Head and neck carcinomas

Last updated: November 24, 2023

Summary

Head and neck carcinomas arise in the squamous cells of the mucosal epithelium in the nasal cavity, paranasal sinuses, oral cavity, pharynx, larynx, and trachea. Other nonsquamous cell carcinomas arise in salivary glands, sinuses, muscles, and nerves of the head and neck. Excluding nonmelanoma skin cancer, oral cavity malignancy is the most common head and neck carcinoma. Nasal cavity, oral cavity, and larynx cancers are generally associated with tobacco and/or alcohol use, whereas pharyngeal carcinomas are typically caused by infections with human papillomavirus and Epstein-Barr virus. Clinical features depend on the site and etiology of the primary tumor. Treatment usually involves surgery followed by radiotherapy and/or chemotherapy. Cancers of the brain, eye, ears, esophagus, thyroid gland, and skin of the head and neck are generally not classified as head and neck cancers and are discussed in other articles.

Oral cavity carcinoma, pharyngeal carcinoma, and laryngeal carcinoma are discussed in more detail in their respective articles.

Epidemiology

Sixth most common type of cancer worldwide
Accounts for ∼ 4% of cancers in the US ^[1]
Oral cavity, pharynx, and larynx carcinomas are the most common head and neck cancers.
Most common subtype: squamous cell carcinoma (SCC)
Median age of diagnosis: 50–60 years of age
Sex: ♂ > ♀

Overview of head and neck cancers

Overview of nasal cavity, paranasal sinus, and pharyngeal cancers
Type	Nasal cavity carcinoma	Paranasal sinus carcinoma	Pharyngeal carcinoma ^[2]
Type	Nasal cavity carcinoma	Paranasal sinus carcinoma	Nasopharyngeal carcinoma ^[3]	Hypopharyngeal carcinoma	Oropharyngeal carcinoma ^[4]
Epidemiology	Peak incidence: 40–50 years of age ♂ > ♀ ^[5] Most common subtype: SCC		Peak incidence: 50–60 years of age ♂ > ♀ (2:1) Most common subtype: SCC
Risk factors and associations	Tobacco use Chronic and/or occupational inhalation exposure to wood dust HPV infection		Tobacco and/or alcohol use Betel nut chewing Exposure to radiation
Risk factors and associations	Inhalation exposure to glues and adhesives	Exposure to air pollution Inhalation exposure to leather, textiles, and formaldehyde EBV infection, sinonasal tract lymphomas	Diets rich in nitrosamine (from eating salted and/or preserved foods) EBV infection	Plummer-Vinson syndrome	HPV infection
Clinical features	Commonly arise in the maxillary and ethmoid sinuses Unilateral nasal obstruction Epistaxis		Painless lymphadenopathy (early symptom) Unilateral nasal discharge, postnasal drip Impaired nasal breathing Nosebleeds Symptoms of eustachian tube obstruction (e.g., recurrent otitis media, hearing loss)	Persistent sore throat Muffled voice Foreign body sensation Dysphagia Odynophagia Otalgia Painless lymphadenopathy
Diagnostics	Rhinoscopy with nasal endoscopy Biopsy and histopathological examination Imaging: CT or MRI		Panendoscopy (laryngoscopy, bronchoscopy, and esophagoscopy) Biopsy and histopathological examination (confirmatory test) Imaging: CT or MRI
Treatment	Early stages (resectable tumors): surgical resection and radiotherapy (pre- or postoperative) Advanced stages (unresectable tumors): radiation therapy combined with chemotherapy		Management options include radiation therapy, chemotherapy, and/or surgery. For more information, see “Pharyngeal cancer.”

