Clinical Features
The clinical features of these cancers are determined by the site of origin, the local extent at presentation, and whether there are metastases. While the tumors are easily accessible in most instances to direct visualization and therefore should be amenable to early diagnosis, most of these cancers become evident at a late stage with not only advanced primary cancers, but also cervical nodal metastases.

Oral cavity cancers usually become evident with a mass or painful ulcer in the mouth (Plate IV-14). As the tumor advances, the tongue may become infiltrated causing dysarthria and dysphagia. Infiltration into the mandible causes severe pain, and, of course, there may be evidence of nodal metastases, usually to the submental, submandibular, and upper deep cervical nodes.

Oropharyngeal cancers become evident with odynophagia or foreign body sensation or evidence of cervical metastases, even at an early stage. Trismus and a persistent sore throat occur as the disease progresses.

Nasopharyngeal cancer is usually relatively asymptomatic at an early stage. However, nasal obstruction, unilateral serous otitis, cervical metastases, facial pain, and an ipsilateral sixth nerve palsy are findings as the tumor progresses. Cancer of the hypopharynx may achieve significant size before giving symptoms. Painful and obstructive dysphagia, referred otalgia, and hoarseness are all symptoms of advanced disease.

Laryngeal cancer, particularly if it arises from the vocal cords, presents with hoarseness as an early symptom; pain on swallowing and nodal metastases develop with advancing stage.

Cancer of the nose and paranasal sinuses may become evident with unilateral rhinorrhea, nasal obstruction, facial pain, and loose teeth, depending on the site of origin. A late finding is evidence of orbital dysfunction and includes diplopia and impaired visual activity. Because the cavities are air-filled, significant growth of the cancer may occur before causing symptoms. In addition, the early symptoms and signs are nonspecific and mimic common ailments (e.g., cold or allergy). This, together with the low index of suspicion because of the rarity of these cancers, contributes to the late presentation.