Head and Neck Cancer

ON THIS PAGE: You will find a drawing of the main body parts affected by head and neck cancer. Use the menu to see other pages.

The next section in this guide is Risk Factors and Prevention . It describes what factors may increase the chance of developing head and neck cancer and ways to help reduce your risk. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for head and neck cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease

Learn more about the basics of cancer screening .

Screening information for head and neck cancer

People who routinely drink alcohol, currently use tobacco products, or have used tobacco products in the past should receive general health screening examination at least once a year. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination using 1 or more of the procedures described in the Diagnosis section.

Regular dental checkups are also important to screen for head and neck cancer. Check in your local community to see if free oral cancer screenings are available.

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems head and neck cancer can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How head and neck cancer is diagnosed

There are many tests used for diagnosing head and neck cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

If a person has symptoms and signs of head and neck cancer, the doctor will take a complete medical history, noting all symptoms and risk factors. In addition, the following tests may be used to diagnose head and neck cancer:

• Physical examination/blood and urine tests. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The doctor will also inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and a mirror for a clearer view. Blood and urine tests may be done to help diagnose cancer.

• Endoscopy. An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is gently inserted through the nose into the throat and down the esophagus to examine inside the head and neck. Sedation is giving a person medication to become more relaxed, calm, or sleepy. The examination has different names depending on the area of the body that is examined, such as laryngoscopy to view the larynx, pharyngoscopy to view the pharynx, or nasopharyngoscopy to view the nasopharynx. When these procedures are combined, they are sometimes referred to as a panendoscopy.

• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s) removed during the biopsy. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A common type of biopsy is called a fine needle aspiration. During this procedure, cells are collected using a thin needle inserted directly into the tumor or lymph node. The cells are examined under a microscope for cancer cells, which is called a cytologic examination.

  The biopsy may include testing to see whether the person has HPV. As described in Risk Factors and Prevention , HPV has been linked to a higher risk of some head and neck cancers. In some cases, whether a person has HPV can also be a factor in determining which treatments are likely to be most effective.

• Biomarker testing of the tumor . Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests can help determine your treatment options , such as immunotherapy.

• X-ray/barium swallow. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A barium swallow may be required to identify abnormalities along the swallowing passage. During a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray. A special type of barium swallow called a modified barium swallow may be needed to evaluate specific swallowing difficulties. If there are signs of cancer, the doctor may recommend a computed tomography (CT) scan (see below).

• Panoramic radiograph. A panoramic radiograph is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect cancer or evaluate the teeth before radiation therapy or chemotherapy. This is often called a Panorex.

• Ultrasound. An ultrasound uses sound waves to create a picture of internal organs.

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The amount of radiation in the tracer is too low to be harmful. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image. This test may be done to see if cancer has spread to the bones.

• Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with head and neck cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for head and neck cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

The cancer care team

Head and neck cancer specialists usually form a multidisciplinary team to care for each patient, and an evaluation should be done by each doctor before any treatment begins. This team often includes these specialists:

• Medical oncologist: A doctor who treats cancer using medications, such as chemotherapy, immunotherapy, and targeted therapy.

• Radiation oncologist: A doctor who specializes in treating cancer using radiation therapy.

• Surgical oncologist: A doctor who treats cancer using an operation.

• Reconstructive/plastic surgeon: A doctor who specializes in reconstructive surgery, which is done to help repair damage caused by cancer treatment.

• Maxillofacial prosthodontist: A specialist who performs restorative surgery in the head and neck areas.

• Otolaryngologist: A doctor who specializes in the ear, nose, and throat.

• Oncologic dentist or oral oncologist: A dentist experienced in caring for people with head and neck cancer.

• Oncology nurse: A nurse who specializes in caring for people with cancer.

• Physical therapist: A health care professional who helps patients improve their physical strength and ability to move.

• Speech-language pathologist: This health care professional specializes in communication and swallowing disorders. This specialist helps patients regain their speaking, swallowing, and oral motor skills after cancer treatment that affects the head, mouth, and neck.

• Audiologist: A medical professional who treats and manages hearing problems.

• Psychologist/psychiatrist: These mental health professionals address the emotional, psychological, and behavioral needs of the person with cancer and the patient's family.

• Social worker: This health care professional provides counseling for patients, family members, and support groups. A social worker may also arrange family meetings, help with practical issues like transportation, and connect patients with local resources.

• Registered dietitian nutritionist: A nutrition professional who helps people understand the best ways to eat and what to eat for their specific conditions and recovery, to ensure they get the proper nutrition.

Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, pharmacists, counselors, and others. It is extremely important for this team to create a comprehensive treatment plan before treatment begins. People may need to be seen by several specialists before a treatment plan is fully developed.