Hypopharyngeal cancer Oropharyngeal carcinoma

Overview of oral cavity, tonsil, tongue, salivary glands, and lip cancers ^[3]
Type	Oral cavity carcinoma ^[2]^[4]	Tonsil carcinoma	Tongue carcinoma ^[6]	Salivary gland carcinoma	Lip carcinoma ^[7]^[8]
Type	Oral cavity carcinoma ^[2]^[4]	Tonsil carcinoma	Tongue carcinoma ^[6]	Salivary gland carcinoma	Epidemiology	Peak incidence: 55–60 years of age ^[9] ♂ > ♀ (2:1) Most common subtype: SCC	Peak incidence: 45–50 years of age ♂ > ♀ Common subtypes: mucoepidermoid carcinoma (most common), adenoid cystic carcinoma	Peak incidence: ∼ 66 years of age ^[8] ♂ > ♀ Common subtypes: SCC, basal cell carcinoma
Risk factors and associations	Oral tobacco use and smoking Long-term alcohol use Human papillomavirus, particularly HPV 16, 18, 31, and 33 Stem cell transplants Poor oral hygiene, chronic mechanical irritation (e.g., incorrectly positioned dentures) Precancerous lesions (e.g., leukoplakia, erythroplakia)			Ionizing radiation, viral infection (e.g., HIV)	Tobacco and/or alcohol use Prolonged sun exposure HPV infection
Clinical features	Nonhealing, usually painless ulcer on tonsils, lateral ventral tongue, lower lip, and/or floor of the mouth Halitosis Bleeding in the mouth Cervical lymphadenopathy			Location: parotid glands > submandibular and sublingual glands > minor salivary glands Insidious onset Painless submucosal swelling or mucosal ulceration (palate, buccal mucosa, lips)	Infiltrative or exophytic lesion of the lips Nonhealing ulcer lesion
Clinical features	Pain (e.g., earache, mouth pain) Dysphagia, odynophagia	Persistent sore throat, globus sensation Unilateral otalgia Unilaterally indurated and/or enlarged tonsil Dysphagia, odynophagia	White or red ulcers on the tongue Localized pain
Diagnostics	Panendoscopy Biopsy and histopathology of the lesion Fine-needle aspiration of any associated lymphadenopathy Imaging: CT or MRI			Ultrasound of the head and neck Biopsy and histopathology of the lesion Mucoepidermoid carcinoma: squamous, mucinous, and polygonal intermediate cells Adenoid cystic carcinoma: slow, infiltrative growth along nerve sheaths Imaging: CT or MRI	Exfoliative cytology and direct microscopy Biopsy and histopathology of the lesion
Treatment	Early stages: surgical resection Advanced stages (with local spread): surgical resection and radiation therapy, with or without chemotherapy Inoperable tumors: radiation therapy with adjuvant chemotherapy For more information, see “Oral cavity cancer” and “Tongue conditions.”			Parotidectomy (superficial or total) Advanced stages (with local spread and/or high-grade tumors): neck dissection and/or adjuvant radiotherapy ^[10]^[11] For more information, see “Malignant tumors of the salivary glands.”	Surgical excision and/or radiotherapy

Tonsillar cancer Oral cancer Squamous cell carcinoma of the parotid gland Mucoepidermoid carcinoma Mucoepidermoid carcinoma of the submandibular gland Tumor of submandibular gland Adenoid cystic carcinoma in parotid gland Basal cell carcinoma

