Head Cancer

What is head cancer?

“Head cancer” is not a single medical diagnosis. It is an everyday term people use when they search for information about cancers that start somewhere in the head. Doctors usually group these conditions in two main ways. The first group is called head and neck cancer, which includes cancers of the mouth, tongue, lips, throat (pharynx), voice box (larynx), nose and sinuses, and salivary glands. The second group is brain tumors, which start inside the brain or the tissues that surround it. Skin cancers of the scalp and face and cancers of the eye are also sometimes described as head cancers, although they are usually managed by their own specialists.

Cancer is a disease in which abnormal cells grow out of control and can invade nearby tissue. A malignant tumor is one that is cancerous and able to spread; a benign tumor is not cancerous, although some benign growths in the head can still cause problems because of their location. Many head and neck cancers begin in the thin, flat cells that line moist surfaces in the mouth, nose and throat; these are called squamous cell carcinomas.

Understanding what is head cancer means recognizing that the outlook, symptoms and treatment differ a great deal depending on exactly where the cancer starts. Head and neck cancers are more common in adults over 50 and have historically affected men more often than women, largely because of tobacco and alcohol use, although patterns are changing as infection with the human papillomavirus (HPV) becomes a more frequent cause. Brain tumors can occur at any age, including in children, and their causes are less well understood. This page gives a general overview; your care team can explain how the information applies to your specific type of cancer.

Head cancer symptoms

Head cancer symptoms vary widely because the head contains many different structures. Symptoms usually relate to the part of the head where the tumor is growing, and they often overlap with common, harmless conditions such as colds, mouth ulcers or tension headaches. What tends to set cancer apart is that the symptom is persistent, lasting for weeks, and does not improve with the usual treatments.

Symptoms that can occur with head and neck cancers include:

• A sore or ulcer in the mouth that does not heal within about three weeks
• A red or white patch on the gums, tongue or lining of the mouth
• A lump in the neck, mouth, jaw or face, which may be painless
• Persistent hoarseness or a change in the voice
• Difficulty or pain when swallowing, or a feeling that something is stuck in the throat
• Ongoing sore throat, especially on one side
• A blocked nose on one side, frequent nosebleeds or unusual nasal discharge
• Numbness of the tongue, lip or part of the face
• Loose teeth or dentures that no longer fit
• Ear pain or reduced hearing on one side without an ear infection
• Unexplained weight loss

Symptoms that can occur with brain tumors are different because the tumor presses on brain tissue or raises pressure inside the skull. These may include headaches that are new, steadily worsening or worse in the morning; nausea and vomiting; seizures in someone who has never had them; weakness or numbness on one side of the body; problems with speech, vision or balance; and gradual changes in personality, memory or concentration.

Early-stage head and neck cancers may cause only mild or vague symptoms, and some are first noticed by a dentist during a routine check. Later-stage disease is more likely to cause a visible neck lump, significant pain, difficulty breathing or eating, and weight loss. Having one or more of these symptoms does not mean you have cancer, but persistent symptoms should always be assessed by a doctor.

Causes and risk factors

Head cancer causes depend on the type. Cancer develops when changes (mutations) in a cell’s DNA allow it to grow and divide abnormally. Some of these changes are triggered by things we are exposed to; others happen by chance or are inherited.

For head and neck cancers, the most clearly established causes and risk factors are:

• Tobacco use in any form, including cigarettes, cigars, pipes, chewing tobacco and snuff
• Heavy alcohol use, which further increases risk when combined with tobacco
• Human papillomavirus (HPV) infection, particularly for cancers of the back of the throat (oropharynx), including the tonsils and base of the tongue
• Epstein-Barr virus (EBV), which is linked to cancer of the upper part of the throat behind the nose (nasopharynx)
• Betel quid or paan chewing, common in parts of Asia
• Workplace exposures such as wood dust, certain chemicals and asbestos, linked to nasal and sinus cancers
• Previous radiation to the head and neck
• Poor oral hygiene and long-term irritation, which some studies associate with mouth cancers
• Sun exposure, which raises the risk of lip and scalp skin cancers

For brain tumors, the causes are much less clear. Most occur without an identifiable reason. Known risk factors include previous radiation therapy to the head and a small number of inherited genetic syndromes, such as neurofibromatosis or Li-Fraumeni syndrome. Despite public concern, high-quality studies have not established a link between mobile phone use and brain tumors. Age, family history and a weakened immune system may also play a role in some head cancers.

It is important to remember that risk factors increase the chance of a disease but do not cause it in every person. Many people with head and neck cancer have never smoked, and many lifelong smokers never develop it.

Head cancer diagnosis

Head cancer diagnosis usually begins when a person or their dentist notices a persistent symptom and a doctor performs a careful examination. Because the head contains many hidden spaces, doctors use a combination of examination, imaging and tissue sampling to confirm whether cancer is present and how far it has spread.

