Head and neck carcinomas arise in the squamous cells of the mucosal epithelium in the nasal cavity, paranasal sinuses, oral cavity, pharynx, larynx, and trachea. Other nonsquamous cell carcinomas arise in salivary glands, sinuses, muscles, and nerves of the head and neck. Excluding nonmelanoma skin cancer, oral cavity malignancy is the most common head and neck carcinoma. Nasal cavity, oral cavity, and larynx cancers are generally associated with tobacco and/or alcohol use, whereas pharyngeal carcinomas are typically caused by infections with human papillomavirus and Epstein-Barr virus. Clinical features depend on the site and etiology of the primary tumor. Treatment usually involves surgery followed by radiotherapy and/or chemotherapy. Cancers of the brain, eye, ears, esophagus, thyroid gland, and skin of the head and neck are generally not classified as head and neck cancers and are discussed in other articles.
|Overview of nasal cavity, paranasal sinus, and pharyngeal cancers|
|Type||Nasal cavity carcinoma||Paranasal sinus carcinoma||Pharyngeal carcinoma |
|Nasopharyngeal carcinoma ||Hypopharyngeal carcinoma||Oropharyngeal carcinoma |
|Risk factors and associations|| || |
| || |
|Overview of oral cavity, tonsil, tongue, salivary glands, and lip cancers |
|Type||Oral cavity carcinoma ||Tonsil carcinoma||Tongue carcinoma ||Salivary gland carcinoma||Lip carcinoma |
|Risk factors and associations|
|Overview of laryngeal and tracheal cancers |
|Type||Laryngeal carcinoma ||Tracheal carcinoma |
|Supraglottic carcinoma||Glottic carcinoma||Subglottic carcinoma|
|Risk factors and associations|| |
Tumors arising in the nasal cavity and/or paranasal sinuses.
- Peak incidence: ≥ 60 years of age
- Prevalence: < 3% of tumors in the respiratory tract
- Sex: ♂ > ♀
- Most common malignant tumors: cutaneous squamous cell carcinoma, adenocarcinoma, neuroendocrine tumors, mucosal melanoma
Nasal cavity carcinoma
- Chronic and/or occupational inhalation exposure to tobacco, wood dust, glues, and adhesives
- Associated with HPV infection
- Paranasal sinus carcinoma
- Most common sites: nasal cavity, followed by the maxillary sinus
- Unilateral nasal obstruction
- Chronic sinusitis
- Advanced disease: a triad of facial asymmetry, palpable or visible tumor in the oral cavity, and visible intranasal tumor
- Resectable tumors: surgical resection and radiotherapy (pre- or postoperative)
- Unresectable tumors: radiation therapy combined with chemotherapy
- Involvement of adjacent structures (e.g., eye orbits, sinuses, palate) causing neuralgias, facial pain, impaired vision, ocular symptoms (e.g., exophthalmos, diplopia), and/or dentalgia
The five-year relative survival rate for nasal cavity and paranasal sinus carcinomas is ∼ 80%.
A patient with unilateral difficulty breathing through the nose may have a malignant tumor.
Histological subtype 
- Infiltrative or exophytic lesion of the lips
- Ulcer lesion
- Pain, numbness, and/or bleeding of the lip
- Advanced stage: loss of sensation around the chin and/or invasion of the premaxilla and nasal cavity
- Physical examination of the lips
- Exfoliative cytology and direct microscopy
- Biopsy and histopathology of the lesion
- See “Diagnostics for cSCC” and “Diagnostics for BCC” as needed
- Surgical excision and/or radiation therapy
- See “Treatment of cSCC” and “Treatment of BCC§ as needed.
- Primary tracheal carcinomas
- Secondary tracheal carcinomas (most common): may arise from hematogenous or lymphatic sites of metastasis, or by direct extension from adjacent structures (e.g., thyroid, esophagus)
- Risk factors: tobacco smoking, inhalation exposure to hydrocarbons
- Direct invasion of the trachea from carcinoma of the lung, esophagus, larynx, or thyroid gland
- Hematogenous spread from carcinoma of the breast, colon, kidney, and melanoma
Clinical features 
- Usually mimics other conditions
- Only symptomatic if obstructing the tracheal lumen
- Symptoms vary based on the location of the tumor and histological subtype.
- Usually a diagnosis of exclusion, after lack of response to treatment for alternative diagnoses (e.g., COPD, bronchitis)
- Imaging: chest x-ray or CT to rule out other conditions
- Bronchoscopy with biopsy (confirmatory test)
- ACC: radiotherapy or chemoradiotherapy
- Mucoepidermoid carcinoma: surgical resection
The five-year overall survival rate for ACC is approx. 80% and approx. 10% for SCC.