Head and Neck Cancer: Recognising Lumps and Swelling

Head and neck cancer encompass a wide variety of malignancies, including the mouth, throat, larynx, sinuses and salivary glands. Although lumps and swelling are some of the most common early warning signs, they don’t always equate to cancer. 

With that said, there are other symptoms that may signal head and neck cancer, making it crucial to pay attention to our body. Read on to find out more!

What is Head and Neck Cancer?

Head and neck cancer encompasses a group of cancers that originate in the mouth, throat, sinuses, and salivary glands. These areas are lined with mucosal surfaces, where abnormal cell growth can occur, leading to cancer. The types of head and neck cancer include:

Types of Head and Neck Cancer

Head and neck cancer are categorised based on its point origin. This includes:

• Oral Cancer – oral cancer is a type of cancer that often starts as persistent sores or lumps that do not heal. It develops in the areas of the mouth, such as lips, gums, tongue, inner lining of the cheeks and lips, roof, and floor of the mouth, and areas near the wisdom teeth.

• Salivary Gland Cancer – salivary gland cancer is a cancer affecting the salivary glands, which are responsible for producing saliva. This type often presents as swelling or a lump near the jaw or under the tongue, sometimes accompanied by pain or dry mouth.

• Nasal Cavity and Paranasal Sinus Cancer – this type of cancer forms in the nasal cavity, which is the hollow space inside the nose. It can also develop in the paranasal sinuses, which are the air-filled spaces around the nasal cavity.

• Nasopharyngeal Cancer – nasopharyngeal cancer originates in the nasopharynx, which is the upper part of the throat located behind the nose.

• Oropharyngeal Cancer – oropharyngeal cancer arises in the oropharynx, which is the middle part of the throat that includes the tonsils, and the base of the tongue.

• Hypopharyngeal Cancer – hypopharyngeal cancer develops in the hypopharynx, which is the lower part of the throat that surrounds the larynx.

• Laryngeal Cancer – laryngeal cancer affects the larynx or voice box, which houses the vocal cords.

How to tell cancerous and benign lumps apart

Lumps associated with head and neck cancers differ from benign lumps like cysts in several notable ways:

Other common symptoms of head and neck cancer

• Facial swelling and changes – tumours can cause asymmetry in the jaw, neck or face, leading to visible deformities.

• Lumps in the neck – these lumps may feel firm, painless or fixed. However, it is often an indicator of lymph node involvement.

• Mouth lumps or ulcers – this refers to persistent sores or lumps in the mouth or tongue that do not heal.

• Salivary gland tumours – this refers to swelling the parotid, submandibular or sublingual glands, accompanied by pain or dry mouth.

• Swelling in the throat – this may cause difficulty swallowing or breathing.

When to see a doctor

It’s always best to be on the safe side when it comes to your health. Seek medical attention if you experience persistent or concerning symptoms because early detection can make all the difference. Similarly, it is essential to pay particular attention to multiple symptoms occurring simultaneously, such as lumps, unexplained bleeding or chronic pain. 

Common risk factors for head and neck cancers 

In Singapore, head and neck is fairly common, with more than 800 new cases [1] are diagnosed annually. The most prevalent type is nasopharyngeal carcinoma (NPC), which is often referred to as nose cancer. In fact, it is one of the top 10 most common types of cancer in Singapore.

With such prevalence, understanding individual risk factors is one of the proactive measures that an individual can take to safeguard their health. This includes:

• Alcohol consumption – heavy, and prolonged alcohol [2] intake is closely associated with cancers of the mouth, throat and voice box. In fact, the risk is even higher for individuals who both smoke, and drink.

• Tobacco use – the use of cigarettes, cigars, chewing tobacco or other tobacco products significant increases [3] the risk of head and neck cancers. As a matter of fact, it remains the leading preventable cause of these cancers.

• Genetic factors – a family history [4] of head and neck cancer or related conditions can predispose individuals to a higher risk, emphasising the importance of regular screenings.