Physical examination. The doctor will look inside the mouth and throat, feel the neck for lumps, and check the face, scalp and lymph nodes. For suspected brain tumors, a neurological examination tests strength, sensation, reflexes, coordination, vision and thinking.

Endoscopy. A thin, flexible tube with a light and camera, called an endoscope, can be passed through the nose or mouth to view the throat, voice box and nasal passages. This is often done in the clinic with local anesthetic spray.

Imaging tests. A CT scan (computed tomography) uses X-rays to build detailed cross-sectional pictures and is helpful for bone and lymph nodes. An MRI scan (magnetic resonance imaging) uses magnets and radio waves and gives especially clear pictures of soft tissue and the brain; it is the main imaging test for suspected brain tumors. A PET scan (positron emission tomography) uses a small amount of radioactive sugar to highlight areas of active cancer and may be used to check whether cancer has spread. Ultrasound is sometimes used to examine neck lumps and guide needle sampling.

Biopsy. A biopsy, in which a small sample of tissue is removed and examined under a microscope by a pathologist, is the only way to confirm a cancer diagnosis for most head cancers. For neck lumps, a fine-needle aspiration uses a thin needle to draw out cells. For mouth and throat lesions, a small piece of tissue may be cut away, sometimes under general anesthetic. For brain tumors, a biopsy may be taken through a small opening in the skull or as part of surgery to remove the tumor.

Laboratory tests. The biopsy sample is often tested for HPV, because HPV-related throat cancers behave differently and may be treated differently. In some cases, molecular or genetic tests on the tumor help guide treatment choices, particularly for brain tumors. Blood tests are used to assess general health but cannot diagnose head cancer on their own.

Staging. Once cancer is confirmed, doctors assign a stage, a standardized description of the tumor’s size, whether it has reached lymph nodes and whether it has spread to distant parts of the body. Brain tumors are usually described by grade (how abnormal the cells look and how fast they are likely to grow) rather than stage. Staging and grading guide treatment planning and are discussed at a multidisciplinary meeting where surgeons, oncologists, radiologists and pathologists review each case together.

Head cancer treatment options

Head cancer treatment options depend on the type and location of the cancer, its stage or grade, the person’s overall health and their own priorities, such as preserving speech or swallowing. Treatment is usually planned by a team that may include head and neck surgeons, neurosurgeons, radiation oncologists, medical oncologists, dentists, speech and swallowing therapists and dietitians. In many hospital groups, including Acibadem, systemic drug treatments are coordinated through a Medical Oncology Department working alongside surgical and radiation specialists.

Surgery. Removing the tumor with a margin of healthy tissue is a common first treatment for many mouth, throat, salivary gland and sinus cancers, and for brain tumors that can be safely reached. Lymph nodes in the neck are often removed at the same time (a procedure called neck dissection). Depending on the area removed, reconstructive surgery may be needed to restore appearance and function. Minimally invasive and robotic approaches are used for some throat cancers.

Radiation therapy. High-energy beams are directed at the cancer to destroy cells. Radiation may be the main treatment, especially for voice box and some throat cancers where it can help preserve function, or it may be given after surgery to reduce the chance of the cancer returning. Modern techniques shape the beams closely to the tumor to spare nearby healthy tissue. Side effects can include mouth dryness, sore mouth and throat, taste changes and skin irritation.

Chemotherapy. These are medicines that kill fast-growing cells. Chemotherapy is often given together with radiation for more advanced head and neck cancers, or before other treatment to shrink a tumor. For certain brain tumors, chemotherapy tablets are given during and after radiation.

Targeted therapy and immunotherapy. Targeted drugs block specific molecules that cancer cells use to grow. Immunotherapy helps the body’s own immune system recognize and attack cancer cells; it is now an established option for some recurrent or advanced head and neck cancers. Your doctor may test the tumor to see whether these treatments are likely to help.

Observation. For some slow-growing benign or low-grade tumors in the head, particularly certain brain tumors, doctors may recommend regular scans and monitoring rather than immediate treatment, especially when treatment risks outweigh the likely benefit.

Supportive and rehabilitation care. Treatment of head cancer can affect eating, speaking, breathing, hearing and appearance. Speech and swallowing therapy, nutritional support (sometimes including a temporary feeding tube), dental care before and after radiation, physical therapy and psychological support are considered part of standard treatment rather than optional extras. Palliative care, which focuses on comfort and quality of life, can be offered at any stage alongside other treatments.

