• The use of tobacco and/or alcohol is the most important contributing factor. Smokers, users of smokeless tobacco, and drinkers who fail to stop after treatment for a primary head and neck cancer are at significantly higher risk of developing another cancer.

• Poor oral hygiene, poorly fitting dentures or broken teeth cause chronic irritation of oral membranes.

• Wood dust inhalation is related to nasal cavity cancer.

• Betel nut chewing is related to cancer of the lining of the cheek.

• Increased carcinoma of nasopharynx among southern Chinese (environmental, not genetic).

• Epstein-Barr virus (EBV) infection is associated with nasopharyngeal cancer.

• Chronic iron deficiency in women is associated with tongue and postcricoid carcinoma.

• Nickel exposure is associated with paranasal sinus cancer.

Symptoms

• A swelling or ulcer that doesn't heal in the mouth or oral cavity.

• Pain, swelling, or bloody discharge in the nose or sinuses, nasal obstruction, double vision or chronic sinus trouble that does not respond to antibiotics.

• Painless swelling that results in paralysis of one side of the face (salivary glands).

• Oropharynx symptoms may be difficulty or pain in swallowing and ear pain, or may not show any symptoms at all.

• Hypopharynx symptoms may include difficulty in swallowing, ear pain and enlarged lymph nodes in the neck, or may not show any symptoms at all.

• Nasopharynx symptoms may include bloody nasal discharge or nasal obstruction, decreased hearing, double vision, pain, hoarseness or enlarged lymph nodes in the neck.

• Persistant hoarseness, difficulty breathing, pain in the larynx.

• Swollen lymph nodes in the neck may be a symptom of metastatic squamous cell cancer.

Any of these symptoms may also be due to other, less serious problems. Still, it is important to see a doctor is any of these problems exist for more than two weeks. Do not wait for pain, because pain is not always an early symptom.

Test for Cancer

Screening is not generally practiced. However, there are three approaches to early detection.

• Call your physician if you notice symptoms of head and neck tumors.

• Examination of your head and neck, including the larynx, by your physician.

• Call your dentist if you notice lesions or white patches in your mouth.

The doctor is the best person to answer questions about treatment. The choice of treatment options for each patient will depend upon the location, size, stage of the disease (whether it has spread to other places), and the patient's general state of health. The doctor develops a plan for treatment that fits each patient's needs.

Questions to consider asking when you talk to the doctor:

• What are the treatment choices?

• Is a clinical trial the right choice?

• What are the risks and benefits for each type of treatment?

• If there is pain, what can be done to relieve it?

• How will the treatment affect everyday activities? For how long?

Head and Neck cancers account for 5 to 10 % of all malignancies. The are more common in men and much more common in people over 50. They have a fairly good cure rate if found early, evaluated adequately, and treated with the best available therapy. Three main treatment methods are used - surgery, radiotherapy and chemotherapy.

Head neck is a broad category of cancers that include tumors in several areas.

• Lip and Oral cavity - Includes the lips, tongue, the inside lining of the cheeks (buccal mucosa), the floor of the mouth, the gums (gingiva) and the hard palate

• Paranasal sinuses and nasal cavity - Sinus areas found above and below eyes and behind the nose

• Salivary glands - Produce saliva to moisten our mouth and help us chew and swallow food

• Oropharynx - The upper part of the throat that can be seen when you say "ahhh". It includes the tonsils

• Nasopharynx - Behind the nose and above the oropharynx It cannot be seen directly, but is viewed with a mirror or scope.

• Hypopharynx - The lower part of the throat (pharynx) where food goes just before we swallow it

• Larynx - Larynx (voice box) is in the front of the neck in the area of the Adam's apple

• Metastatic squamous cell cancer to cervical (neck) lymph nodes - If the cancer is discovered in the lymph nodes in the upper part of the neck is squamous cell (or epidermoid), it is usually a metastasis (spread) from a head and neck cancer. If no other primary source can be found such as lung cancer, this cancer is treated as a head and neck cancer. It is important to note that this type of cancer my be curable

1. What are the possible causes or risk factors for head and neck cancers?

ANSWER: Tobacco and/or alcohol is the most important contributing factor. Smokers and drinkers who fail to stop after treatment for a primary head and neck cancer are at a higher risk of developing another cancer.

• Poor oral hygiene, poorly fitting dentures or broken teeth cause chronic irritation or oral membranes

• Wood dust inhalation is related to nasal cavity cancer

• Betel nut chewing (India) is related to cancer of the lining of the cheek

• Increased cancer of nasopharynx among southern Chinese (environmental, not genetic)

• Epstein-Barr virus (EBV) infection is associated with nasopharyngeal cancer

• Chronic iron deficiency in women is associated with tongue and area just below the Adam's apple cancer

• Nickel exposure is associated with paranasal sinus cancer

2. What are the signs and symptoms of head and neck cancers?

ANSWER: Specific symptoms depend on the location of the cancer. Tumors can appear as ulcerations of the mucous membranes with hard, rolled edges, or less commonly as protruding growths.

• Swelling ulcer that does not heal (mouth & oral cavity)

• Pain, swelling, bloody nasal discharge, nasal obstruction, double vision or chronic sinus trouble that does not respond to antibiotics

• Painless swelling and later paralysis of one side of the face (salivary glands)

• Difficulty or pain on swallowing and ear pain. (oropharynx-may also have no symptoms)

• Difficulty swallowing, ear pain, and enlarged lymph nodes in the neck (hypopharynx-may have no symptoms)

• Bloody nasal discharge or nasal obstruction, decreased hearing, nerve signs (double vision, pain, hoarseness) or enlarged lymph nodes in the neck (nasopharynx)

• Persistent hoarseness, difficulty breathing, pain (larynx)

• Swollen, painless lymph nodes in the neck (metastatic squamous cell cancer)

3. How are head and neck cancers diagnosed?

ANSWER: Head and neck cancers are diagnosed by specific tests depending upon the location of the cancer.

• Physical examination

• Inspection of oral and nasal cavities using mirrors and lights

• Examination of suspicious lesions & back of tongue

• Blood Tests

• Epstein -Barr (EB) virus antibody measurements may be helpful in diagnosing hidden nasopharyngeal cancer with metastasis (spread) into t he cervical lymph nodes

• Imaging

• X-rays of the sinuses and skull

• CT and MRI, barium esophogram, laryngogram and chest X ray

• Biopsy

• Biopsy of suspicious lesions

• In the case of metastatic disease, biopsy of normal tissue may be necessary to determine site of origin

4. Why does my doctor need to know the stage of my disease and what does it mean?

ANSWER: Your doctor needs to know the stage (extent) of your disease to determine the best treatment for you. Staging is an evaluation of disease.

Accuracy of staging is critical, a slight difference in the location and size of the lesion can have a significant effect on the therapy chosen, the extent of the surgery and the prognosis (a prediction of the course of the disease).