Head & Neck Cancer Diagnosis & Detection

The team of cancer doctors at Cancer Treatment Centers of America (CTCA) uses sophisticated imaging technology and tools to conduct a complete evaluation and ensure an accurate head and neck cancer diagnosis.

During your first visit to a CTCA hospital, you’ll undergo a comprehensive exam to precisely evaluate your cancer and determine if it has spread to any other part of your body. This helps your team formulate an individualized treatment plan that is appropriate for you.

Throughout your cancer treatment, we will use diagnostic imaging and laboratory tests to monitor your progress. If the disease is resisting treatment, we will modify your treatment or recommend using a different therapy.

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The following tests are often the first step in diagnosing head and neck cancer:

Medical History and Physical Exam: The first step in diagnosing oral cancer is usually a general physical. Your doctor will ask you about your symptoms, whether you have any of the known risk factors, and about any other medical conditions. During a physical exam, your doctor may find signs of a head and neck cancer, or a precancerous condition. These signs may include bumps or other abnormalities on your head, face or neck, or problems with the nerves of the face and/or mouth. Your doctor will also check inside your mouth for any signs of oral cancer.

If your doctor is concerned that you may have cancer, he or she will refer you to a specialist for additional tests. This specialist will likely be either an oral and maxillofacial surgeon or a head and neck surgeon, typically referred to as an ear, nose and throat (ENT) doctor or an otolaryngologist.

Complete Head and Neck Exam: The specialist will carefully examine the entire area of your head and neck, including the lymph nodes of the neck, to check for any signs of cancer.

This exam may include the use of mirrors so that your doctor can see areas inside the neck that are not easily viewed. Other procedures that may aid in the head and neck cancer detection process include:

• Indirect Pharyngoscopy and Laryngoscopy: Your doctor may place small mirrors at the back of your mouth in order to clearly examine your throat, the base of your tongue and part of your larynx (voice box).
• Endoscopy: A fiber optic scope that uses a flexible, lighted, narrow tube may be inserted into the mouth or nose so that your doctor can examine hard-to-see areas such as the larynx and behind the nose.

Panendoscopy: If your doctor suspects the presence of cancer, a more thorough examination of the head and neck will likely be done. In this exam, an individual is given general anesthesia in an operating room so that the entire region of the body can be closely inspected for cancer. Endoscopes are used to look at the throat, larynx, esophagus and possibly the windpipe (trachea) and bronchi. If any tumors are found, your doctor will remove samples that can be looked at under a microscope.

Biopsy: Only a biopsy can give a definitive head and neck cancer diagnosis. A sample of tissue or cells is required for a biopsy, which must be conducted before treatment can begin. The types of biopsies typically used for diagnosing oral cancers are:

• Incisional Biopsy: A small piece of tissue is cut from an abnormal-looking area. If the abnormal region is easily accessed, the sample may be taken at your doctor’s office. If the tumor is deeper inside the mouth or throat, the biopsy may need to be done in an operating room, with general anesthesia administered to prevent any pain.
• Fine Needle Aspiration (FNA): Here, a very thin needle attached to a syringe is used to extract (aspirate) cells from a tumor or lump. This approach can be particularly useful for several situations that can occur with oral cancer.

Imaging Tests for Head and Neck Cancer

If a head and neck cancer diagnosis is made, various kinds of imaging tests can help determine the extent of the disease. If questions remain after a biopsy, then an imaging test may also be used to help determine whether cancer is present. The types of imaging tests commonly used when diagnosing head and neck cancers include:

Chest X-ray: An X-ray of the chest may be taken to check if the cancer has spread to the lungs. Cancer will not be present in the lungs unless it is in an advanced stage. An X-ray is usually an outpatient procedure, meaning that you do not have to be admitted to a hospital for the test. If the result is abnormal, further tests will be done.

Computed Tomography (CT) Scan: A CT scan can provide information about the size, shape and position of any tumors, and may also help identify enlarged lymph nodes that may contain cancer cells.

Magnetic Resonance Imaging (MRI): An MRI scan may be used to examine head and neck cancer.

Positron Emission Tomography (PET) Scan: For patients who have received a head and neck cancer diagnosis, a PET scan may be useful for seeing if cancer has spread to the lymph nodes, for determining the originating site of cancer when it is found in the lymph nodes first or for checking the entire body for any spreading of cancer cells.

Barium Swallow: Also known as an “upper GI series,” a barium swallow involves drinking a chalky drink made of a barium-based solution, which allows cancer cells in the esophagus and upper part of the digestive system to be seen with an x-ray. This imaging test for head and neck cancer can also show if the disease is interfering with swallowing.

Next Topic: Head & Neck Cancer Staging