Overview of laryngeal and tracheal cancers ^[6]
Type	Laryngeal carcinoma ^[2]^[12]			Tracheal carcinoma ^[13]
Type	Supraglottic carcinoma	Glottic carcinoma	Subglottic carcinoma	Tracheal carcinoma ^[13]
Epidemiology	Peak incidence: 40–70 years of age ♂ > ♀ Most common subtype: SCC			Peak incidence: 60–70 years of age ♂ > ♀ Primary tracheal carcinomas are uncommon. Most common subtypes: SCC and adenoid cystic carcinoma
Risk factors and associations	Tobacco and/or alcohol use HPV 6 and 11 Exposure to paint, asbestos, gasoline fumes, and radiation Betel nut chewing Diets rich in nitrosamines and fats			Tobacco use Exposure to hydrocarbons (e.g., wood smoke, asphalt fumes)
Clinical features	Usually discovered at an advanced stage Dysphagia Hoarseness (usually late-onset) Foreign body sensation Airway obstruction	Persistent hoarseness/change in voice Otalgia Chronic cough Hemoptysis Stridor	Usually discovered at an advanced stage Dyspnea and/or stridor	Wheezing, stridor, cough, dyspnea, and hemoptysis Symptoms of invasion of the larynx and/or pharynx (e.g., dysphagia, hoarseness)
Diagnostics	Direct laryngoscopy: may reveal irregular, nodular, or ulcerative lesions Biopsy and histopathology of the lesion Fine-needle aspiration of any associated lymphadenopathy Imaging: CT without contrast, MRI, and/or ultrasound of the neck			Bronchoscopy with biopsy and histopathology of the lesion Imaging: chest x-ray or CT
Treatment	Early stages: radiotherapy or transoral endoscopic laser resection Advanced stages (with lymph node and/or distant organ metastasis): total laryngectomy For more information, see “Laryngeal carcinoma.”			Surgical resection with adjuvant radiation or chemoradiotherapy

Laryngoscopic view of glottic carcinoma (T1a) Glottic carcinoma (T1b) Laryngeal squamous cell carcinoma

Nasal cavity and paranasal sinus carcinomas

Definition

Tumors arising in the nasal cavity and/or paranasal sinuses.

Epidemiology ^[5]

Peak incidence: ≥ 60 years of age
Prevalence: < 3% of tumors in the respiratory tract
Sex: ♂ > ♀
Most common malignant tumors: cutaneous squamous cell carcinoma, adenocarcinoma, neuroendocrine tumors, mucosal melanoma

Etiology ^[14]

Nasal cavity carcinoma
- Chronic and/or occupational inhalation exposure to tobacco, wood dust, glues, and adhesives
- Associated with HPV infection
Paranasal sinus carcinoma
- Chronic and/or occupational inhalation exposure to air pollution, tobacco, wood dust, leather, textiles, and formaldehyde
- Associated with HPV infection, EBV infection, and sinonasal tract lymphomas

Clinical features

Most common sites: nasal cavity, followed by the maxillary sinus
Unilateral nasal obstruction
Epistaxis
Chronic sinusitis
Hyposmia/anosmia
Advanced disease: a triad of facial asymmetry, palpable or visible tumor in the oral cavity, and visible intranasal tumor

Paranasal sinuses

Diagnostics

Nasal endoscopy
Biopsy and histopathological examination
Imaging: CT and MRI

Treatment

Resectable tumors: surgical resection and radiotherapy (pre- or postoperative)
Unresectable tumors: radiation therapy combined with chemotherapy

Complications

Involvement of adjacent structures (e.g., eye orbits, sinuses, palate) causing neuralgias, facial pain, impaired vision, ocular symptoms (e.g., exophthalmos, diplopia), and/or dentalgia

Prognosis ^[15]

The five-year relative survival rate for nasal cavity and paranasal sinus carcinomas is ∼ 80%.

A patient with unilateral difficulty breathing through the nose may have a malignant tumor.

Lip carcinoma

Definition

A malignant tumor of the lips.

Epidemiology

Peak incidence: ∼ 66 years of age ^[8]
Sex: ♂ > ♀

Etiology ^[16]

Risk factors
- Tobacco use, alcohol use, prolonged UV exposure
- Associated with HPV infection

Histological subtype ^[16]

SCC (most common)
Basal cell carcinoma

Clinical features

Infiltrative or exophytic lesion of the lips
Ulcer lesion
Pain, numbness, and/or bleeding of the lip
Advanced stage: loss of sensation around the chin and/or invasion of the premaxilla and nasal cavity

Squamous cell carcinoma

Diagnostics

Physical examination of the lips
Exfoliative cytology and direct microscopy
Biopsy and histopathology of the lesion
See “Diagnostics for cSCC” and “Diagnostics for BCC” as needed

Treatment ^[16]

Surgical excision and/or radiation therapy
See “Treatment of cSCC” and “Treatment of BCC§ as needed.

