Symptoms, Risk and Diagnosis
Siteman’s head and neck cancer program can provide broad-based treatments because of its strong multidisciplinary approach. The team includes specialists in otolaryngology, radiation oncology, medical oncology, radiology, pathology, audiology, prosthodontics, oral surgery, speech therapy, psychology and dietetics. The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on a personalized treatment that meets your needs. Specialists here excel in using technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.
Symptoms of Head and Neck Cancers
Symptoms depend on where in the head and neck the cancer occurs. Early on, many head and neck cancers don’t have symptoms. When they do, you should bring these symptoms to your doctor’s attention:
- A sore throat lasting more than two weeks
- One-sided ear pain
- Painful or difficult swallowing
- A change in voice that lasts more than two weeks
- A lump on the face or neck
- A non-healing sore in facial skin, eyelids, the nose, cheek, tongue, roof of the mouth, throat or lip
- Trouble breathing, especially noisy breathing
- Trouble opening the mouth fully
- Trouble moving the tongue or tongue pain
- Coughing up blood
- Blocked sinuses that do not clear
- Persistent headaches or pain in the sinus areas
- Numbness or tingling in the face
- Pain in the upper teeth, loose teeth, poor fitting dentures
Risk Factors for Head and Neck Cancers
Risk factors vary with the type of head or neck cancer, but may include:
- Smoking or chewing tobacco
- Heavy alcohol use
- Being infected with human papillomavirus (HPV): The number of oropharyngeal cancers linked to HPV infection is increasing.
- Being male and older than 40 years
- Being exposed to the Epstein-Barr virus
- Being exposed to certain workplace chemicals or dust
- Prior radiation therapy to the head and neck
Diagnosing Head and Neck Cancers
Making a diagnosis of a specific type of head and neck cancer may involve different approaches. Depending on the type and location of the cancer, the following tests and procedures may be used:
- History and physical: This basic exam looks at the patient’s present illness, past history and surgeries, social history and family history. Then a comprehensive head and neck exam is performed. For certain types of head and neck cancer, a series of questions and tests to check the brain, spinal cord, and nerve function may be done.
- Fiberoptic Endoscopy: This exam involves using a flexible thin tube-like instrument with a light and lens for viewing, done as an office procedure to visualize the area from your nose to the bottom of the larynx, including the throat and sinuses.
- Nasal Endoscopy: A nasal endoscope, a thin, rigid tube-like instrument with a light and a lens for viewing, is inserted into the nose. A special tool on the endoscope may be used to remove samples of tissue. The tissues samples are viewed under a microscope by a pathologist to check for signs of cancer.
- CT scan (CAT scan): A series of detailed pictures of areas inside the body, taken from different angles may be combined with injection or oral intake of a dye to help the organs or tissues show up more clearly.
- PET-CT scan (positron emission tomography scan): Radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Cancer cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. During the same session, a CT scan is performed to accurately locate the abnormalities.
- MRI (magnetic resonance imaging): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
- PET-MRI: A PET/MRI scanner is able to perform both a PET scan and MRI magnetic resonance imaging scan at the same time. Siteman has one of the first PET/MR scanners in the world. MRI offers excellent contrast among soft tissues while PET offers excellent images of molecular activity within the body. Simultaneous PET/MRI is used when the information from both modalities is needed for diagnosis or tumor staging.
- In-office Ultrasound with or without needle biopsy is used to evaluate lymph nodes, thyroid or tongue masses.
- Biopsy: Cells or tissue is removed during a biopsy so they can be viewed under a microscope by a pathologist for signs of cancer. The biopsy can be a fine needle aspiration (FNA) biopsy, which involves removal of tissue or fluid using a thin needle. You might also have an incisional biopsy to remove part of a lump or a sample of tissue that doesn’t look normal.
- Laryngoscopy/Microlaryngoscopy: This procedure looks at the area between the sinuses and esophagus for abnormal areas. A laryngoscope (a thin, tube-like instrument with a light and a lens for viewing) used with or without the microscope is inserted through the mouth to see the larynx. A special tool on the laryngoscope may be used to remove samples of tissue for microscopic examination. This procedure is usually done in the operating room.
- HPV (human papilloma virus) test. This laboratory test checks tissue samples for certain types of HPV, which has been linked to head and neck cancer.
Stages of Head and Neck Cancers
Stages are generally I through IV, depending on the extent of the cancer. Staging can be very useful in determining the correct treatment. Unlike many other types of cancer, some stage IV squamous cell cancers are curable.
The prognosis (chance of cure) depends on the following:
- The size and location of the tumor in the head and neck
- Whether the cancer has spread to other parts of the body and where it has spread
- The type of tumor (based on how the cancer cells look under a microscope)
- Whether the cancer is primary or has recurred after treatment
- Whether the patient has quit using tobacco or alcohol if those were a factor in the disease
Clinical trials are a good option for getting the latest treatment. For head and neck cancers that have metastasized, the standard of care is clinical trials.