Diagnosing head and neck cancer

A thorough and accurate cancer diagnosis is the first step in developing a head and neck cancer treatment plan. Your multidisciplinary team of cancer experts will use a range of tests and tools designed for diagnosing head and neck cancer, evaluating the disease and planning your individualized treatment. Throughout your treatment, we’ll use imaging and laboratory tests to track the size of the tumors, monitor your response to treatment, and modify your plan when needed.

Types of procedures that may be used for diagnosing head and neck cancer include:

Indirect pharyngoscopy and laryngoscopy

These procedures are often used to examine the back of the throat. We use indirect pharyngoscopy and laryngoscopy to check for signs of head and neck cancer. During an indirect pharyngoscopy and laryngoscopy, we place small mirrors at the back of your mouth to clearly examine your throat, the base of your tongue and part of your larynx.

Endoscopy

This procedure allows doctors to examine the head and neck from the inside. An endoscope may be inserted into the mouth or nose so that the doctor can examine hard-to-see areas of the head and neck, such as the larynx and behind the nose.

Panendoscopy

This is a procedure used if your doctor suspects the presence of head and neck cancer. Panendoscopy is a diagnostic test used to examine the upper digestive system. If tumors are found during the procedure, the doctor may remove samples for a biopsy.

Biopsy

A biopsy is the only test that can support a definitive head and neck cancer diagnosis. A sample of tissue or cells is required for a biopsy, which must be conducted before treatment may 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.

X-rays

Images of the chest may be taken to determine whether the cancer has spread to the lungs. Cancer will not be present in the lungs unless it has advanced. 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 performed.

Barium swallow

These tests may show irregularities in the pharynx, mouth and surrounding areas, and is often used to detect small, early head and neck tumors. Also known as an "upper GI series," a barium swallow involves drinking a chalky drink made of a barium-based solution, which allow tumors to be better seen during an X-ray.

Imaging tests

Imaging tests that are used to diagnose head and neck cancer include:

Computed tomography (CT) scan: A CT scan may provide information about the size, shape and position of the tumor, and may help identify enlarged lymph nodes to determine whether they contain cancer cells.

Magnetic resonance imaging (MRI): An MRI may be used to examine the head and neck cancer area for signs of cancer.

Positron emission tomography (PET) scan: For patients who have been diagnosed with head and neck cancer, a PET scan may be used to determine whether cancer has spread to the lymph nodes, to identify the original site of cancer when it is discovered in the lymph nodes, or to check the entire body for the spread of cancer.

Next topic: How is head and neck cancer treated?