How head and neck cancer is treated

Many cancers of the head and neck can be cured, especially if they are found early. Although eliminating the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When planning treatment, doctors consider how treatment might affect a person’s quality of life, such as how a person feels, looks, talks, eats, and breathes.

Treatment options and recommendations depend on several factors, including the type and stage of head and neck cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for head and neck cancer because there are different treatment options. Learn more about making treatment decisions .

The common types of treatments used for head and neck cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Overall, the main treatment options are surgery, radiation therapy, chemotherapy, and targeted therapy. Surgery or radiation therapy by themselves or a combination of these treatments may be part of the treatment plan. More treatment details can be found each specific cancer type section. See the Introduction for a complete list of different types of head and neck cancer.

• Surgery

• Radiation therapy

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Physical, emotional, and social effects of cancer

• Metastatic head and neck cancer

• Remission and the chance of recurrence

• If treatment does not work

Surgery

During surgery, the goal is to remove the cancerous tumor and some surrounding healthy tissue during an operation. Types of surgery for head and neck cancer include:

• Laser technology. This may be used to treat an early-stage tumor, especially if it was found in the larynx.

• Excision. This is an operation to remove the cancerous tumor and some surrounding healthy tissue, known as a margin.

• Lymph node dissection or neck dissection. If the doctor suspects the cancer has spread, the doctor may remove lymph nodes in the neck. This may be done at the same time as an excision.

• Reconstructive (plastic) surgery. If cancer surgery requires major tissue removal, such as removing the jaw, skin, pharynx, or tongue, reconstructive or plastic surgery may be done to replace the missing tissue. This type of operation helps restore a person’s appearance and the function of the affected area. For example, a prosthodontist may be able to make an artificial dental or facial part to help restore the ability to swallow and speak. A speech-language pathologist may then be needed to help the patient relearn how to swallow and communicate using new techniques or special equipment. Learn more about reconstructive surgery .

Depending on the location, stage, and type of the cancer, some people may need more than 1 operation. Sometimes, it is not possible to completely remove the cancer, and additional treatments may be necessary. For example, surgery may be followed by radiation therapy, chemotherapy, or both to destroy cancer cells that cannot be removed during surgery.

Side effects of surgery

Side effects of surgery depend on the type and location of the surgery. Every patient is encouraged to talk with their doctor about the side effects expected from a specific surgery and how long the side effects are likely to last. Common side effects from head and neck surgery include temporary or permanent loss of normal voice, impaired speech, and hearing loss . People often have difficulty chewing or swallowing after cancer surgery, which may require a tube inserted in the stomach for feeding purposes. If lymph nodes were removed, there may be stiffness in the shoulders afterward. In addition, lymphedema can occur. After a total laryngectomy, which is the removal of the larynx, people may have decreased thyroid gland function that will need to be managed, such as by taking thyroid hormone medication.

Another potential side effect is swelling of the mouth and throat area, making it difficult to breathe. If this side effect develops, patients may receive a temporary tracheostomy, which creates a hole in the windpipe to make breathing easier.

Some people experience facial disfigurement from surgery due to the location of the tumor. Reconstructive surgery (see above) may be recommended to help appearance or maintain important functions, such as chewing, swallowing, and breathing. Patients should meet with different members of the health care team to help them make decisions about their treatment and understand the recovery process. Programs that help patients adjust to changes in body image may be useful both before and after the surgery. Talking with your doctor about what to expect and how recovery will be handled can help you cope.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery .

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Radiation therapy may be used in different ways to treat head and neck cancers, including to help cure the disease or lessen the symptoms of cancer and its treatment. It can be used on its own or in combination or in sequence with other treatments, such as surgery or chemotherapy.

The most common type of radiation therapy is called external-beam radiation therapy, which is radiation given from a machine outside the body. A specific type of external-beam radiation therapy is called intensity-modulated radiation therapy (IMRT). IMRT uses advanced technology to accurately direct the beams of radiation at the tumor. This helps reduce damage to nearby healthy cells, potentially causing fewer side effects.

Proton therapy is another type of external-beam radiation therapy that uses protons rather than x-rays. At this time, proton therapy is not a standard treatment option for most types of head and neck cancer, but it may be used more in the future to treat these types of cancer as technology changes. See the Latest Research section for more information.

When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy.

Before beginning radiation therapy for any type of head and neck cancer, patients should be examined by a dentist who has expertise in managing the oral problems related to cancer and its treatment. This specialist can coordinate the patient’s dental care with their regular dentist as needed. Because radiation therapy can cause tooth decay, damaged teeth at risk may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning cancer treatment. Learn more about dental and oral side effects . People should also receive an evaluation from a speech-language pathologist who has experience treating people with head and neck cancer.

