Head & Neck Cancers

Definition of head and neck cancer: Cancer that arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx [voice box]).

Cancers of the head and neck, which include cancers of the oral cavity, larynx, pharynx,salivary glands, and nose/nasal passages, account for approximately three percent of allmalignancies in the United States.

Tobacco and alcohol use are the most important risk factors for most head and neck cancers. In addition, infection with certain types of human papillomavirus (HPV), particularly HPV type 16 (HPV16) and HPV type 18 (HPV18), causes more than half of all cases of oropharyngeal cancer, a type of head and neck cancer. There are no standard or routine screening tests for head and neck cancers. Standard treatments for head and neck cancers, which depend on the tumor location, the tumor stage, and the patient’s age and overall health, include radiation therapy, surgery,chemotherapy, targeted therapy, or a combination of treatments.

THE FOLLOWING STAGES ARE USED FOR LARYNGEAL CANCER:

Stage 0 (Carcinoma In Situ)

In stage 0, abnormal cells are found in the lining of the larynx. These abnormal cells may becomecancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I laryngeal cancer depends on where cancer began in thelarynx:

• Supraglottis: Cancer is in one area of the supraglottis only and the vocal cords can move normally.
• Glottis: Cancer is in one or both vocal cords and the vocal cords can move normally.
• Subglottis: Cancer is in the subglottis only.

Stage II

In stage II, cancer is in the larynx only. Stage II laryngeal cancer depends on where cancer began in the larynx:

• Supraglottis: Cancer is in more than one area of the supraglottis or surrounding tissues.
• Glottis: Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cordscannot move normally.
• Subglottis: Cancer has spread to one or both vocal cords, which may not move normally.

Stage III

Stage III laryngeal cancer depends on whether cancer has spread from the supraglottis, glottis, or subglottis.

In stage III cancer of the supraglottis:

• cancer is in the larynx only and the vocal cords cannot move, and/or cancer is in tissuesnext to the larynx. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in one area of the supraglottis and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller and the vocal cords can move normally; or
• cancer is in more than one area of the supraglottis or surrounding tissues and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller.

In stage III cancer of the glottis:

• cancer is in the larynx only and the vocal cords cannot move, and/or cancer is in tissuesnext to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in one or both vocal cords and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller and the vocal cords can move normally; or
• cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally. Cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller.

In stage III cancer of the subglottis:

• cancer is in the larynx and the vocal cords cannot move; cancer may have spread to onelymph node on the same side of the neck as the original tumor and the lymph node is 3centimeters or smaller; or
• cancer is in the subglottis and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller; or
• cancer has spread to one or both vocal cords, which may not move normally. Cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller.

Stage IV

Stage IV is divided into stage IVA, stage IVB, and stage IVC. Each substage is the same for cancer in the supraglottis, glottis, or subglottis.

• In stage IVA:
  • cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
  • cancer has spread to one lymph node on the same side of the neck as the original tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters, or has spread to more than one lymph node anywhere in the neck with none larger than 6 centimeters. Cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. The vocal cords may not move normally.
• In stage IVB:
  • cancer has spread to the space in front of the spinal column, surrounds the carotid artery, or has spread to parts of the chest. Cancer may have spread to one or morelymph nodes anywhere in the neck and the lymph nodes may be any size; or
  • cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery, or to parts of the chest. The vocal cords may not move normally.
• In stage IVC, cancer has spread to other parts of the body, such as the lungs, liver, or bone.

THE FOLLOWING STAGES ARE USED FOR LIP AND ORAL CAVITY CANCER:

Stage 0 (Carcinoma In Situ)

In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and the tumor is 2 centimeters or smaller. Cancer has not spread to the lymph nodes.

Stage II

In stage II, the tumor is larger than 2 centimeters but not larger than 4 centimeters, and cancerhas not spread to the lymph nodes.

Stage III

In stage III, the tumor:

• may be any size and has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the tumor; or
• is larger than 4 centimeters.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC.

• In stage IVA, the tumor:
  • has spread through tissue in the lip or oral cavity into nearby tissue and/or bone (jaw, tongue, floor of mouth, maxillary sinus, or skin on the chin or nose); cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the tumor; or
  • is any size or has spread through tissue in the lip or oral cavity into nearby tissue and/or bone (jaw, tongue, floor of mouth, maxillary sinus, or skin on the chin or nose), and cancer has spread:
    • to one lymph node on the same side of the neck as the tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
    • to more than one lymph node on the same side of the neck as the tumor and the lymph nodes are not larger than 6 centimeters; or
    • to lymph nodes on the opposite side of the neck as the tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.
• In stage IVB, the tumor:
  • may be any size and has spread to one or more lymph nodes that are larger than 6centimeters; or
  • has spread further into the muscles or bones in the oral cavity, or to the base of theskull and/or the carotid artery. Cancer may have spread to one or more lymph nodes anywhere in the neck.
• In stage IVC, the tumor has spread beyond the lip or oral cavity to distant parts of the body, such as the lungs. The tumor may be any size and may have spread to the lymph nodes.

THE FOLLOWING STAGES ARE USED FOR OROPHARYNGEAL CANCER:

Stage 0 (Carcinoma In Situ)

In stage 0, abnormal cells are found in the lining of the oropharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and is 2 centimeters or smaller and is found in the oropharynx only.

Stage II

In stage II, the cancer is larger than 2 centimeters but not larger than 4 centimeters and is found in the oropharynx only.

Stage III

In stage III, the cancer is either:

• 4 centimeters or smaller; cancer has spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller; or
• larger than 4 centimeters or has spread to the epiglottis (the flap that covers the tracheaduring swallowing). Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller.

Stage IV

Stage IV is divided into stage IVA, IVB, and IVC as follows:

• In stage IVA, cancer:
  • has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing. Cancer may have spread to one lymph nodeon the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller; or
  • has spread to one lymph node on the same side of the neck as the tumor (the lymph node is larger than 3 centimeters but not larger than 6 centimeters) or to more than one lymph node anywhere in the neck (the lymph nodes are 6 centimeters or smaller), and one of the following is true:
    • tumor in the oropharynx is any size and may have spread to the epiglottis (the flap that covers the trachea during swallowing); or
    • tumor has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing.
• In stage IVB, the tumor:
  • surrounds the carotid artery or has spread to the muscle that opens the jaw, the bone attached to the muscles that move the jaw, nasopharynx, or base of the skull. Cancer may have spread to one or more lymph nodes which can be any size; or
  • may be any size and has spread to one or more lymph nodes that are larger than 6centimeters.
• In stage IVC, the tumor may be any size and has spread beyond the oropharynx to other parts of the body, such as the lung, bone, or liver.

All information was taken from the NCI (National Cancer Institute)