Head and Neck Cancer Recurrence: How Likely Is It?

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Many people who have had head and neck cancer say that fear of recurrence is worse than the fear that accompanied the initial diagnosis. While cancer is a physical disease, it also causes real emotional turmoil. But with reliable, accurate facts about the likelihood of recurrence and its symptoms, you can make timely and informed decisions that can increase the chances of a better outcome.


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What are the chances that head and neck cancer will recur?

That depends on the stage at diagnosis. Eighty to 90 percent of people with early disease (stage I and II) will go into remission with a low likelihood of recurrence if they make certain lifestyle changes, like stopping tobacco and alcohol use. That’s because tobacco and alcohol are estimated to cause 75 percent of all head and neck cancers. People with advanced disease at diagnosis (stage III and IV) are at high risk of recurrence. The earlier it’s found, the more likely treatment can control it.


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What if the cancer is related to earlier HPV infection?

Recurrence in people with head and neck cancer related to human papillomavirus (HPV) can expect a better outcome. That’s the case even with advanced disease, especially in nonsmokers. It’s encouraging to know that HPV-related head and neck cancer has cure rates close to 90 percent. HPV is believed to cause 70 percent of mouth and throat cancers in the U.S. That’s why preventive HPV vaccine is wise for boys and girls, ideally at age 11-12.


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Where does head and neck cancer usually recur?

It often returns where it initially occurred, which is called locoregional recurrence. It can recur in the oral cavity, tongue, lip, pharynx (throat behind the mouth and nasal cavity stopping above the esophagus and the larynx), or larynx (right below the pharynx). It can also recur in the salivary glands, sinuses, or nasopharynx (upper part of the throat behind the nose). If you have advanced disease, it could recur in a distant organ, usually the lungs, and, less frequently, in bone.


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If a recurrence is in the mouth or throat, what are the symptoms?

Recurrence symptoms vary by site. In the mouth, a recurrence might cause white patches and sores. There could be bleeding and pain. If you have dentures, you might notice that the fit has changed. In the pharynx, a recurrence could make swallowing, breathing, or hearing difficult. Other symptoms are sore throat, headaches, or hoarseness. Symptoms of recurrence in the salivary glands could cause numbness, pain, and swelling.


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Can it recur in the sinuses? If so, what are the symptoms?

It can, but recurrence in the sinuses is less common. If it does happen, it might cause what seems like a chronic sinus infection that persists in spite of treatment. Recurrence in the nasopharynx could cause headache or facial pain, nose bleeds, problems with breathing, and ringing in the ears. A recurrence in the larynx could cause ear pain, a sore throat, coughing, difficulty breathing, or discomfort when swallowing. If you have any change or discomfort, it’s important not to ignore it.


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What other symptoms could indicate a recurrence?

The most common symptoms are swelling or a sore that does not heal. Look for red or white patches in the mouth as well as lumps in the head or neck area. Chronic pain, numbness, and hoarseness should also be checked by a doctor. Another symptom might be unpleasant breath despite good oral hygiene. Difficulty with normal functions that we take for granted, such as swallowing and chewing, should be discussed with a doctor. Again, changes that persist should raise suspicion.


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Why is it important to catch a recurrence early?

The sooner a recurrence is assessed and confirmed, the sooner treatment can begin, and the more likely it can be controlled. More and more promising treatments and innovations are emerging. Some have been recently approved, while others are being tested in clinical trials. It’s important to ask your oncologist, or cancer specialist, about new types of treatment and opportunities for clinical trials.


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What are the recommendations for follow-up care?

They vary based on factors such as age, stage, and where the cancer is located, so start by asking your oncologist what they recommend for you. Then make sure the recommendation is shared among your entire care team: oncologist, primary care doctor, family members, and other caregivers. Periodic checkups are important in order to watch for recurrence at the original site (called surveillance), but also for a possible second primary cancer, which means emergence of a new cancer somewhere else.


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So how often should I see a doctor for surveillance?

The American Cancer Society has published recommendations based on a review of articles by head and neck cancer experts. A physical examination is recommended every 1–3 months for the first year after primary treatment, every 2–6 months in the second year, and every 4–8 months in the third through fifth years. After five years without a recurrence, an annual checkup is recommended. If a primary care doctor finds unusual symptoms, they should immediately refer you to your oncologist.


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How often should I see a doctor for screening and early detection of a second primary cancer?

Screening for other cancers should be done per national guidelines for each type of cancer. People who have had head and neck cancer who are smokers, however, are at increased risk for a second primary cancer and for lung cancer. The intensity of the person’s smoking history may indicate the need for annual lung cancer screening via low-dose computed tomography (CT) scans. If you are a smoker, make sure to discuss this with your doctor.


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Can my doctor help me with anxiety about a possible recurrence?

Yes. Anxiety and depression are experienced by many, many people with a cancer diagnosis. Doctors know this and have ways to help, so speak up. Therapies that may help include medication, one-on-one counseling, joining a support group, engaging in regular physical activity, and resuming a normal routine that includes your favorite hobbies.


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Lifestyle changes can reduce risk of recurrence or a second primary cancer

Tobacco and alcohol cessation can greatly reduce risk, as can good nutrition — try a diet low in fats with lots of vegetables, fruits, and whole grains. Successfully making healthy changes can make you feel empowered. Taking control by eliminating harmful habits is a great achievement. For information and support, reach out to your doctor, or contact the Head and Neck Cancer Alliance. They provide support to head and neck cancer patients and fund research for head and neck cancers.