Neck Cancer

Neck cancer is a broad term that can be related to many different types of cancer in the neck. Most commonly, these cancers are related to metastases (or the regional spread) of cancers from other sites. These cancers often arise from the oral cavity, nasopharynx, oropharynx, hypopharynx, supraglottis, glottis, larynx, and trachea.

What Are The Causes Of Neck Cancer?

Tobacco: The most common cause of neck cancer is chronic tobacco exposure. This can be includes both smoking and smokeless tobacco. To a lesser degree second hand smoke mays also contribute to developing cancer.

Alcohol: Chronic alcohol use is also a long term risk factor for developing cancer of the head and neck.

Gender: Men are more likely to develop head and neck cancer, independent of other risk factors.

Certain illnesses: Viral illnesses such as Epstein-Barr Virus (EBV) and Human Papilloma Virus (HPV) are independent risk factors for head and neck cacner.

Environmental exposure: Exposure to irritants in the environment such as radiation or ultraviolet (UV) light may lead to the development of certain types of cancer.

What Are The Signs And Symptoms Of Neck Cancer?

Lump in the Neck. Neck cancers most commonly present as enlarged neck masses. These typically are present for a prolonged period of time (weeks to months), often are increasing in size, and may be painful or uncomfortable.

Pain. Frequently patients may present with throat soreness, that is non-specific in quality and nature. Conversely, patients may present with increasing pain with swallowing.

Bleeding. Bleeding from a site within the throat may be a presenting sign. Any bleeding without full visualization or characterization of the involved site, warrants further workup.

Hoarseness. Frequently, patients will present with hoarse voice, or changes in voice quality. Any voice changes that do not resolve after three months of conservative management should be evaluated by a specialist.

Breathing Difficulties. Patient’s may report breathing difficulties or noisy breathing, particularly when lesions increase in size and encroach on the airway.

Swallowing Difficulties. Masses near or around the esophagus or vocal cords may cause intolerance to solid food that may progress to intolerance to liquid. Patients may also have a sensation of food being stuck in their throat that does not resolve with throat clearing (globus).

What Are The Risk Factors Of Neck Cancer?

Tobacco: The most common cause of neck cancer is chronic tobacco exposure. This can be includes both smoking and smokeless tobacco. To a lesser degree second hand smoke mays also contribute to developing cancer.
Alcohol: Chronic alcohol use is also a long term risk factor for developing cancer of the head and neck.

Gender: Men are more likely to develop head and neck cancer, independent of other risk factors.

Certain illnesses: Viral illnesses such as Epstein-Barr Virus (EBV) and Human Papilloma Virus (HPV) are independent risk factors for head and neck cacner.

Environmental exposure: Exposure to irritants in the environment such as radiation or ultraviolet (UV) light may lead to the development of certain types of cancer.

How Is Neck Cancer Diagnosed?

In order to properly diagnose and manage neck cancer, the primary cancer site must first be identified. This is usually done through combined imaging and endoscopic evaluations.

Imaging. Oftentimes a physician may elect to obtain imaging that will help in better understanding the presence of cancer and any other underlying issues. Imaging may be performed to assist in identifying the primary site, or of the general region to better define disease extent. The physician may elect to obtain further imaging in situations in which they are concerned for local invasion (e.g. into bone, muscle, adjacent sites), or regional invasion (to the neck).

• Chest X-rays: Chest radiography may be obtained in order to define the presence of disease in the lungs. Often times patients with larygneal cancer, have a longstanding history of smoking may have associated lesions in their lungs that should be identified.
• Computed Tomography (CT): CT-Scans usually provide a more detailed image of the head and neck region, identifying parts of the tumor that is not readily seen on exam, as well as the presence of regional disease not readily detected (e.g. in the neck). CT-Scans can be obtained with or without contrast. Given the complexity of the region, usually CT scans are obtained with scans, to help in identify the vascular architecture within the neck. However, this is not always necessary, and CT scans may be obtained without contrast in circumstances that preclude patient receiving contrast (iodine allergies, kidney disease).
• Magnetic Resonance Imaging (MRI): MRI can also be utilized with or without contrast in order to provide superior visualization of soft tissue as well as the brain. Often times an MRI may be needed if there is indeterminate findings on other imaging modalities, with a need for more accurate mapping.
• 18-Fluorodeoxyglucose Positron Emission Tomography (18-FDG PET): FDG-PET scans may be performed with CT or MRI imaging modalities and are utilized for the identification of regional or distant metastases.
• Ultrasound (US): Ultrasound may be utilized to better characterize neck masses, or used in conjunction with biopsy techniques. US can indicate suspicious characters of lesions that would direct a physician to more aggressive workup (biopsy, excision).
• Barium Swallow: Swallow studies may be performed in order to determine the degree of obstruction, and presence of any other lesions within the esophagus.

Biopsy. Taking a biopsy will confirm the presence of abnormal cells under microscopic view, and is imperative in making the diagnosis of laryngeal cancer.

