Head and Neck Cancers: Types, Risk Factors, and Treatment Options — Overview, Diagnosis & Treatment Options | MyMedicPlus

Head and neck cancers (HNC) encompass malignancies of the oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, nasal cavity, paranasal sinuses, and salivary glands. Squamous cell carcinoma accounts for over 90% of cases. Approximately 65,000 new US HNC cases are diagnosed annually, with approximately 15,000 deaths. HPV-positive oropharyngeal cancer is now the most rapidly increasing HNC subtype in Western countries, driven by sexual transmission of HPV-16.

Tobacco (cigarettes, cigars, smokeless tobacco) and alcohol are the dominant risk factors for non-HPV HNC, with synergistic interaction increasing risk 30-fold. HPV-16 causes the majority of oropharyngeal cancers (60-80% in Western populations). EBV causes nasopharyngeal carcinoma. Betel nut causes oral cavity cancer predominant in South and Southeast Asia. UV radiation causes lip cancer. Occupational exposures (asbestos, nickel, chromium, wood dust, formaldehyde) increase risk in specific subsites. Immunosuppression significantly elevates all HNC risks.

Presenting symptoms vary by subsite. Common presentations include a persistent non-healing oral ulcer or red or white patch (oral cavity), painless neck mass (oropharynx, frequently HPV-related), hoarseness lasting more than 3 weeks (larynx), dysphagia or odynophagia (pharynx, hypopharynx), nasal obstruction or epistaxis (nasopharynx, sinonasal), and serous otitis media in adults (nasopharynx). Referred otalgia, trismus, cranial nerve deficits, and weight loss indicate advanced disease. Most HNC patients present at Stage III or IV.

Diagnosis requires direct examination under general anesthesia (panendoscopy: laryngoscopy, esophagoscopy, bronchoscopy) with biopsy of primary lesion and any suspicious areas. CT and MRI characterize local extent and cervical nodal involvement. PET-CT detects distant metastases and synchronous second primaries. p16 immunohistochemistry is used as a surrogate for HPV status in oropharyngeal cancer. AJCC 8th edition uses separate staging systems for HPV-positive and HPV-negative oropharyngeal cancer. EBV DNA testing is performed for nasopharyngeal cancer.

Stage I-II disease: single-modality surgery or radiation. Locally advanced Stage III-IV (excluding nasopharynx): concurrent cisplatin (100 mg/m2 every 3 weeks or 40 mg/m2 weekly) plus 66-70Gy IMRT (preferred for organ-preservation) or primary surgery plus adjuvant RT or chemoRT. HPV-positive oropharyngeal cancer: de-intensification trials (reduced radiation dose, immunotherapy substituting platinum) for favorable-risk patients. Cetuximab (anti-EGFR) for platinum-ineligible locally advanced disease. Pembrolizumab-based regimens for recurrent or metastatic disease. Salivary gland tumors: surgery plus radiation; androgen deprivation for AR-positive salivary cancers.

Outcomes vary substantially by subsite and HPV status. HPV-positive oropharyngeal cancer: 5-year OS approximately 80-85% even at Stage III-IV. HPV-negative oropharyngeal, oral cavity, hypopharyngeal cancers: 5-year OS approximately 50-60% for Stage III-IV. Nasopharyngeal cancer: 5-year OS approximately 75-80% for Stage II-III with chemoradiation. Laryngeal cancer: 5-year OS Stage I approximately 85-90%, Stage IV approximately 30-40%. Complete metabolic response on post-treatment PET-CT (Deauville score 1-2) predicts excellent prognosis and may avoid planned neck dissection.

Tobacco cessation is the most effective preventive measure and reduces HNC risk by approximately 50% within 5 years. Alcohol reduction, particularly combined with tobacco cessation, further reduces risk. HPV vaccination (Gardasil 9) recommended at ages 9-12 and catch-up to age 26 (or up to 45 in selected adults) prevents HPV-16/18 infection, reducing oropharyngeal and other HPV-related HNC. Betel nut avoidance is critical in South Asian populations. Regular dental examinations with oral cancer screening, and annual ENT examination for high-risk patients (smokers over age 40), enable earlier detection.