Head and neck tumor

In addition, Epstein-Barr viruses (EBV) are a common cause of tumors of the upper throat (nasopharynx). An association with exposure to wood dust has been described for cancer of the nasal (paranasal) sinus mucosa. The cause of the tumors that develop in the salivary glands is unknown. The mainstays of treatment are surgery and radiotherapy with or without chemotherapy, either alone or in combination. If the tumor is discovered early, the chances of recovery are good.

Overview: What are head and neck tumors?

Malignant head and neck tumors do not respect tissue boundaries and grow into the surrounding tissue. They can also form metastases. They are classified into different types depending on the tissue from which they arise:

• Carcinomas in the mucous membrane – these occur most frequently and usually originate from surface cells (squamous cell carcinomas).
• Carcinomas in the salivary glands – these are rarer and originate from the saliva-producing cells and the salivary duct cells.
• Sarcomas that develop in the connective and supporting tissue.
• Lymphomas that occur in the lymph nodes or other lymphatic organs such as the tonsils.

All regions of the head and neck can be affected: There are tumors in the oral cavity (oral cavity carcinomas), in the throat (pharyngeal carcinomas), in the larynx (laryngeal carcinomas), in the nose, the paranasal sinuses and in the salivary glands. In rare cases, only lymph node metastases without a recognizable primary tumor are diagnosed.

Frequency and age

Around three percent of all cancers in Switzerland affect the mouth and throat. Every year, around 1,150 people in Switzerland are newly diagnosed with cancer of the oral cavity or pharynx. Men are particularly at risk: they make up more than two thirds of those affected. However, the number of women suffering from the disease has increased in recent years; experts attribute this to the fact that more and more women are smoking. The disease mostly affects older people. In the case of oral cavity cancer, for example, only ten percent of sufferers are younger than 50 and 35 percent are older than 70. According to estimates, every year 50 out of 100,000 people in Central Europe are diagnosed with a head and neck tumor. In countries where people chew a lot of tobacco or betel nut, significantly more people develop tumors in the head and neck area. There are often also tumors on the gums. In Central Europe, however, laryngeal cancer is most common in the head and neck area. For some years now, cancers of the oral cavity caused by the so-called human papillomavirus (HPV) have also been on the rise. The people affected tend to be younger.

Head and neck tumor: causes and risk factors

Every cancer develops through a combination of different factors. The most important cause of head and neck tumors is the consumption of tobacco and alcohol, especially in large quantities and over a long period of time. Laryngeal cancer, for example, hardly ever occurs in non-smokers. Lip and tongue tumors often develop in pipe smokers. Chewing tobacco is more likely to cause cancer of the gums or buccal mucosa. The number of tumors induced by human papillomaviruses (HPV) in the mucosal cancer of the oropharynx (palatine and lingual tonsils) has increased in recent years. Many of these patients do not consume alcohol or tobacco.

Other risk factors that promote cancer in the mouth, throat or neck:

• Frequent contact with harmful substances, such as asbestos or formaldehyde
• Exposure to wood dust
• Infection with Epstein-Barr viruses (EBV)
• chronically inflamed or stressed areas on the oral mucosa, for example due to sharp edges of dentures, neglect of oral hygiene
• certain diseases of the oral mucosa, e.g. lichen ruber

A hereditary predisposition also increases the risk of developing a head and neck tumor. Anyone with a weakened immune system, for example due to an HIV infection or after an organ transplant, also has an increased risk.

Symptoms: Foreign body sensation with head and neck tumor

Before a head and neck tumor develops, precancerous stages (precancerous lesions) are sometimes recognizable. Leukoplakia (white callus disease, also known as leukokeratosis) is conspicuous: The mucous membranes of the mouth develop a white or reddish-white coating that cannot be rubbed off. The cells they contain can develop atypia and eventually become cancerous. In most cases, the precursors do not cause any symptoms and are therefore often only discovered by chance. They should always be checked and in most cases treated.

Depending on the area in which a tumor grows and how large it is, it causes different symptoms. In many cases, there are hardly any or unspecific symptoms at the beginning.

