What To Know About Head and Neck Cancer

Head and neck cancer is a group of cancers that primarily develop in the tissues lining the mouth, throat, nose and salivary glands. They usually impact areas that are involved in breathing, speaking, chewing and swallowing.  

For Head and Neck Cancer Awareness Month, we asked Niema Razavian, MD, a radiation oncologist at Moffitt Cancer Center, and Erin Guidera, a speech-language pathologist, some of the most pressing questions about these types of cancers. 

What are the main symptoms someone experiences before receiving a head and neck cancer diagnosis? 

Razavian: 

When I see patients for the first time, there are usually two groups I see. I have patients who come in with symptoms, and I have some patients who don't come in with symptoms at all. For people who don't have symptoms, these patients typically come in after noticing a lump in their neck. We call it an asymptomatic or no-symptom neck mass. That's a common presentation for cancers related to the human papillomavirus (HPV). For the other group of patients, the most common symptoms we see in patients with head and neck cancer are things like pain, difficulty swallowing and voice changes.  

Once someone is diagnosed, how is head and neck cancer typically treated? 

Razavian: 

There are three big buckets of treatment when it comes to head and neck cancer. There's the radiation bucket, which I do as a radiation oncologist, there's systemic therapy, which is what a medical oncologist does and can consist of things like chemotherapy or immunotherapy, and then there's surgery, which is done by a head and neck surgeon. The treatment a patient gets really depends on the type of cancer. Some cancers, like early-stage larynx cancers, can be treated with radiation alone, without any other treatments. Other cancers do require surgery first, and then maybe radiation with chemotherapy afterward. For some cancers, if they're more advanced and have spread to multiple parts of the body, something like immunotherapy from the medical oncologist may be the first treatment a patient receives. 

What are some of the challenges that head and neck cancer patients deal with?  

Guidera: 

Certainly, communication will be affected by many of these cancers. That might be a voice disorder, or somebody has hoarseness or difficulty at the level of their larynx, so their voice box. Or maybe it's more of a speech disorder or an articulation disorder, which is difficulty forming the sounds and the shapes in the mouth. Many of these patients have had major surgeries. Maybe their tongue has been either partially or fully removed, or their jaw has been removed. So, certainly, communication from a global perspective can be affected in this patient population. The other big thing, and probably a bigger focus in my practice, is swallowing disorders. A big portion of my cases as a speech language pathologist includes swallowing and swallowing disorders, assessing somebody's ability to safely and efficiently swallow, assessing whether it's a problem with the mouth part of the swallow, the throat part of the swallow, the esophagus part of the swallow, and then trying to help provide safe oral intake for these patients.  

What is a big misconception about head and neck cancer?  

Razavian: 

The treatments these days are not like the treatments they were 20 years ago. There are still tough treatments to get, but we've really, both from a radiation side, a chemotherapy side and a surgery side, made a lot of advances over the years. While it can still impact people's quality of life, the degree to which it affects patients is nowhere near what it was before. With these advancements, I hope to alleviate some of the fear people might have about receiving this diagnosis.