All About Head And Neck Cancer

Head and Neck Cancers are a major public health concern globally and in India. According to the Indian Council of Medical Research (ICMR), they account for approximately 25–30% of all cancer cases among men and a smaller but significant proportion among women. These cancers commonly involve the oral cavity, pharynx, larynx, nasal cavity, and salivary glands, making them among the most frequent malignancies in low- and middle-income countries (1,3).

The high burden in India is primarily attributed to tobacco use (smoked and smokeless forms), alcohol consumption, and betel quid chewing, along with poor oral hygiene and viral infections such as HPV and EBV (1,3,4).

What is Head and Neck Cancer?

Head and Neck Cancer (HNC) refers to a group of biologically similar cancers that originate in the mucosal surfaces of the upper aerodigestive tract, including the mouth, throat, nasal passages, and voice box (2,3).

Approximately 90% of all head and neck cancers are squamous cell carcinomas (HNSCC), which begin in the epithelial cells that line these regions (3,4).

HNC can also arise in other structures such as the salivary glands, thyroid gland, and paranasal sinuses, though these are less common and biologically distinct. If not detected early, these cancers can invade surrounding tissues, spread to regional lymph nodes in the neck, and eventually metastasize to distant organs such as the lungs and bones (2,4,5).

Types of Head and Neck Cancer (2,3,4,5)

Head and Neck Cancers are categorized based on the site of origin:

Stages of Head and Neck Cancer

The American Joint Committee on Cancer (AJCC) TNM staging system (8th Edition) is used to stage Head and Neck Cancers.

It assesses three components:

• T (Tumour): Size and extent of the primary tumour
• N (Nodes): Spread to regional lymph nodes
• M (Metastasis): Spread to distant organs (5,6).

Each anatomical site (oral cavity, oropharynx, larynx, etc.) has site-specific TNM definitions. The stages are then grouped from Stage I (localized) to Stage IV (advanced or metastatic).

• Stage I: Tumour ≤2 cm, confined to the site of origin.
• Stage II: Tumour 2–4 cm, without nodal involvement.
• Stage III: Tumour >4 cm or spread to a single ipsilateral lymph node ≤3 cm.
• Stage IVA: Spread to multiple lymph nodes or structures beyond the primary site.
• Stage IVB/IVC: Extensive nodal or distant metastasis.

For HPV-positive oropharyngeal cancers, the AJCC 8th edition introduces separate staging criteria recognizing their distinct biology and better prognosis (5,6).

Causes and Risk Factors (2,3,4,5)

The development of Head and Neck Cancer is multifactorial. Key risk factors include:

• Tobacco Use and alcohol consumption: in the form of Cigarette, bidi, and smokeless forms (gutkha, khaini) account for up to 80% of oral cancers in India (1,3). Alcohol Consumption acts synergistically with tobacco to increase risk.
• Human Papillomavirus (HPV) Infection: especially HPV type 16 is associated with oropharyngeal cancers.
• Epstein–Barr Virus (EBV): is linked with nasopharyngeal carcinoma.
• Occupational Exposures: such as wood dust, textile fibers, asbestos, and formaldehyde.
• Poor Oral Hygiene and Chronic Irritation: due to sharp teeth, ill-fitting dentures, or poor dental care can lead to developing ulcers and cancers.
• Dietary Factors: such as low intake of fruits and vegetables, micronutrient deficiencies.
• Genetic Predisposition: with family history and certain polymorphisms may increase susceptibility.
• Therapeutic radiation: to the head and neck region prior to other forms of treatment lead to the development of these cancers.

Symptoms (3,4,5)

Symptoms vary depending on the site of origin but often include:

• A non-healing ulcer or growth in the mouth.
• Persistent sore throat or hoarseness.
• Loosening of teeth which can be associated with other conditions such as gum disease, injury, or teeth grinding (bruxism)
• Difficulty swallowing (dysphagia) or pain while swallowing.
• Lump in the neck (enlarged lymph node).
• Ear pain, especially referred pain in throat or tonsillar cancer.
• Nasal obstruction or bleeding.
• Unexplained weight loss, fatigue, or persistent cough in advanced stages.

Persistent symptoms lasting more than 2–3 weeks should prompt evaluation by an ENT specialist or a Head & Neck Oncologist (3,4).

Screening and Diagnosis (3,4,5,6)

Early detection significantly improves outcomes.

Multidisciplinary tumour boards play a critical role in accurate diagnosis and management (6,7).

Treatment of Head and Neck Cancer (3,4,5,6,7)

Treatment depends on the site, stage, HPV status, and overall health of the patient.

Multidisciplinary care involving Surgical, Medical, and Radiation Oncologists, along with Speech and Swallow Therapists, is essential for optimal outcomes.

Survival Rate (2,3,4,5)

Survival outcomes depend on the site, stage, and HPV status:

• Early-stage (Stage I–II): 5-year survival of 70–90% with appropriate treatment.
• Locally advanced (Stage III–IVA): 5-year survival of 40–60%.
• Recurrent or metastatic disease: 5-year survival <20%, though immunotherapy is improving prognosis.

HPV-positive oropharyngeal cancers have significantly better survival rates compared to HPV-negative cancers (5,6).

Regular follow-up is critical to detect recurrence, second primary tumours, and manage long-term treatment effects.

References

1. Indian Council of Medical Research (ICMR) – National Cancer Registry Programme, 2023.
2. National Cancer Institute (NCI), USA – Head and Neck Cancers Fact Sheet (Updated 2024).
3. Cleveland Clinic – Head and Neck Cancer Overview (2024).
4. HCG Oncology – Types and Treatment of Head and Neck Cancer (2024).
5. National Comprehensive Cancer Network (NCCN) Guidelines – Head and Neck Cancers, Version 2025.1.
6. American Cancer Society (ACS) – Head and Neck Cancer: Diagnosis, Staging, and Treatment (2024).
7. World Health Organization (WHO) & International Agency for Research on Cancer (IARC) – Global Cancer Observatory Report, 2024.