Head and Neck Cancer Need-to-Know

The Head and Neck Cancer Need-to-Know blog post is PeopleBeatingCancer.org’s pillar page on Head and Neck Cancer (HNC). As a long-term cancer survivor myself, my purpose in creating and managing PeopleBeatingCancer is to address my lament, “I wish I knew then what I know now.” The more that newly diagnosed cancer patients know about their cancer diagnosis, the better their decision-making will be.

While the content and links to the many blog posts on PeopleBeatingCancer.org is extensive, you may have one or more questions. Questions about your individual diagnosis, treatment plan, side effects, etc. Please scroll down the page, post your question, and I will respond as soon as possible.

The three basic categories for learning about head and neck cancers are:

Diagnosis/Risk

Therapies-

Side Effects

While I believe this list is important, I would emphasize the evidence-based non-conventional side of HNC more by highlighting:

Prehabilitation, regardless of your treatment plan, has been shown to enhance treatment efficacy while reducing side effects.
Diet and gut microbiome-

Research has shown that both prehabilitation and enhancing your gut microbiome can increase the efficacy of your therapies while reducing your side effects. Please be sure to scroll down to the list of common side effects. The possibility of these side effects should give you the incentive to prehabilitate, enhance your nutrition, exercise, etc. 😊

The Basics:

Globally, head and neck cancer accounts for 650,000 new cases of cancer and 330,000 deaths annually on average. In 2018, it was the seventh most common cancer worldwide, with 890,000 new cases documented and 450,000 people dying from the disease.^[12] The risk of developing head and neck cancer increases with age, especially after 50 years. Most people who do so are between 50 and 70 years old.^[22]

What is Head and Neck Cancer?

Here are 10 of the most important things to know about head and neck cancer, written for patients, caregivers, and clinicians alike:

1. Head and neck cancer is a group of diseases, not one cancer

It includes cancers of the oral cavity, oropharynx (tonsils, base of tongue), larynx, hypopharynx, nasopharynx, sinuses, and salivary glands. Treatment and prognosis vary widely depending on the exact site and stage.

2. HPV-related cancers are biologically different

Human papillomavirus (HPV), especially HPV-16, causes many oropharyngeal cancers.
HPV-positive cancers tend to:

Occur in younger patients
Respond better to treatment
Have significantly better survival rates
This distinction now directly affects staging and treatment decisions.

3. Tobacco and alcohol remain major risk factors

Smoking, smokeless tobacco, and heavy alcohol use are still the leading causes of non-HPV head and neck cancers. Combined tobacco and alcohol use multiplies risk rather than simply adding to it.

4. Early symptoms are often subtle and easily missed

Warning signs can include:

A persistent sore throat
Hoarseness lasting >2–3 weeks
Mouth sores that don’t heal
Difficulty or pain with swallowing
A neck lump
Many patients are diagnosed late because early symptoms resemble benign conditions.

5. A neck mass can be the first sign of cancer

In adults, a new, persistent neck lump should be considered cancer until proven otherwise—particularly HPV-related oropharyngeal cancer, which often presents this way.

6. Treatment is frequently multimodal

Care often involves surgery, radiation, and/or chemotherapy, sometimes in combination.
Treatment plans are best determined by a multidisciplinary team (ENT surgery, radiation oncology, medical oncology, speech therapy, nutrition, dentistry).

7. Functional outcomes matter as much as survival

Treatment can affect:

Speech
Swallowing
Taste
Saliva production
Breathing
Preserving function and quality of life is a central goal, especially as survival rates improve.

8. Nutrition and swallowing support are critical

Weight loss and malnutrition are common. Early involvement of:

Speech and swallowing therapists
Registered dietitians
can prevent complications and improve treatment tolerance.

9. Long-term side effects and survivorship issues are common

Survivors may experience:

Chronic dry mouth
Dental problems
Neck stiffness or lymphedema
Fatigue
Hearing changes
Long-term follow-up and survivorship care plans are essential.

10. Early detection and prevention save lives

HPV vaccination prevents many HPV-related head and neck cancers
Smoking cessation dramatically lowers risk
Regular dental and medical exams improve early detection

David Emerson

Cancer Survivor
Cancer Coach
Director PeopleBeatingCancer

Specific head and neck cancers include cancers of the mouth (oral cavity), throat (pharynx – nasopharyngeal, oropharyngeal, hypopharyngeal), voice box (larynx), nasal cavity & sinuses, salivary glands, and sometimes thyroid and certain skin cancers on the face/neck, often arising from squamous cells lining these areas, but typically excluding brain or eye cancers.

