Cancer has spread beyond the nasopharynx and may have spread to the cranial nerves, the hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the bone around the eye. Cancer may also have spread to one or more lymph nodes on one or both sides of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller.

Stage IV-B

Cancer has spread to lymph nodes between the collarbone and the top of the shoulder and/or the affected lymph nodes are larger than 6 centimeters.

Stage IV-C

Cancer has spread beyond nearby lymph nodes to other parts of the body.

Opharyngeal Cancer

Stage 0

Abnormal cells are found in the lining of the oropharynx and may become cancer and spread into nearby normal tissue. (also called carcinoma in situ)

Stage I

Cancer has formed and is 2 centimeters or smaller and is found in the oropharynx only.

Stage II

The cancer is larger than 2 centimeters but not larger than 4 centimeters and is found in the oropharynx only.

Stage III

The cancer is either:

4 centimeters or smaller; cancer has spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller; or
larger than 4 centimeters or has spread to the epiglottis (the flap that covers the trachea during swallowing). *may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller.

Stage IV-A

has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing. Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller; or
has spread to one lymph node on the same side of the neck as the tumor (the lymph node is larger than 3 centimeters but not larger than 6 centimeters) or to more than one lymph node anywhere in the neck (the lymph nodes are 6 centimeters or smaller), and one of the following is true:
tumor in the oropharynx is any size and may have spread to the epiglottis (the flap that covers the trachea during swallowing); or
tumor has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing.

Stage IV-B

surrounds the carotid artery or has spread to the muscle that opens the jaw, the bone attached to the muscles that move the jaw, nasopharynx, or base of the skull. Cancer may have spread to one or more lymph nodes which can be any size; or
may be any size and has spread to one or more lymph nodes that are larger than 6 centimeters.

Stage IV-C

The tumor may be any size and has spread beyond the oropharynx to other parts of the body, such as the lung, bone, or liver.

Paranasal Sinus and Nasal Cavity Cancer

There is no standard staging system for cancer of the sphenoid and frontal sinuses.

Maxillary Sinus

Stage 0

Abnormal cells are found in the innermost lining of the maxillary sinus and may become cancer and spread into nearby normal tissue. (also called carcinoma in situ)

Stage I

Cancer has formed in the mucous membranes of the maxillary sinus.

Stage II

Cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bone at the back of the maxillary sinus or the base of the skull.

Stage III

Cancer has spread to any of the following:

Bone at the back of the maxillary sinus.
Tissues under the skin.
The eye socket.
The base of the skull.
The ethmoid sinuses.

Or cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following:

The lining of the maxillary sinus.
Bones around the maxillary sinus, including the roof of the mouth and the nose.
Tissues under the skin.
The eye socket.
The base of the skull.
The ethmoid sinuses.

Stage IV-A

to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or
to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.
The lining of the maxillary sinus.
Bones around the maxillary sinus, including the roof of the mouth and the nose.
Tissues under the skin.
The eye socket.
The base of the skull.
The ethmoid sinuses.

Or cancer has spread to any of the following:

The front of the eye.
The skin of the cheek.
The base of the skull.
Behind the jaw.
The bone between the eyes.
The sphenoid or frontal sinuses.

Cancer may also have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.

Stage IV-B

Cancer has spread to any of the following:

The back of the eye.
The brain.
The middle parts of the skull.
The nerves in the head that go to the brain.
The upper part of the throat behind the nose.
The base of the skull

Cancer may be found in one or more lymph nodes of any size, anywhere in the neck. Or cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the maxillary sinus.

Stage IV-C

Cancer may be anywhere in or near the maxillary sinus, may have spread to lymph nodes, and has spread to organs far away from the maxillary sinus, such as the lungs.

Nasal Cavity and Ethmoid Cancer

Stage 0

Abnormal cells are found in the innermost lining of the nasal cavity or ethmoid sinus and may become cancer and spread into nearby normal tissue. (also called carcinoma in situ)

Stage I

Cancer has formed and is found in only one area (of either the nasal cavity or the ethmoid sinus) and may have spread into bone.

Stage II

Cancer is found in two areas (of either the nasal cavity or the ethmoid sinus) that are near each other or has spread to an area next to the sinuses. Cancer may also have spread into bone.

Stage III

Cancer has spread to any of the following:

The eye socket.
The maxillary sinus.
The roof of the mouth.
The bone between the eyes.

Or cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following:

The nasal cavity.
The ethmoid sinus.
The eye socket.
The maxillary sinus.
The roof of the mouth.
The bone between the eyes.

Stage IVA

Cancer has spread:

to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or
to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.
The nasal cavity.
The ethmoid sinus.
The eye socket.
The maxillary sinus.
The roof of the mouth.
The bone between the eyes.
The front of the eye.
The skin of the nose or cheek.
Front parts of the skull.
The base of the skull.
The sphenoid or frontal sinuses.
Cancer may have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.