• Operative Biopsy: These are biopsies performed under general anesthesia. This allows for more complete visualization and mapping of the tumor and tissue sampling, and is known as “direct laryngoscopy with biopsy”.
• Lymph Node Biopsy. If a patient presents with a neck mass, particularly in the setting of no identifiable lesion, the physician may sample tissue from lymph node. There are several types of lymph node biopsy.
• Fine Needle Biopsy (FNB). If the mass can be felt by the clinician, then a small needle can be introduced with an attempt at extracting cells for microscopic assessment. The appearance of abnormal cells will help support the diagnosis of cancer. Sometimes, not enough cells are extracted, and repeat biopsies may need to be performed. This may also be performed with the help of ultrasound or computed tomography (CT) guidance
• Core Biopsy (CB). Similar to the Fine Needle Biopsy, a core biopsy is performed by introducing a larger caliber needle, with extraction of tissue as opposed to cells. This core biopsy allows for extraction of more tissue and can be more useful, but often times not necessary, as an FNB is sufficient. This can also be done with or without ultrasound or CT-guided assistance
• Operative Biopsy. If the location of the node is too deep, or not readily felt by a clinician, the surgeon may elect to perform biopsy under general anesthesia in an operating room.

Blood Work. The physician may elect to perform routine blood analysis to assist in determining the presence of oropharyngeal cancer or other present diseases. Blood work may not be necessary, and the decision to obtain blood work is individualized to every patient.

• Liver Function Tests (LFTs): Can be utilized to determine the presence of concurrent liver disease that may be associated with risk factors for the development of oropharyngeal cancer (alcohol consumption, hepatitis). Furthermore, abnormal values may indicate the presence of metastatic liver disease.
• Complete Blood Count (CBC): This will identify the presence of any anemia that can sometimes be associated with poor nutrition, or chronic illness.
• Nutritional Blood Work: If a patient seems nutritionally depleted, particularly in advanced cases, the clinician may elect to obtain laboratory work up to measure nutrition markers in the blood work. This may assist in determining if a patient requires supplemental nutrition.

What Are The Possible Treatments For Neck Cancer?

Treatment Plan. Depending on the site of disease, the clinical staging, and patient factors (comorbid health conditions, patient preferences) a patient specific treatment plan should be outlined. Broadly speaking there are 3 types of treatment that can be used in combination or separately depending on the type and stage of cancer. The decision to embark on a particular treatment plan should be made involving a multidisciplinary team of physicians (surgeons, radiation oncologists, and medical oncologists) and the patient. Patient specific goals and outcomes should be defined, with a thorough discussion of the risks, benefits, and alternatives of all the separate treatment types. Broadly state, nasopharyngeal cancer is usually treated with Radiation with or without chemotherapy.

Surgery. Surgery is commonly performed in the treatment of neck cancer. The extent and type of surgery is heavily influenced on the site of lesion, as well as patient’s general health status.

Radiation. Radiation is another option for treatment of hypopharyngeal cancer.

• Definitive Radiation (with or without chemotherapy). This type of radiation treatment involves using radiation as the primary mode to treat the tumor. The goals of definitive radiation therapy is complete removal of all tumor with external sources of radiation.
• Adjuvant Radiation (with or without chemotherapy). This refers to the use of radiation in combination with surgery. The goal of adjuvant radiation is to treat any remaining disease after surgical removal (e.g in circumstances with positive margins).
• Neoadjuvant Radiation (with or without chemotherapy). Radiation given prior to surgery is referred to as neoadjuvant radiation. This is not routinely performed in the treatment of hypopharyngeal cancers and is used in academic centers as part of larger studies.

Chemotherapy. The use of systemic medications is used adjunctively with either surgery or radiation, and is used to target disease distant from the local site. It is not used as a primary treatment modality as it does not facilitate eradication at the primary site. Chemotherapy is often used in circumstances of advanced disease (Stage III or IV), or when certain risk factors for distant disease are present. Such risk factors include lymph nodes with disease that have extended out of their capsule (not contained), positive surgical margins, or involvement of nerves and blood vessels.

• Induction Chemotherapy. This refers to chemotherapy performed prior to surgery or radiation. This may be used to determine the biological response of the tumor to chemotherapy, as well as “shrink” tumors to a manageable size that can be better removed with surgery or radiation.
• Adjuvant Chemotherapy. This refers to chemotherapy given after definitive treatment with another modality was performed (either surgery or radiation).
• Concurrent Chemotherapy. This refers to the decision to administer chemotherapy and radiation concurrently after surgery. This may be the case in situations of predictors of aggressive disease on pathology.

Are There Preventative Steps Or Measures To Avoid Neck Cancer?

General well being, and maintaining a healthy lifestyle are the best ways to prevent the development of head and neck cancer. Avoiding irritants such as alcohol, tobacco, and UV radiation will also prevent the development of head and neck cancer.

What Are The Risks If Neck Cancer Is Left Untreated?

If head and neck cancer is left untreated will continue to progress and cause significant detriment to a patient’s health. As the tumor grows patients will experience progressive worsening of their ability to swallow, speak, and breathe. Ultimately this can cause severe nutritional problems, airway problems, speech impediment, and ultimately result in the untimely death of a patient.

Key Take Aways From Neck Cancer

1. Symptoms related to swallowing, speaking, pain in the mouth, or breathing that do not resolve or progress over the course of weeks to months should be evaluated by a specialist.
2. Smoking cessation is an important part in the prevention and treatment of throat cancer.
3. Multiple options exist in the treatment of throat cancer. It is important to speak with a specialist that can discuss all surgical and non-surgical options available.

What Makes Dr. Mourad The Right Doctor For Neck Cancer?

Dr. Mourad is a Head and Neck Surgeon with advanced training in reconstructive surgery. He performs all aspects of head and neck cancer surgery including minimally invasive and reconstructive procedures. He is also a leader in his field with two published books, numerous book chapters, and more than 40 peer reviewed publications in the scientific literature. He frequently speaks at national and international conferences to help in advancing this field. Most importantly, Dr. Mourad is empathetic to the needs of his patients. He views the ability to treat his patients to be nothing short of an honor and a privilege.