Signs and symptoms
Primary tumor location
Specific head and neck tumors often have a distinctive history at presentation. Vocal changes lasting more than two weeks in a smoker should elicit an examination for laryngeal carcinoma. Given this early symptom, patients tend to show earlier signs of laryngeal carcinoma than with other lesions of the head and neck and, therefore, often have a better prognosis. Moreover, the lymphatic supply to the larynx is not as great as in other head and neck regions and regional metastasis may occur later.
Difficulty swallowing may be the initial symptom for pharyngeal or hypopharyngeal tumors; however, a common symptom for hypopharyngeal lesions is the unfortunate finding of a metastatic neck node. Oral ulcers that will not heal are signs for oral carcinoma. Physical exams may show squamous cell carcinoma of the head and neck as an exophytic, ulcerative or infiltrative lesion.
Metastatic disease in the head and neck tends to occur in a predictable and systematic fashion. Regional neck metastasis most commonly occurs to the jugular digastric lymph nodes, but various lymph node chains might be affected depending on the primary tumor location and size.
For example, oral carcinomas have a tendency to spread to the submandibular and submental lymph nodes, bilaterally. Meanwhile, laryngeal carcinomas usually demonstrate initial neck metastasis to the jugular digastric lymph nodes. Oral carcinomas have a tendency to metastasize earlier than laryngeal carcinomas, with approximately 35 percent lymph node involvement at initial presentation. Metastasis to the supraclavicular region indicates a poor prognosis as does large cervical metastasis or bilateral neck disease. Distant metastasis most often manifests in the lungs followed by the liver, bone and brain. Overall, approximately 15 percent to 20 percent of patients with head and neck cancer manifest distant metastasis at first symptoms or within six months of diagnosis.