Stage IV-B

Cancer has spread to any of the following:

The back of the eye.
The brain.
The middle parts of the skull.
The nerves in the head that go to the brain.
The upper part of the throat behind the nose.
The base of the skull.

Cancer may be found in one or more lymph nodes of any size, anywhere in the neck. Or cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the nasal cavity and ethmoid sinus.

Stage IV-C

Cancer may be anywhere in or near the nasal cavity and ethmoid sinus, may have spread to lymph nodes, and has spread to organs far away from the nasal cavity and ethmoid sinus, such as the lungs.

Symptoms of Head and Neck Cancer

If you are experiencing any of these symptoms, we urge you to speak to your provider as soon as possible for further examination.

Mouth ulcer that won’t heal
Lump in the neck, jaw or mouth
Pain or weakness in the face
Neck pain
Difficulty swallowing
Speech problems

Hearing loss or ear pain
Lingering sore throat
Red or white patches in the throat or mouth
Weight loss
Numbness in the tongue
Loose teeth or dentures no longer fit

How to Diagnose Head and Neck Cancer

If your provider would like to further investigate the possibility of a head or neck cancer, one or more of the following diagnostic procedures may be performed:

BARIUM SWALLOW

Involves swallowing a barium-based chalky solution to detect small, early head and neck tumors in the larynx, mouth, pharynx and other surrounding areas using an x-ray imaging technique

BIOPSY

A tissue sample of the tumor or mass is either collected through an incision (in-office or surgically) or fine needle aspiration and is analyzed by a pathologist to see if they are cancerous.

COMPUTERIZED TOMOGRAPHY (CT SCAN)

A donut-shaped piece of equipment uses low dose radiation, either with or without a contrast fluid to detect abnormalities of the sinuses and nasal cavities.

ENDOSCOPY

Endoscopy: A thin, tube-like device with a camera(endoscope) is inserted into your nose or mouth to examine areas of the head and neck that are difficult to see. A biopsy may or may not be done in conjunction.

GENOMIC TESTING

Analyzes cells taken during a biopsy to see if there are any genetic mutations linked to a cancer type helps identify the best treatment plans for your cancer.

HPV Test: This is a standard test for anyone diagnosed with throat cancer to determine the least intensive treatment plan.

LIVER BIOPSY

Uses saliva or blood to determine if your cancer is at risk of spreading to create the most personalized treatment plan.

MAGNETIC RESONANCE IMAGING (MRI)

Provides detailed images of the head and neck area using magnetic fields to identify any abnormalities that may be cancer.

PANOREX

Is an panoramic x-ray of your jawbone and teeth that can help find cancer, see if the cancer has spread to the jaw, and evaluate dental health prior to radiation therapy.

POSITRON EMISSION TOMOGRAPHY (PET)

A radioactive substance is injected into your bloodstream to collect in cancerous cells and identify the exact location of your cancer.

PHYSICAL EXAM

Our experienced Head and Neck Oncologist look for abnormalities with an exhaustive examination of the mouth and throat.

THYROID NODULE ASSESSMENT

Is a thorough evaluation of your thyroid nodules to determine if you have thyroid cancer and determine the risk level.

Types of Head and Neck Cancer Treatments

Your head and neck cancer treatment plan will vary depending on multiple factors including, but not limited to, your stage of diagnosis, as well as the location of your cancer. Your dedicated team of cancer specialist will discuss your treatment options and plan with you, allowing you and your loved ones to consider all possible treatment options for your diagnosis.

CHEMOTHERAPY

Uses powerful drugs specifically designed to destroy your head and neck cancer cells that are dividing rapidly. These drugs may be given before or during radiation to improve your outcome and care.

TARGETED THERAPIES

Targeted therapies, a new form of chemotherapy, allow our doctors to create personalized treatments to target specific genetic differences by using Genomic testing.

CLINICAL TRIAL

You may be a candidate for a clinical trial for your head and neck cancer, ask our specialist if this is a treatment option for you.

RADIOACTIVE IODINE THERAPY (THYROID)

Because your thyroid gland absorbs the majority of iodine in your body, a radioactive iodine can be administered in a liquid or capsule form to target and destroy cancer cells in the thyroid with less harm to the rest of your body.

RADIATION

Several radiation therapies are used to treat Head and Neck Cancer; intensity-modulated radiation therapy (IMRT), where precise radiation doses that utilize computer-controlled x-ray accelerators target a malignant tumor and external beam therapy (EBT), where a beam of high-energy x-rays or proton beams-generated outside the body- target the tumor site.

SURGERY

Your head and neck tumors can be removed surgically with minimally invasive techniques like Transoral Laser Microsurgery (TML), Transoral Robotic Surgery (TORS), and Transnasal Endoscopy plus more extensive surgeries for complicated tumors in delicate or hard to reach areas of the head and neck.