• HPV infection – the human papillomavirus (HPV) infection, particularly the HPV-16 [5], is strongly linked to oropharyngeal cancers.

• Occupational exposure – long-term exposure to harmful substances such as asbestos [6], wood dust [7], and certain industrial chemicals [8] or formaldehyde can elevate the risk of developing cancers in the nasal cavity, sinuses or throat.

How are head and neck cancers diagnosed?

When it comes to diagnosing Head and Neck cancer, the diagnostic procedure typically begins with a thorough examination:

• Imaging tests – imaging tests are advanced imaging techniques, such as computerised tomography (CT) scan, magnetic resonance imaging (MRI), and positron emission tomography (PET) scan. It is used to pinpoint the exact location, size, and spread of the tumours, providing crucial information for staging, and treatment planning.

• Biopsies – biopsies are the gold standard for diagnosis. It involves taking a small tissue sample from the suspected area for microscopic examination. There are three different types of biopsies, which are fine-needle aspiration, core biopsy, and surgical biopsy.

• Endoscopic procedure – endoscopic procedures are minimally invasive techniques, which allow Head & Neck specialists direct visualisation of affected areas using specialised instruments. Some of these instruments include nasoendoscopes or laryngoscpes, which are used to assess the extent of the disease.

What are the stages of head and neck cancer?

Understanding the stage of head and neck cancer is crucial for both diagnosis, and treatment planning. It provides insight into how far the cancer has spread, and helps guide the next steps in your care. Head and neck cancers are classified into five stages, starting at Stage 0, and progressing to Stage IV.

• Stage 0 (Carcinoma in Situ) – stage 0 is the earliest stage. It indicates abnormal cells in the lining of the affected area. While not yet invasive, these cells have the potential to develop into cancer.

• Stage I – stage I is an early-stage cancer, where the tumour is small, measuring no more than 2 centimeters. At this stage, the cancer has not spread to the lymph nodes.

• Stage II – stage II describes a tumour larger than 2 centimeters, but not exceeding 4 centimeters. Like stage I, the cancer remains localised, and has not reached the lymph nodes.

• Stage III – stage III indicates the tumour may exceed 4 centimeters or have spread to a single lymph node on the same side of the neck as the tumour. The affected lymph node will measure less than 3 centimeters in size.

• Stage IV – stage IV is the most advanced stage, and indicates that the cancer has spread extensively. It may involve nearby tissues, multiple lymph nodes or even distant organs like the lungs. The subcategories of stage IV are:

• Localised – localised spread to tissues in the head and neck.
• Lymph node involvement – this involves one large node or multiple nodes on the same or opposite side of the neck.
• Metastasis – this refers to where the cancer has spread to distant parts of the body.

Treatment Options for Head and Neck Cancer

Once the Head & Neck specialist has confirmed a diagnosis, and determined the characteristics of the tumour, which includes its staging, they will proceed to outline a treatment plan. Depending on how advanced the staging is, treatment may involve a standalone treatment plan or a combination of multiple treatments to better improve the outcomes. 

Primary treatment

• Chemotherapy – chemotherapy is a systemic treatment using potent drugs to kill or slow the growth of cancer cells. While it can be prescribed as a standalone treatment, it is typically combined with radiotherapy for advanced-stage cancers.
• Radiotherapy – radiotherapy uses high-energy radiation to precisely target, and destroy cancer cells while sparing surrounding healthy tissue. It is often used alone or in combination with other treatments.
• Surgery – surgical removal of tumours, and affected tissues is often the first-line of treatment for localised cancers. The procedures may range from minimally invasive techniques to more extensive surgeries, such as neck dissections. However, this will depend on the size, and location of the tumour.

Advanced therapies

• Immunotherapy – immune is a cutting-edge approach that harnesses the body’s immune system to identify, and attack cancer cells. The treatment often offers hope for advanced or recurrent cancers.
• Targeted therapy – targeted therapy involves the use of innovative drugs that specifically target molecular pathways, which are critical for cancer cell survival, and proliferation. As a result, it minimises damage to normal cells.

