Felt a lump in your neck? Have a mouth sore that refuses to heal? Or perhaps your voice has been hoarse for weeks?
These symptoms may seem minor, but they can sometimes be early warning signs of head and neck cancer. According to Dr. Daniel M. Alonzo, head of the Healthway Cancer Care Hospital (HCCH) Head and Neck Center of Excellence, recognizing these signs and seeking medical attention early can make a significant difference in treatment and recovery.
Head and neck cancers can develop in the mouth, throat, nose, sinuses, larynx, salivary glands and other structures in the head and neck. Because these areas contain vital structures that control breathing, swallowing, speech and the senses, treatment must address not only the cancer but also the patient’s ability to function and maintain quality of life.
‘The best way to prevent damage to function is early diagnosis. If there is cancer, early diagnosis and early treatment lead to an excellent outcome with no impact on function,’ said Dr. Alonzo.
Know the warning signs
Dr. Alonzo said the symptoms and behavior of head and neck cancers vary depending on where they develop.
In his clinical experience, nasopharyngeal cancer is among the more frequently encountered head and neck cancers, followed by cancers of the oral cavity. Other cancers may develop in the oropharynx, larynx and salivary glands.
Thyroid cancer is also common in the head and neck region, he noted, although it is often discussed separately because most thyroid cancers are slow-growing and well-differentiated and are highly treatable.
Risk factors also vary by cancer type. Smoking, heavy alcohol consumption, advancing age and human papillomavirus (HPV) infection are among the known risk factors for head and neck cancers.
Age can also play a role. Dr. Alonzo said oral cavity cancers are more commonly seen among older adults, particularly those in their late 60s and beyond, and are strongly associated with age and lifestyle factors such as smoking and heavy alcohol consumption.
Oropharyngeal cancers, on the other hand, are increasingly being seen in younger patients, including those without a history of smoking or heavy alcohol use. Dr. Alonzo attributed much of this trend to HPV.
He emphasized that HPV vaccination can substantially reduce the risk of HPV-related cancers when administered at the recommended age.
The location of a tumor can also determine how early it is detected. Dr. Alonzo said cancers of the nose and sinuses may go unnoticed until they have grown considerably, while cancers of the oral cavity may be easier to spot because lesions can be visible in the mouth.
A mouth sore that does not heal, however, should not simply be dismissed as an ordinary singaw.
‘If you have a sore that doesn’t heal after three weeks, get it examined immediately, as stage 1 or 2 oral cancer is very curable,’ said Dr. Alonzo.
The same applies to persistent changes in the voice.
‘If you are hoarse for more than three weeks, see a doctor right away, as stage 1 larynx cancer has an excellent cure rate,’ he added.
Other warning signs include persistent nosebleeds, ongoing one-sided nasal obstruction, hearing loss or muffled hearing, a sensation of blockage in one ear, and ringing or tinnitus in a single ear.
In the mouth and throat, symptoms to watch for include persistent mouth or throat sores, sore throat, pain or difficulty when swallowing, hoarseness, and spitting or coughing up blood.
A lump in the neck is another important warning sign, particularly in an adult.
‘A lateral neck mass on the side of the neck in an adult must be considered malignant until proven otherwise,’ Dr. Alonzo said.
While these symptoms can have causes other than cancer, persistent or unexplained symptoms should be evaluated rather than ignored.
Why an ENT specialist?
Because many head and neck cancers first present through symptoms involving the ear, nose or throat, Dr. Alonzo said an ENT specialist-or otolaryngologist-is often the appropriate physician to consult.
‘The most common entry of patients with head and neck cancers is an ear, nose, and throat symptom or sign,’ he said.
An ENT specialist can examine the affected area, determine whether further testing is necessary and, when appropriate, coordinate a biopsy and imaging studies such as CT, MRI or PET scans.
At HCCH, patients can also be referred among ENT subspecialists depending on their condition. These include specialists in the nose and sinuses, ear, larynx, maxillofacial bones, pediatric ENT and reconstruction.
When a diagnosis of cancer is confirmed, care shifts to a multidisciplinary approach involving specialists such as head and neck surgeons, radiation oncologists, medical oncologists, pathologists, radiologists and nutritionists, depending on the patient’s needs.
In nasopharyngeal cancer, for example, treatment may involve radiation and medical oncology alongside nutritional and other supportive services.
‘There is one doctor who is the captain of the ship, who leads the team from beginning to end of the journey, but everyone gets involved along the way,’ Dr. Alonzo explained. ‘The multidisciplinary team revolves around the patient and around the disease.’
Saving function, not just life
For head and neck cancer patients, successful treatment involves more than eliminating the tumor.
Dr. Alonzo said doctors must work to preserve the airway for breathing, swallowing and its related functions such as chewing and taste, as well as speech, hearing and smell.
Appearance is another important consideration, particularly because some head and neck surgeries can affect facial structures.
For this reason, rehabilitation is an integral part of recovery. Depending on the patient’s condition, this may include voice rehabilitation, swallowing therapy and facial reanimation to restore facial movement and symmetry.
‘Saving a life is only part of the goal,’ Dr. Alonzo said. The ultimate goal is to cure the patient and prolong life while preserving function, appearance and dignity.
At HCCH, this continuum of care extends from diagnosis and treatment to management of complications, rehabilitation and long-term surveillance.
Don’t wait for symptoms to worsen
For Dr. Alonzo, one of the biggest challenges in improving outcomes is changing the way people respond to symptoms.
A neck mass, for example, may be painless and may not interfere with eating or daily activities, leading patients to postpone consultation.
His advice is simple: don’t wait for a symptom to become painful or disruptive before seeking help.
‘If you notice any symptom-any of what I enumerated earlier-have it checked early. When you get examined early, you get the right diagnosis and the right treatment by the right doctor at the right time,’ he said.