Prognosis ^[8]^[17]

Early stage SCC has a five-year survival rate of ∼ 90%.
SCC that originates in the upper lip and/or labial commissure has a worse prognosis than SCC of the lower lip.

Tracheal carcinoma

Definition

A malignant tumor of the trachea.

Classification

Primary tracheal carcinomas
- Uncommon: approx. 0.2% of all respiratory malignancies in the US ^[18]
- Main subtypes: SCC (∼ 85%) and adenoid cystic carcinoma (∼ 15%)
- Very rare: mucoepidermoid carcinoma, carcinoid tumors, pleomorphic adenoma
- Usually malignant in adults and benign in children
Secondary tracheal carcinomas (most common): may arise from hematogenous or lymphatic sites of metastasis, or by direct extension from adjacent structures (e.g., thyroid, esophagus)

Epidemiology ^[18]

Peak incidence: 60–70 years of age
Sex: ♂ > ♀

Etiology

Risk factors: tobacco smoking, inhalation exposure to hydrocarbons
Direct invasion of the trachea from carcinoma of the lung, esophagus, larynx, or thyroid gland
Hematogenous spread from carcinoma of the breast, colon, kidney, and melanoma

Clinical features ^[13]

Usually mimics other conditions
Only symptomatic if obstructing the tracheal lumen
Symptoms vary based on the location of the tumor and histological subtype.
- Airway obstruction: wheezing, stridor, cough, dyspnea, and hemoptysis
- Invasion of adjacent structures (e.g., larynx, pharynx): dysphagia, hoarseness (due to recurrent nerve palsy)

Diagnostics

Usually a diagnosis of exclusion, after lack of response to treatment for alternative diagnoses (e.g., COPD, bronchitis)
Imaging: chest x-ray or CT to rule out other conditions
Bronchoscopy with biopsy (confirmatory test)
- SCC: exophytic or ulcerous lesions that can be multifocal (up to 10%) or arise as an intraluminal nodule
- Adenoid cystic carcinoma (ACC): polypoid lesions in the trachea or main stem bronchi
- Mucoepidermoid carcinoma: polypoid lesions from bronchial glands in the central airways

Treatment ^[19]

SCC
- Localized carcinoma: complete surgical resection with postoperative radiation or chemoradiotherapy
- Unresectable, nonmetastatic carcinoma: chemoradiotherapy
ACC: radiotherapy or chemoradiotherapy
Mucoepidermoid carcinoma: surgical resection

Prognosis

The five-year overall survival rate for ACC is approx. 80% and approx. 10% for SCC. ^[13]