Open areas in the oral cavity that do not heal are suspicious for oral cancer, and larger tumors can also cause pain, difficulty speaking or swallowing and weight loss. Tumors in the area of the throat are also initially asymptomatic in many cases and are often diagnosed on the basis of enlarged lymph nodes. Symptoms such as earache, blocked nasal breathing and hearing loss due to middle ear catarrh can also occur. In the area of the larynx, the classic symptoms are hoarseness and, in advanced cases, difficulty swallowing or shortness of breath. Tumors of the salivary glands present as swelling and, in certain cases, facial nerve paralysis.

Head and neck tumors: Diagnosis with us

In a consultation, we first ask about your medical history and possible risk factors such as smoking or heavy alcohol consumption. This is followed by a physical examination. With the help of mirrors and an endoscope, we look into the mouth, throat, larynx and nose. If a tumor of the oral cavity, pharynx and larynx is suspected, a more intensive examination/endoscopy under anesthesia is performed to assess the extent of the tumor and take samples, as well as to rule out other tumor foci. In the case of salivary gland tumors, the diagnosis is usually made by ultrasound-guided removal of cell material (fine needle aspiration). The cell and tissue samples are examined for cancer cells under a microscope.

Ultrasound and tomographic imaging (CT, MRI, PET/CT) for head and neck tumors

The important question is whether the tumor has already spread and formed metastases. Head and neck tumors usually affect the lymph nodes first. With an ultrasound examination (sonography) we can check whether the lymph nodes have enlarged. If there is any suspicion, we use a thin needle to remove cells from the lymph node for microscopic examination.

Other methods are computed tomography (CT) and magnetic resonance imaging (MRI): These procedures allow us to get a detailed picture of how far the tumor has spread and whether there are already metastases (metastases) in other organs. In rare cases, digital subtraction angiography (DSA) can also be used to visualize the blood vessels in detail. For some specific questions, positron emission tomography (PET) is also an option, which is combined with computer tomography or magnetic resonance imaging in a so-called PET/CT or PET/MRI.

Head and neck tumors: prevention, early detection, prognosis

If you want to prevent head and neck tumors, you should avoid all tobacco products – cigarettes and cigars as well as e-cigarettes, pipes and chewing tobacco. You should also only drink alcohol in small quantities. Good oral hygiene is also important. If you smoked, for example when you were younger, you should take even minor complaints seriously and have them checked by us. If you discover sores in the oral cavity that do not heal immediately, or if you suffer from persistent hoarseness for at least three weeks, you should consult us. Regular check-ups at the dentist are also recommended. Recently, a blood test has also become available that can contribute to the early detection of HPV-related cancers.

Progression and prognosis (head and neck tumor)

The prognosis for a head and neck tumor depends on where exactly the tumor is located and how early it is diagnosed. The earlier a cancer is treated, the better the chances of recovery. If the cancer is detected at an early stage, 75 to 90 percent of patients are still alive after five years. However, if the tumor is already at an advanced stage, this rate decreases. At an advanced stage with distant metastases, for example in the lungs, a cure is usually no longer possible.

Many people affected by cancer are impaired in their function (speech and swallowing) and sometimes also in their appearance. Psychosocial support during and after treatment helps to cope with the difficult time of the therapies and their side effects as well as any anxieties that arise. In addition, the complications caused by swallowing problems can be avoided with the help of close speech therapy and nutritional advice.

Clinical picture: Treatment with surgery and radiation

How a head and neck tumor is treated depends on its location, the stage of the tumor and the state of health of the person affected. Tumors of the oral cavity and paranasal sinuses are usually treated surgically, sometimes followed by radiotherapy (possibly with concomitant chemotherapy). The same applies to cancers of the salivary glands. Tumors of the pharynx and larynx can be treated either with surgery or radiotherapy with or without concomitant chemotherapy, depending on the histology, tumor stage, expected side effects and the patient’s wishes.

Drug treatment

Offshoots can form in head and neck tumors. In this situation, drugs, most commonly chemotherapy and/or immunotherapy, are used with the aim of achieving disease control for as long as possible.

In addition, depending on the risk profile and tumor stage, chemotherapy and antibody therapies are also a common adjuvant therapy to radiotherapy with the aim of healing and/or organ preservation.

At an advanced stage, palliative care can be involved to optimize symptoms.