Overview of the Most Common Head and Neck Cancers

Squamous cell carcinoma represents more than 90% of head and neck malignancies, making it by far the most common type of head and neck cancer. 1

Epidemiology and Classification

Head and neck cancer is the seventh most common cancer worldwide and ninth most common cancer in the United States 1
The crude incidence of squamous cell carcinoma of the head and neck (SCCHN) in the European Union is 34.6/100,000/year, with a mortality rate of 13.7/100,000/year 1
Head and neck cancers encompass several anatomic sites including the oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, paranasal sinuses, nasal cavity, and salivary glands 1

Represents a significant proportion of head and neck cancers with distinct anatomical regions:
- Glottic region (60-65% of laryngeal cases)
- Supraglottic region (30-35% of laryngeal cases)
- Subglottic region (5% of laryngeal cases) 2
Squamous cell carcinoma accounts for approximately 95% of all primary laryngeal malignancies 2
Early-stage glottic cancer has excellent cure rates of 80-90% due to early symptomatology (hoarseness) and sparse lymphatic drainage 2

Common sites include the buccal mucosa, floor of mouth, anterior tongue, alveolar ridge, retromolar trigone, and hard palate 1
Treatment typically involves surgical excision with or without neck dissection, followed by radiation or chemoradiation depending on risk factors 1
Squamous cell carcinoma is the predominant histological type 1

Includes cancers of the base of tongue, tonsil, posterior pharyngeal wall, and soft palate 1
Human papillomavirus (HPV) is strongly associated with oropharyngeal cancers, particularly those of the tonsils and base of tongue 1
HPV-related oropharyngeal cancer has significantly better prognosis than HPV-negative disease 3

Less common than other sites but generally presents at advanced stages 1
Associated with poor prognosis due to late presentation and rich lymphatic drainage 1
Predominantly squamous cell carcinoma in histology 1

Relatively rare with a worldwide incidence of 0.5 to 1.0/100,000 per year, but higher rates in Southeast Asian countries 1
Strongly associated with Epstein-Barr virus (EBV) infection, particularly the nonkeratinizing subtypes 1
Often presents with advanced local disease, with skull base involvement in 25-35% of cases 1

Less common than squamous cell carcinomas of other head and neck sites 1
Adenoid cystic carcinoma is one of the more common salivary gland malignancies 4
Treatment typically involves surgery and radiotherapy 4

Tobacco use and alcohol consumption are responsible for 75-85% of head and neck squamous cell carcinomas, with a synergistic effect when combined 2, 3
Viral associations:
- Human papillomavirus (HPV) with oropharyngeal cancer
- Epstein-Barr virus (EBV) with nasopharyngeal cancer 1, 3
Other risk factors include radiation exposure, chronic infection, immunosuppression, poor oral hygiene, and poor nutrition 2
In developing countries, areca nut (betel quid) chewing is a significant risk factor 3

Comprehensive evaluation includes physical examination, endoscopy, and imaging studies 1, 2
CT with contrast and/or MRI with contrast of primary site and neck are standard imaging modalities 1
PET-CT is considered for advanced stage (III-IV) disease to evaluate for distant metastases 1, 4
Biopsy is essential for definitive diagnosis 1

Treatment approach varies based on primary site, stage, and patient factors 1
Early-stage disease may be treated with single-modality therapy (surgery or radiation) 1
Advanced disease typically requires multimodality treatment:
- Surgery followed by adjuvant therapy (radiation or chemoradiation)
- Definitive chemoradiation with surgery reserved for salvage 1
Cetuximab may be considered in combination with radiation therapy for patients who cannot receive cisplatin-based therapy 1, 5
Organ preservation strategies are important considerations, particularly for laryngeal and hypopharyngeal cancers 1

The 5-year relative survival for laryngeal SCC is approximately 61%, which is better than other head and neck sites 2
HPV-positive oropharyngeal cancer has significantly better prognosis (130 months median survival) compared to HPV-negative disease (20 months) 3
Nasopharyngeal cancer has a relatively high rate of distant metastases compared to other head and neck cancers 1
Despite advances in treatment, 40-60% of patients with locally advanced disease will experience relapse 6