In 2009, approximately 35,720 men and women (25,240 men and 10,480 women) in the United States will be diagnosed with cancer of the oral cavity and pharynx, and 7,600 will succumb to these diseases. Further, an estimated 12,290 men and women (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer, and 3,660 will die from this malignancy. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).
Head and neck cancers encompass a diverse group of uncommon tumors that frequently are aggressive in their biologic behavior. Moreover, patients with a head and neck cancer often develop a second primary tumor. These tumors occur at an annual rate of 3% to 7%, and 50% to 75% of such new cancers occur in the upper aerodigestive tract or lungs.
The anatomy of the head and neck is complex and is divided into sites and subsites (Figure 1). Tumors of each site have a unique epidemiology, anatomy, natural history, and therapeutic approach. This chapter will review these lesions as a group and then individually by anatomic site.
MALIGNANCIES OF THE HEAD AND NECK
EPIDEMIOLOGY
Gender
Head and neck cancer is more common in men; 66% to 95% of cases occur in men. The incidence 
by gender varies with anatomic location and has been changing as the number of female smokers has increased. The male-female ratio is currently 3:1 for oral cavity and pharyngeal cancers. In patients with Plummer-Vinson syndrome, the ratio is reversed, with 80% of head and neck cancers occurring in women.
Age
The incidence of head and neck cancer increases with age, especially after 50 years of age. Although most patients are between 50 and 70 years old, younger patients can develop head and neck cancer. There are more women and fewer smokers in the younger patient group.
It is controversial whether head and neck cancer is more aggressive in younger patients or in older individuals. This “aggressiveness” probably reflects the common delay in diagnosis in the younger population, since, in most studies, younger patients do not have a worse prognosis than do their older counterparts.
Race
The incidence of laryngeal cancer is higher in African-Americans relative to the white, Asian, and Hispanic populations.
Additionally, in African-Americans, head and neck cancer is associated with lower survival for similar tumor stages. The overall 5-year survival rate is 56% in whites and 34% in African-Americans.
Geography
There are wide variations in the incidence of head and neck cancer among different geographic regions. The risk of laryngeal cancer, for example, is two to six times higher in Bombay, India, than in Scandinavia. The higher incidence of the disease in Asia is thought to reflect the prevalence of risk factors, such as betel nut chewing and use of smokeless tobacco. In the United States, the high incidence among urban males is thought to reflect exposure to tobacco and alcohol. Among rural women, there is an increased risk of oral cancer related to the use of smokeless tobacco (snuff).
Nasopharyngeal carcinoma is another head and neck tumor with a distinct ethnic predilection. Endemic areas include southern China, northern Africa, and regions of the far Northern Hemisphere—areas in which the diet of inhabitants includes large quantities of salted meat and fish. When people from these regions migrate to areas with a lower disease incidence, their risk falls but remains elevated. Cancer of the nasopharynx in these geographic areas also has been associated with Epstein-Barr virus (EBV) infection (see section on “Etiology and risk factors”).
