Specialist Centre

“Head and neck tumors” is a term used to describe any type of cancer that originates in the head or neck region, excluding intracranial tumors that fall under neurosurgical care. These tumors typically arise from the lining cells of surfaces in the head and neck, such as the mucosa of the mouth, nose, and throat.

The lifetime risk of developing cancer in the upper aerodigestive tract (UADT) is 1 in 46 for men and 1 in 197 for women.
In Italy, over 9,000 cases are diagnosed each year, with more than 75% occurring in men. However, the incidence is rising among women.
The average age of onset is above 40 (with about 24% of new cases diagnosed in patients over 70), but there has been a recent increase in younger individuals.
While head and neck tumors account for 3% of all cancers in Italy, they are the seventh most common cancer in Europe. They are about half as common as lung cancer but twice as common as cervical cancer.

The 5-year survival rate for head and neck tumors is 57%.
The probability of surviving five years after diagnosis, having survived the first year, is 68% for men and 74% for women. After five years, the likelihood of survival rises to 79.9% for men and 87.3% for women.
Among men, the 5-year survival rate shows no geographical differences. For women, however, survival rates are lower in central Italy (54%) compared to the north (59%) and the south (57%).
The 10-year survival rate is 48%.

Alcohol and tobacco rank among the most significant risk factors for developing head and neck cancers, particularly those affecting the oral cavity, oropharynx, hypopharynx, and larynx. It is estimated that 75% of head and neck cancers are attributable to tobacco and alcohol use.
Men who consume more than three units* of alcohol daily and women who consume more than two units daily are at a significantly higher risk of developing head and neck cancer.
The combined use of alcohol and tobacco amplifies this risk substantially, making it greater than using either substance alone.
*A unit is equivalent to 250 ml of wine with 12% alcohol content.
Infections with carcinogenic strains of Human Papillomavirus (HPV), particularly HPV-16, are another risk factor, especially for oropharyngeal cancers involving the tonsils or the base of the tongue.
Occupational exposure to wood dust is specifically linked to nasopharyngeal cancer.

- Inhalation of asbestos dust and exposure to various chemicals
- Diets deficient in vitamins A and B
- Poor or improper oral hygiene, particularly in individuals using dental prostheses
- Epstein-Barr Virus (EBV), associated with nasopharyngeal cancers
- Prior radiotherapy to the head and neck area
- Severe and prolonged immunosuppression
- Certain extremely rare genetic disorders

The symptoms of head and neck cancers often overlap with those of other conditions. Prompt recognition of these symptoms, particularly in high-risk individuals, is crucial for early diagnosis. Early detection significantly impacts treatment outcomes, as cancers identified in their initial stages—especially those without lymph node involvement—boast cure rates ranging from 75% to 100%.
It is important to consult a physician if any of the following symptoms persist for more than three weeks:
- Sore throat, burning sensations, or lesions in the oral cavity
- Hoarseness, painful or difficult swallowing, resulting in malnutrition and weight loss
- Nasal congestion or bleeding from one nostril
- Swelling in the neck region
- Persistent ear pain

Laryngeal cancers: Early signs often include voice changes. As the disease progresses, swallowing may become difficult and/or painful.
Pharyngeal cancers: Symptoms can include a sensation of a foreign body or throat pain, the presence of neck lumps (enlarged lymph nodes), difficulty swallowing, bad breath, nasal voice, and excessive salivation. Additional signs may involve hearing problems (hearing loss, buzzing, ringing, a sensation of a blocked ear, recurrent ear infections), heavy nasal discharge, and nosebleeds. In advanced stages, symptoms may escalate to headaches, loss of smell, reduced or double vision.
Oral cancers: Initial symptoms are often mild, such as small painful blisters, ulcers, or sores that fail to heal, and difficulty moving the tongue. In more advanced stages, patients may find it impossible to open their mouths.
Paranasal sinus cancers: Common symptoms include nasal obstruction, heavy discharge, and nosebleeds. Advanced cases may present with pain, altered facial sensitivity, vision disturbances, and tongue deviation.
Salivary gland cancers: Manifestations include swelling in the parotid area (in front of the ear) or submandibular regions, as well as facial muscle paralysis.
Thyroid cancers: Symptoms include swelling in the front of the neck and changes in voice.
 

The following assessments are crucial for diagnosis and staging:
·       Specialist consultation: Conducted by an otolaryngologist or maxillofacial surgeon.
·       Endoscopy: Performed using rigid or flexible endoscopes linked to a monitor or recording systems.
·       Radiological imaging: Techniques such as ultrasound, CT scans, and contrast-enhanced magnetic resonance imaging (MRI) are utilized to determine the tumor's local spread, regional involvement, or distant metastases (staging).
·       Biopsy: Involves sampling and microscopic examination of biological tissue to confirm the diagnosis, provide details about the tumor, and predict its potential behavior.

·       Head and neck cancers can be broadly divided into two main groups based on the stage of the disease, each with distinct prognostic outcomes and therapeutic approaches.
·       The first group includes early-stage cancers, stages I and II, characterized by the absence of lymph node involvement and a primary tumor that remains localized—generally less than 4 cm in diameter and confined to a single site. These cancers have a favorable prognosis, with 5-year survival rates ranging from 80% to 100%. Treatment options include surgery or radiotherapy, with the choice tailored to each case based on factors such as the tumor's location and the patient’s preferences.
·       When the disease is diagnosed at an advanced stage, stages III and IV, the prognosis declines significantly, with 5-year survival rates averaging around 40%. The primary distinction between these two groups lies in the presence of metastatic lymph nodes in advanced stages (III and IV), compared to their absence in early stages (I and II).
·       Unfortunately, the majority of head and neck cancers are diagnosed at advanced stages. These cases demand a multidisciplinary team approach before any therapeutic intervention. Evidence consistently shows that patients whose treatments are planned and managed by a multidisciplinary team have significantly better outcomes compared to those treated by a single specialist.
·       For locally advanced tumors, treatment may involve a combination of surgery and chemotherapy, while radiotherapy is almost always part of the strategy, either as an alternative to surgery or as an adjuvant therapy.
 

·       Two types of head and neck cancers have viral origins.
·       The first is undifferentiated nasopharyngeal carcinoma, historically referred to as lymphoepithelioma or Schmincke’s tumor. This cancer arises in the nasopharynx and is associated with the Epstein-Barr Virus (EBV). It stands out from other squamous cell carcinomas due to its pronounced systemic aggressiveness.
·       The second is P16-positive squamous cell carcinoma of the tonsil or base of the tongue, linked to Human Papillomavirus (HPV) infection. This type of cancer primarily affects younger individuals who are not exposed to traditional risk factors such as smoking or alcohol consumption. It is marked by rapid lymph node involvement but also by fewer genetic mutations, which make it highly responsive to chemotherapy and radiotherapy. Prognosis for HPV-positive oropharyngeal cancers is significantly better than for HPV-negative ones. However, like HPV-negative cancers, they retain the ability to metastasize to distant sites, although typically over a longer period. A notable characteristic of metastatic HPV-positive cancers is the lack of preferred target organs, meaning metastases can occur in any organ or system.