References

Head and Neck Cancer: Statistics. https://www.cancer.net/cancer-types/head-and-neck-cancer/statistics. Updated: February 1, 2021. Accessed: January 4, 2022.
Johnson DE, Burtness B, Leemans CR, Lui VWY, Bauman JE, Grandis JR. Head and neck squamous cell carcinoma. Nature Reviews Disease Primers. 2020; 6 (1).doi: 10.1038/s41572-020-00224-3 . | Open in Read by QxMD
Chang ET, Ye W, Zeng Y-X, Adami H-O. The Evolving Epidemiology of Nasopharyngeal Carcinoma. Cancer Epidemiology Biomarkers & Prevention. 2021; 30 (6): p.1035-1047.doi: 10.1158/1055-9965.epi-20-1702 . | Open in Read by QxMD
Weatherspoon DJ, Chattopadhyay A, Boroumand S, Garcia I. Oral cavity and oropharyngeal cancer incidence trends and disparities in the United States: 2000–2010. Cancer Epidemiology. 2015; 39 (4): p.497-504.doi: 10.1016/j.canep.2015.04.007 . | Open in Read by QxMD
Turner JH, Reh DD. Incidence and survival in patients with sinonasal cancer: a historical analysis of population-based data.. Head Neck. 2012; 34 (6): p.877-85.doi: 10.1002/hed.21830 . | Open in Read by QxMD
Gunderson LL. Clinical Radiation Oncology. Elsevier Health Sciences ; 2015
Regezi JA, Sciubba JJ, Jordan RCK. Oral Pathology. Saunders ; 2012
Han AY, Kuan EC, Mallen-St Clair J, Alonso JE, Arshi A, St John MA. Epidemiology of Squamous Cell Carcinoma of the Lip in the United States. JAMA Otolaryngology–Head & Neck Surgery. 2016; 142 (12): p.1216.doi: 10.1001/jamaoto.2016.3455 . | Open in Read by QxMD
What Are the Key Statistics About Oral Cavity and Oropharyngeal Cancers?. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.html. Updated: January 6, 2017. Accessed: February 16, 2017.
Marchese-Ragona R, De Filippis C, Marioni G, Staffieri A. Treatment of complications of parotid gland surgery. Acta Otorhinolaryngol Ital. 2005; 25 (3): p.174-178.
Brunicardi F, Andersen D, Billiar T, et al.. Schwartz's Principles of Surgery. McGraw-Hill Education ; 2014
Laryngeal and Hypopharyngeal Cancers. https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer/about/key-statistics.html. Updated: January 12, 2022. Accessed: February 8, 2022.
Napieralska A, Miszczyk L, Blamek S. Tracheal cancer – treatment results, prognostic factors and incidence of other neoplasms. Radiology and Oncology. 2016; 50 (4): p.409-417.doi: 10.1515/raon-2016-0046 . | Open in Read by QxMD
Gaissert HA, Mark EJ. Tracheobronchial Gland Tumors. Cancer Control. 2006; 13 (4): p.286-294.doi: 10.1177/107327480601300406 . | Open in Read by QxMD
Sherani K, Vakil A, Dodhia C, Fein A. Malignant tracheal tumors. Curr Opin Pulm Med. 2015; 21 (4): p.322-326.doi: 10.1097/mcp.0000000000000181 . | Open in Read by QxMD
Wenig BM. Atlas of Head and Neck Pathology. Elsevier Health Sciences ; 2015
Survival Rates for Nasal Cavity and Paranasal Sinus Cancers. https://www.cancer.org/cancer/nasal-cavity-and-paranasal-sinus-cancer/detection-diagnosis-staging/survival-rates.html. Updated: April 19, 2021. Accessed: December 20, 2021.
Head and neck cancers. https://www.cancer.gov/types/head-and-neck/hp/adult/lip-mouth-treatment-pdq. Updated: January 1, 2021. Accessed: November 10, 2021.
Raskob GE, Zitsch RP, Park CW, Renner GJ, Rea JL. Outcome Analysis for Lip Carcinoma. Otolaryngology–Head and Neck Surgery. 1995; 113 (5): p.589-596.doi: 10.1177/019459989511300510 . | Open in Read by QxMD

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Head and neck carcinomas

Summary

Epidemiology

Overview of head and neck cancers

Nasal cavity and paranasal sinus carcinomas

Definition

Epidemiology [5]

Etiology [14]

Clinical features

Diagnostics

Treatment

Complications

Prognosis [15]

Lip carcinoma

Definition

Epidemiology

Etiology [16]

Histological subtype [16]

Clinical features

Diagnostics

Treatment [16]

Prognosis [8][17]

Tracheal carcinoma

Definition

Classification

Epidemiology [18]

Etiology

Clinical features [13]

Diagnostics

Treatment [19]

Prognosis

References

3 free articles remaining

Epidemiology ^[5]

Etiology ^[14]

Prognosis ^[15]

Etiology ^[16]

Histological subtype ^[16]

Treatment ^[16]

Prognosis ^[8]^[17]

Epidemiology ^[18]

Clinical features ^[13]

Treatment ^[19]