Patients may experience short- and long-term pain or difficulty swallowing, changes in voice because of swelling and scarring, and loss of appetite due to a change in their sense of taste. It is important that patients begin speech and swallowing therapy early, before radiation therapy begins to help prevent long-term problems with speaking or eating.

Radiation therapy to the head and neck area may also damage the salivary glands, causing dry mouth , also called xerostomia. ASCO recommends using IMRT or other radiation therapy methods that reduce the amount of radiation directed at the salivary glands to reduce the risk of this side effect.

In addition, radiation therapy to the head and neck may cause redness or skin irritation in the treated area, swelling, bone pain, nausea, fatigue, mouth sores, and sore throat. Many of these side effects go away soon after treatment has finished. Other side effects may include hearing loss due to a buildup of fluid in the middle ear, a buildup of earwax that dries out because of the radiation therapy’s effect on the ear canal, and scarring (fibrosis). If the treatment damaged the lymph nodes, there may be a risk for lymphedema .

Depending on where the radiation therapy is administered, treatment also may cause a condition called hypothyroidism in which the thyroid gland (located in the neck) slows down and causes the patient to feel tired and sluggish. This may be treated with thyroid hormone replacement medication. Every patient who receives radiation therapy to the neck area should have their thyroid function checked regularly. Patients are encouraged to talk with their health care team about what side effects of radiation therapy to expect before treatment begins, including how these side effects can be prevented or managed.

Learn more about the basics of radiation therapy .

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Therapies using medication

The treatment plan may include medication to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for head and neck cancer include:

• Chemotherapy

• Targeted therapy

• Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy .

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them.

• EGFR inhibitors. For head and neck cancers, treatments that target a tumor protein called epidermal growth factor receptor (EGFR) may be recommended. Researchers have found that drugs that block EGFR help stop or slow the growth of certain types of head and neck cancer.

• Tumor-agnostic therapy. Larotrectinib and entrectinib are oral medications, both are targeted therapies that are not specific to a certain type of cancer but focuses on a specific genetic change in NTRK genes. This type of genetic change is uncommon but does occur in a range of cancers, including a subset of salivary gland cancers called secretory carcinomas. Larotrectinib and entrectinib are approved as a treatment for tumors that are metastatic or cannot be removed with surgery and has worsened with other treatments that carry a genetic abnormality in NTRK.

Talk with your doctor about possible side effects for a specific medication and how they can be prevented or managed. Learn more about the basics of targeted treatments .

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Immunotherapy ( updated 12/2022)

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system's ability to attack cancer cells.

Currently, there are 2 immunotherapy drugs approved by the U.S. Food and Drug Administration (FDA) to treat recurrent or metastatic head and neck squamous cell carcinoma:

• Pembrolizumab (Keytruda). Pembrolizumab can be used by itself if the tumor expresses a certain amount of the PD-L1 protein or if the cancer continues to grow or spread during treatment with platinum-based chemotherapy. It can also be used in combination with chemotherapy regardless of the level of PD-L1 expressed by the tumor.

• Nivolumab (Opdivo). Nivolumab can be used if the cancer continues to grow or spread during treatment with platinum-based chemotherapy.

This information is based in part on the ASCO guideline, “ Immunotherapy and Biomarker Testing in Recurrent and Metastatic Head and Neck Cancers .” Please note that this link takes you to a different ASCO website.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Metastatic head and neck cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, targeted therapy, radiation therapy, or immunotherapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent head and neck cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from head and neck cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning and what caregivers should know about end of life care for people with advanced head and neck cancer .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about head and neck cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about head and neck cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• New medications. Many studies are underway to learn more about new types of drugs that may help treat head and neck cancer.

• Immunotherapy. An active area of immunotherapy research is focused on drugs that block a protein called PD-1. PD-1 is found on the surface of T cells, which are a type of white blood cell that helps the body’s immune system fight disease. Because PD-1 keeps the immune system from destroying cancer cells, stopping PD-1 from working allows the immune system to better eliminate the disease. There are 2 immunotherapy drugs approved for the treatment of metastatic or recurrent head and neck cancers (see Types of Treatment ). Researchers are studying PD-1 immunotherapy for people with recurrent and metastatic head and neck cancer in clinical trials.

• Combined therapies. Most research for head and neck cancer focuses on combining different types of treatments to improve treatment effectiveness and the patient’s quality of life.

• Radiofrequency thermal ablation (RFA). RFA is a minimally invasive treatment option that applies heat to the tumor to destroy cancer cells. It is usually used to treat a localized tumor that cannot be removed by surgery.

