Head and neck cancer basics: risk factors, sites and staging
- Topic
Most head and neck cancers start in the lining of the mouth and throat; tobacco, alcohol and some viruses cause most of them.
What it is
Head and neck cancer groups the tumours of the oral cavity, pharynx (nasopharynx, oropharynx, hypopharynx), larynx, nose and sinuses and salivary glands. Most are squamous cell carcinomas of the mucosa and spread first to the neck lymph nodes. Two causal routes matter for the exam: tobacco plus alcohol (mouth, hypopharynx, larynx) and viruses (HPV for the oropharynx, EBV for the nasopharynx). This page gives the map of sites, the risk factors and the principles of staging; the diseases are on their condition pages.
Key facts
- Glottic cancer gives early hoarseness, so it is often found early and has the best prognosis; subglottic cancer has the worst.
- Early-stage laryngeal cancer (stage I or II) can be treated with surgery or radiotherapy alone, usually preserving the larynx; advanced stages need combined treatment.
- AJCC 8th edition also changed the T categories of the oral cavity and added extranodal extension to the N category (except virus-related cancers).
- Patients with tobacco-related cancer are at risk of a second primary tumour elsewhere in the upper aerodigestive tract and lungs.
Structure
- Oral cavity: lips, anterior two thirds of the tongue, floor of mouth, gums, hard palate, cheek mucosa.
- Oropharynx: tonsils, base of tongue, soft palate and pharyngeal walls, from the soft palate to the level of the hyoid.
- Nasopharynx: behind the nose; most tumours start in the fossa of Rosenmüller, next to the auditory tube opening.
- Hypopharynx: around the larynx (pyriform sinuses), down to the oesophagus.
- Larynx: supraglottis, glottis (vocal folds) and subglottis, each with its own staging.
- Others: nasal cavity and sinuses, salivary glands.
Sites and their main risk factors
| Site | Main risk factors | Typical first sign |
|---|---|---|
| Oral cavity | Tobacco (smoked or chewed), alcohol, betel quid | Non-healing ulcer, red or white patch |
| Oropharynx | HPV-16; also tobacco and alcohol | Neck lump, sore throat, earache |
| Nasopharynx | Epstein-Barr virus, Chinese ancestry, wood dust | Neck lump, one-sided middle ear fluid |
| Larynx | Tobacco (strongest), alcohol (supraglottis), occupational fumes | Hoarseness (glottis) |
| Nose and sinuses | Wood dust and other occupational exposures | One-sided blockage, bleeding |
| Salivary glands | Previous radiation to the head and neck | Lump under the jaw or in front of the ear, facial weakness |
In clinical practice
- HPV vaccination protects against the HPV types that cause oropharyngeal cancer.
- Quitting tobacco and alcohol is part of treatment and lowers the risk of a second primary.
- A patient may come with only a neck node: the primary is often small and hidden in the tonsil, base of tongue or nasopharynx.
Next step / Initial management
- First workup in primary care: full mouth and neck exam, history of tobacco, alcohol and occupational exposure; record symptom duration.
- Diagnosis is confirmed by biopsy of the primary site, done by the specialist; imaging (CT, MRI, PET) is used for staging.
- Offer help to stop smoking and drinking and HPV vaccination according to the national schedule.
- Refer urgently (same week) to otolaryngology or head and neck surgery any patient with a red flag; treatment is decided by a multidisciplinary oncology team.
Test yourself
Think of the answer, then tap the question to see it.
Which virus is linked to most oropharyngeal (tonsil and base of tongue) cancers?
High-risk human papillomavirus, especially HPV-16.
What changed for oropharyngeal cancer in the AJCC 8th edition staging?
HPV-associated oropharyngeal cancer has its own staging system, separate from HPV-negative oropharyngeal cancer, because it behaves as a different disease.
Which laryngeal subsite usually has the best prognosis, and why?
The glottis: hoarseness appears early and so tumours tend to be found at an early stage.
What is the main treatment of nasopharyngeal carcinoma?
Radiotherapy, with chemotherapy added for advanced stages; surgery is rarely used because of the site.
Connections
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Head and Neck Cancers (National Cancer Institute (NIH), 2021); HPV and Oropharyngeal Cancer (Centers for Disease Control and Prevention (CDC), 2024); Head and Neck cancers: major changes in the American Joint Committee on Cancer eighth edition cancer staging manual (CA Cancer J Clin) (PubMed, US National Library of Medicine, 2017); Oropharyngeal Squamous Cell Carcinoma (StatPearls (NCBI Bookshelf), 2023); Laryngeal Cancer (StatPearls (NCBI Bookshelf), 2024); Nasopharyngeal Cancer (StatPearls (NCBI Bookshelf), 2024).
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Representative model, for educational purposes only.