Specific Cancers Often Classified as Head & Neck Cancers:

Oral Cavity Cancer: Lips, gums, tongue, cheeks, roof, and floor of the mouth.
Throat (Pharyngeal) Cancers:
- Nasopharyngeal: Upper part of the throat behind the nose.
- Oropharyngeal: Middle part, including tonsils and base of tongue.
- Hypopharyngeal: Lower part of the throat.
Laryngeal Cancer: Voice box (larynx).
Nasal Cavity & Paranasal Sinus Cancer: Hollow areas inside the nose and surrounding bones.
Salivary Gland Cancer: Cancers in the glands that produce saliva.
Thyroid Cancer: Cancers in the thyroid gland, often grouped here.
Skin Cancers: On the face, scalp, and neck.

Key Distinction: While brain, eye, and esophageal cancers occur in the head or neck region, they are usually treated separately because they have different biology, symptoms, and treatments. Most head and neck cancers are squamous cell carcinomas, originating in the moist lining tissues.

As a long-term cancer survivor myself, I have come to believe that addressing short-term, long-term, and late-stage side effects of head and neck cancer is as important to the patient as conventional treatments are.

Though the newly diagnosed HNC is understandably focused on treatment, please also focus on the side effects explained below in order to take steps as early in the process as possible in order to treat and hopefully heal your short-term, long-term and late stage side effects.

Head and neck cancer treatments—most commonly surgery, radiation therapy, chemotherapy, and immunotherapy—can cause a distinct set of side effects because they affect structures essential for eating, speaking, breathing, and appearance. The most common side effects are outlined below, grouped by system and treatment phase.

Most Common Side Effects

1. Mouth and Throat Effects

These are among the most frequent and impactful.

Mucositis (painful inflammation and ulceration of the mouth/throat)
Dry mouth (xerostomia) from salivary gland damage
Thick or sticky saliva
Sore throat
Difficulty swallowing (dysphagia)
Pain with swallowing (odynophagia)
Increased dental decay and oral infections

Often most severe during and shortly after radiation and chemoradiation.

2. Taste and Smell Changes

Loss or alteration of taste (dysgeusia)
Metallic or bitter taste
Reduced enjoyment of food
Loss of appetite

Taste changes may last months and sometimes remain long term.

3. Nutrition and Weight Changes

Weight loss
Malnutrition
Dehydration
Need for feeding tube (temporary or long-term)

These are common, especially during chemoradiation.

4. Speech and Voice Changes

Hoarseness
Weak or breathy voice
Slurred or unclear speech
Difficulty articulating words

More common after laryngeal surgery or radiation to the voice box.

5. Skin and Soft Tissue Effects

Radiation dermatitis (redness, peeling, burning)
Skin fibrosis or thickening
Neck stiffness
Lymphedema (swelling of face or neck)

6. Fatigue

Persistent, often profound fatigue
Can last months after treatment ends
Multifactorial (inflammation, nutrition, sleep disruption, anemia)

7. Pain

Mouth, throat, ear, jaw, or neck pain
Nerve-related pain in some patients
Jaw stiffness (trismus)

8. Hearing and Neurologic Effects (especially with cisplatin)

Hearing loss
Tinnitus
Peripheral neuropathy (numbness or tingling)

9. Endocrine and Long-Term Effects

Hypothyroidism (after neck radiation)
Chronic dry mouth
Dental complications and osteoradionecrosis
Swallowing dysfunction (may persist or worsen over time)

10. Psychosocial and Functional Effects

Depression and anxiety
Changes in appearance
Social isolation
Speech and eating difficulties affecting quality of life

Side Effects by Treatment Type (Summary)

Treatment	Common Side Effects
Surgery	Pain, swelling, speech/swallowing changes, scarring
Radiation	Mucositis, dry mouth, taste loss, skin burns, fatigue
Chemotherapy	Nausea, fatigue, infections, hearing loss, neuropathy
Immunotherapy	Fatigue, rash, thyroid dysfunction, inflammation

Key Takeaway

Head and neck cancer treatment side effects are common, often cumulative, and highly impactful, but many are manageable and improve with early intervention. Multidisciplinary care—speech therapy, nutrition support, dental care, pain management, and psychosocial support—plays a critical role in recovery and long-term quality of life.

Head and Neck Cancer Need-to-Know Head and Neck Cancer Need-to-Know Head and Neck Cancer Need-to-Know