The aetiology of head and neck cancer differs by subsite and by histology. This note covers the burden, the causal exposures, the two oncogenic viruses, inherited susceptibility, the aetiology of each subsite, the premalignant lesions, the risk factor history, the tests that assign a cause, and prevention.
Scope and definitions
What the term covers: the nasopharynx, oropharynx, hypopharynx, larynx, oral cavity, salivary glands and sinonasal tract, with a 2 to 1 male preponderance and onset typically after the fifth decade. Thyroid malignancy has a separate aetiology.
Dominant histology: well over 95% of mucosal head and neck tumours are squamous cell carcinoma, driven mainly by tobacco and alcohol.
Non-squamous histology: salivary carcinoma, sarcoma, lymphoma and mucosal melanoma are not related to tobacco and alcohol, so a non-smoking non-drinking patient with a head and neck mass carries a different differential.
Burden: the seventh most common malignancy worldwide, over 850,000 cases and about 450,000 deaths annually, with a predicted 30% annual increase by 2030. The UK sees around 9,500 new cases in males and 4,300 in females a year.