Rehabilitation

One of the key aspects of treatment for head and neck cancer is rehabilitation. It is essential for improving quality of life post-treatment. This may include:

• Speech therapy – speech therapy helps patients regain communication skills, particularly after surgeries that affect the vocal cords or throat.
• Swallowing therapy – swallowing therapy addresses difficulties with eating, and drinking, which are often caused by tumour removal or radiation.
• Nutritional support - nutritional support are tailored plans to maintain strength, and support healing during, and after the treatment.

Can head and neck cancers be prevented?

It should be emphasised that head and neck cancer is a highly preventable disease. Preventing head and neck cancer requires a proactive approach to health, and lifestyle choices. While some risk factors, like genetics, cannot be controlled, many can be addressed through informed decisions, and preventive measures. By understanding these steps, it will empower individuals to reduce their risk, and improve their overall well-being.

Avoiding tobacco and excessive alcohol use

The use of tobacco, and excessive alcohol consumption are the leading preventable risk factors for head and neck cancers. Smoking, chewing tobacco, and prolonged alcohol use damage cells in the mouth, throat, and nearby tissues, significantly increasing cancer risk.  By eliminating tobacco, and moderating alcohol intake, it will undoubtedly set you on the path towards prevention.

Speaking of the path towards prevention, support programmes such as nicotine replacement therapies, and counselling can provide essential tools to help individuals quit. Similarly, reducing alcohol consumption through moderation strategies or support groups can also contribute to lower cancer risk, and overall better health.

HPV Vaccination

HPV is a major cause [9] of oropharyngeal cancers. As such, vaccination against HPV is a proven preventive measure, particularly for younger individuals as it helps protect against the strains of the virus that are commonly associated with cancer. Widespread vaccination programmes have shown promising results in reducing cancer incidence rates in both men, and women.

Regular Medical Check-ups

The primary step to lowering your risk of developing cancer is to undergo routine medical examinations, and screenings. This is due to the fact that both are indispensable for early detection, especially for individuals at high risk due to lifestyle choices, family history or occupational exposure. Regular check-ups with a healthcare provider enable doctors to identify any abnormal changes in the head and neck region before they progress into more severe conditions.

Remember; early detection often leads to more effective treatment, fewer complications, and better treatment outcomes. Medical screenings, such as visual inspections, imaging tests, and biopsies, play critical roles in diagnosing cancers at an early stage, particularly when they are most treatable.

Summary 

In a nutshell, proactive health measures and awareness can make a significant difference in preventing head and neck cancers. In addition, recognising the symptoms early, such as persistent hoarseness, unexplained lumps or difficulty swallowing, combined with timely medical advice, are vital steps to safeguarding your health against head and neck cancers. By taking preventative actions, and making informed lifestyle changes, you can reduce your risk of developing the disease, and ensure a healthier future.

Schedule a consultation with us today for a comprehensive diagnosis and personalised treatment plan.

References

[1]  Head and Neck Cancer: Symptoms and Risk Factors - HealthXchange. (n.d.). In www.healthxchange.sg. Retrieved January 22, 2025, from https://www.healthxchange.sg/cancer/head-neck-cancer/head-neck-cancer-symptoms-risk-factors

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[6] Clin B, Gramond C, Thaon I, Brochard P, Delva F, Chammings S, Gislard A, Laurent F, Paris C, Lacourt A, Pairon JC. Head and neck cancer and asbestos exposure. Occup Environ Med. 2022 Oct;79(10):690-696. doi: 10.1136/oemed-2021-108047. Epub 2022 Apr 7. PMID: 35393288; PMCID: PMC9484389.

[7] Langevin SM, McClean MD, Michaud DS, Eliot M, Nelson HH, Kelsey KT. Occupational dust exposure and head and neck squamous cell carcinoma risk in a population-based case-control study conducted in the greater Boston area. Cancer Med. 2013 Dec;2(6):978-86. doi: 10.1002/cam4.155. Epub 2013 Nov 4. PMID: 24403272; PMCID: PMC3892403.

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