Living with head cancer and outlook

The outlook for head cancer varies enormously and no single statement applies to everyone. In general, cancers that are found early, before they have spread to lymph nodes or other organs, are more likely to be cured than those found late. HPV-related throat cancers tend to respond better to treatment than tobacco-related cancers at a similar stage. For brain tumors, the outlook depends heavily on the type and grade of tumor, its location and whether it can be removed; some are curable, while others are treated to control growth and maintain quality of life for as long as possible.

Life after treatment often involves adjustment. Changes in speech, swallowing, taste, saliva production, appearance and energy are common and may improve over months, sometimes with the help of therapists. Regular follow-up visits, which typically include examinations and periodic scans, are important because head and neck cancers can return and because people who have had one such cancer have a higher risk of developing another, particularly if they continue to smoke or drink. Stopping tobacco and reducing alcohol after diagnosis can meaningfully improve recovery and reduce this risk.

Emotional effects, including anxiety, low mood and worry about recurrence, are common and are a normal response to a serious illness. Many people find that counseling, support groups or talking openly with their care team helps. Family members and caregivers may also need support, especially when treatment affects communication or independence.

Frequently asked questions

What is head cancer, and is it the same as brain cancer?

Head cancer is an informal term rather than a medical diagnosis. It most often refers to head and neck cancers of the mouth, throat, voice box, nose, sinuses and salivary glands, but people also use it to mean brain tumors or skin cancers of the scalp. Brain cancer is one specific group within this broader idea, and it is diagnosed and treated differently from cancers of the mouth and throat.

What are the first head cancer symptoms people notice?

Early head cancer symptoms are often subtle and easy to mistake for minor problems. Common first signs of head and neck cancer include a mouth ulcer that does not heal, a painless neck lump, persistent hoarseness or a sore throat on one side that lasts for weeks. Brain tumors may first cause new headaches, seizures or changes in vision, speech or balance. Persistence, rather than severity, is often the clue that a symptom needs medical assessment.

What are the main head cancer causes?

For head and neck cancers, tobacco, heavy alcohol use and HPV infection are the most firmly established causes, with Epstein-Barr virus, betel quid, certain workplace dusts and chemicals, and previous radiation also playing a role. For most brain tumors, no specific cause can be identified, although prior radiation to the head and a few rare inherited conditions increase risk.

How is head cancer diagnosis confirmed?

Diagnosis is confirmed with a biopsy, in which a small piece of tissue or a sample of cells is examined under a microscope. Before and after the biopsy, doctors use physical examination, endoscopy and imaging tests such as CT, MRI and sometimes PET scans to locate the tumor and check whether it has spread. Blood tests alone cannot confirm or rule out head cancer.

What are the standard head cancer treatment options?

Standard treatment options include surgery, radiation therapy, chemotherapy, targeted therapy and immunotherapy, used alone or in combination depending on the cancer type and stage. Some slow-growing tumors are monitored with regular scans instead of being treated immediately. Rehabilitation, including speech, swallowing and nutritional support, is a routine part of care for many patients.

Can head cancer be cured?

Many head cancers can be cured, particularly when they are found at an early stage and treated fully. Others can be controlled for long periods even if a cure is not possible. Because outcomes depend on the exact type, location, stage and the person’s general health, only your own care team can give you a realistic picture of what to expect in your situation.

Which specialist treats head cancer?

Care is usually shared by a team. Head and neck cancers are commonly managed by ear, nose and throat surgeons or head and neck surgeons together with radiation and medical oncologists. Brain tumors are managed by neurosurgeons, neuro-oncologists and radiation oncologists. Dentists, speech therapists, dietitians and nurses are also involved throughout treatment.

When to see a doctor

Most symptoms in the head are caused by common, harmless conditions, but some should not be ignored. Make an appointment with a doctor or dentist if you have any of the following for more than about three weeks:

• A mouth ulcer, sore or patch that does not heal
• A lump in the neck, mouth, jaw or face
• Hoarseness or a change in your voice
• Difficulty or pain when swallowing
• A persistent sore throat, especially on one side
• A blocked nose on one side, repeated nosebleeds or unusual nasal discharge
• Unexplained numbness of the face, tongue or lips
• Unexplained weight loss

Seek urgent medical care, including emergency services if needed, for these red-flag warning signs:

• A seizure in someone who has never had one before
• Sudden weakness, numbness or drooping on one side of the face or body
• Sudden confusion, difficulty speaking or understanding speech
• A severe headache that comes on suddenly, or the worst headache of your life
• Sudden loss of vision or double vision
• Difficulty breathing, noisy breathing or a feeling that your airway is blocked
• Heavy or uncontrolled bleeding from the mouth, nose or throat
• Inability to swallow liquids or your own saliva

If you are already being treated for head cancer, contact your care team promptly about a fever during chemotherapy, new bleeding, sudden swelling of the face or neck, or any rapid change in symptoms, as these may need same-day assessment.