Diagnosis, Symptoms and Types of Head and Neck Cancers

Mount Sinai’s head and neck oncology team is comprised of some of the world’s finest experts in diagnosing and treating cancers of the larynx, throat, tongue, tonsil, thyroid, parathyroid, salivary gland, sinuses, and trachea. Our fellowship trained physicians are also renowned for their microvascular and reconstructive surgery techniques. As the patient, it is important to understand your condition so you can effectively partner with your doctor in order to achieve the best possible long-term health.

Diagnosing Head and Neck Cancer

In order to diagnose your condition, your doctor will evaluate your medical history and perform a physical examination, which may include visual inspection of your oral and nasal cavities, neck, throat, and tongue. Your doctor may also feel for lumps on your neck, lips, gums, and cheeks.

Depending on your symptoms, your doctor may order some of these common diagnostic tests and procedures:

  • Biopsy: The removal of tissue, which is send to a pathologist, who studies it under a microscope. A biopsy is the only sure way to tell whether a person has cancer.
  • CT (CAT) scan: Detailed images of the interior of your head and neck that are created by a computer linked to an X-ray machine.
  • Magnetic resonance imaging (MRI): The use of a powerful magnet linked to a computer to create detailed pictures of areas inside the head and neck.
  • PET scan: A test using sugar modified in a specific way so that it is absorbed by cancer cells and appears as dark areas on the scan.
  • X-ray: Creates images of areas inside the head and neck on film.

If your diagnosis is cancer, your doctor will want to learn the stage, or extent, of the disease. Staging is a careful attempt to find out whether your cancer has spread and, if so, to which parts of your body. Staging may involve an examination under anesthesia in the operating room, X-rays and other imaging procedures, and laboratory tests. Knowing the stage of your head or neck cancer will help your doctor plan your treatment.

Risk Factors for Head and Neck Cancers

Head and neck cancers are more common in men, particularly over the age of 50, but thyroid cancers are more common in women by a measure of 3 to 1 versus men. HPV (human papillomavirus) is now the leading cause of oral and throat cancers, accounting for approximately 80 percent of cases. The use of tobacco, including smokeless tobacco (also called "chewing tobacco" or "snuff"), and alcohol are also risk factors for head and neck cancers. People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone.

Other risk factors for cancers of the head and neck vary by the location of cancer:

  • Oral cavity and oropharynx : Sun exposure, poor oral hygiene, a weakened immune system, and marijuana use, in addition to human papillomavirus (HPV) infection, which is transmitted through sexual activity, including oral sex; the use of mouthwash with a high alcohol content is also a possible contributing factor.
  • Salivary glands: Radiation exposure to the head and neck from diagnostic X-rays or from radiation therapy, and environmental/occupational exposure to sawdust and chemicals associated with the leather industry and pesticides.
  • Paranasal sinuses and nasal cavity: Certain industrial exposures such as wood, asbestos, formaldehyde or glue fumes,  or nickel dust inhalation; tobacco and alcohol use may play less of a role in this type of cancer, as well as HPV.
  • Nasopharynx: Asian, particularly Chinese, ancestry, Epstein-Barr infection, occupational exposure to wood dust, tobacco and alcohol use, and consumption of certain preservatives or salted foods.
  • Hypopharynx: Plummer-Vinson (Paterson-Kelly) syndrome, a rare disorder that results from iron and other nutritional deficiencies. This syndrome is characterized by severe anemia and leads to difficulty swallowing.
  • Larynx: Exposure to airborne particles of asbestos, especially in the workplace.

Immigrants from Southeast Asia who use paan (betel quid) in their mouth should note that this habit has been strongly associated with an increased risk for oral cancer. Also, consumption of mate, a tea-like beverage habitually consumed by South Americans, has been associated with an increased risk of cancers of the mouth, throat, esophagus, thyroid, and larynx.

Symptoms of Head and Neck Cancer

The symptoms of several head and neck cancers include a lump or sore that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice. The following symptoms vary by cancer site, and may also be caused by less serious conditions.

  • Oral cavity: A white or red patch on the gums, tongue, or lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; or unusual bleeding or pain in the mouth.
  • Nasal cavity and sinuses. Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; nosebleeds, frequent headaches, swelling or other trouble with the eyes, pain in the upper teeth, or problems with dentures.
  • Salivary glands. Swelling under the chin or around the jawbone; numbness or paralysis of the muscles in the face; or pain that does not go away in the face, chin, or neck.
  • Oropharynx and hypopharynx: Ear pain.
  • Nasopharynx: Trouble breathing or speaking, frequent headaches, pain or ringing in the ears, or trouble hearing.
  • Larynx: Pain when swallowing or ear pain.
  • Metastatic squamous neck cancer: Pain in the neck or throat that does not go away.