• Gene therapy. Gene therapy is a targeted form of treatment that uses biologic gene manipulation to change bits of genetic code in a person’s cells. Although gene therapy is relatively new, it appears to show promise in treating head and neck cancer.

• Photodynamic therapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor that stays longer in cancer cells than in healthy cells. A laser is then directed at the tumor to destroy the cancer cells. The long-term effects of photodynamic therapy are still being studied.

• Proton therapy. Proton therapy can be added to a treatment plan to reduce the damage done to healthy tissue. This radiation therapy technique may help protect important structures in the head, such as the brain stem and the optic nerves that run to the eyes, when used to treat nasopharyngeal cancer , chordoma, or chondrosarcoma. A chordoma is a rare tumor that usually occurs in the spine or the base of the skull. Chondrosarcoma is a tumor that develops in cartilage. They are both types of bone cancer .

• HPV. Researchers continue to investigate the link between HPV and head and neck cancers . These studies are evaluating why HPV raises the risk of the disease and how the virus may affect the outcome of some treatments. Studies are also looking at whether the HPV vaccine that is currently used to prevent cervical, vaginal, vulvar, and anal cancer is effective at preventing some head and neck cancers as well.

• Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current head and neck cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in head and neck cancer, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Review research, news, and information for people with head and neck by visiting the Cancer.Net Blog .

• From the 2022 ASCO Plenary Series, a study discussed how people with advanced nasopharyngeal cancer can be treated with immunotherapy and chemotherapy .

• Listen to a podcast from an ASCO expert discussing highlights from the ASCO Annual Meeting in 2022 about 2 studies addressing locally advanced head and neck cancer .

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance in how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Cancer rehabilitation is a major part of follow-up care after head and neck cancer treatment. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible.

People may receive physical therapy to maintain movement and range of movement, as well as speech and swallowing therapy to regain skills like talking and eating. Proper evaluation and treatment may often prevent long-term speech and swallowing problems. Supportive care or palliative care to manage symptoms and maintain nutrition after treatment may be recommended. Some people may need to learn new ways to eat or prepare foods differently. Learn more about cancer rehabilitation .

After treatment for head and neck cancer, people may look different, feel tired, and be unable to talk or eat the way they used to. Many people experience depression . The health care team can help people adjust and connect them with support services. Support groups may help people cope with changes following treatment, as well as mentoring programs through patient advocacy groups.

Doctors want to keep track of your recovery in the months and years ahead. Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of head and neck cancer first diagnosed and the types of treatment given. Your doctor will also teach you which signs and symptoms of recurrence to watch for.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them. For example, if you received radiation therapy, your doctor may recommend regular blood tests to check the function of your thyroid gland. Your doctor may refer you to a specialist to treat some of the late effects associated with head and neck cancer.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed. Survivorship care guidelines created by the American Cancer Society (ACS) and endorsed by ASCO recommend that all survivors of head and neck cancer develop a survivorship care plan with their cancer care team.

This is also a good time to talk with your doctor and health care team about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences. ASCO emphasizes that survivors of head and neck cancer should receive follow-up care from a multidisciplinary team that includes primary care physicians, oncology specialists, otolaryngologists, dentists, and others.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of head and neck cancer do I have?

• Where is the tumor located?

• What stage is the cancer? What does this mean?

• Can you explain my pathology report (laboratory test results) to me?

• Is it important to find out whether the tumor was caused by HPV? Why or why not?

• Should I get an additional consultation or second opinion?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What clinical trials are available for me? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the possible side effects of this treatment, both in the short term and the long term?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• Can you recommend an oncologic dentist?

• Should I see a speech-language pathologist before starting treatment?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having surgery

• Is surgery necessary, or is chemotherapy and radiation therapy an option to eliminate the cancer?

• What type of surgery do you recommend?

• Will any lymph nodes need to be removed? If so, what type of neck dissection will be done? What does this mean?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term effects of having this surgery?

• Will this surgery affect my speech or ability to chew and swallow?

• How will this surgery affect my appearance?

• Will I need to have reconstructive surgery to replace lost tissue?

Questions to ask about having radiation therapy or systemic therapy using medication

• What type of treatment is recommended?

• What is the goal of this treatment?

• How will this treatment be given?

• Will this treatment be given at a hospital, a clinic, or in my home?

• How long will I need to continue this treatment?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term and late effects of having this treatment?

• What can be done to prevent or manage these side effects?

Questions to ask about planning follow-up care

• Will I need physical therapy, speech therapy, dietitian, or another type of rehabilitation during or after finishing treatment?

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.