Head and Neck Cancer: Diagnosis
How is head and neck cancer diagnosed?
If your healthcare provider thinks you might have head and neck cancer, you will need to have certain exams and tests. Diagnosing head and neck cancer starts with your healthcare provider asking questions about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam. You may also see an ear, nose, and throat specialist, called an ENT or otolaryngologist or a head and neck surgeon.
What tests might I need?
You may have one or more of the following tests:
Endoscopy. These tests use a long, thin, flexible tube with a light and a camera at the end. This tube or scope is put in through your mouth or nose. It helps the doctor get a close look at the inside of your nasal cavity, mouth, throat or pharynx, and voice box or larynx. The name of these test depends on which part of the head and neck is being checked. For instance, a pharyngoscopy looks at the pharynx, and a laryngoscopy looks at the larynx. When all of these areas are checked during the same test, it's called a panendoscopy.
Panorex films. This is an X-ray of your jaw that shows if the cancer has spread into the bone.
Barium swallow. This is a series of X-rays taken while you swallow a chalky substance called barium. The barium coats the inside of your throat so any swallowing changes can be seen on the X-rays.
CT scan. In this test, an X-ray beam takes a series of pictures of the inside of your body from many angles. These images are then combined by a computer, giving a detailed 3-D picture of your body. The CT scan can be used to check the head and neck and is sometimes used to evaluate the chest, too.
MRI. This test uses magnets and radio waves to take detailed pictures of the inside of your body, much like a CT scan. But MRIs do not use X-rays. This test may be used to look for cancer in the neck.
A biopsy is the only sure way to know if you have cancer. During a biopsy, a tiny piece or sample of tissue is removed from the tumor. Then a pathologist, a specialist who examines tissue samples in a lab looks at the tissue under a microscope to check for cancer cells. The tissue that's taken out may also be tested for signs of human papilloma virus (HPV) infection. It usually takes a few days for the results of your biopsy to come back. A biopsy can sometimes be done in your doctor’s office. Or it may need to be done in the hospital with surgery. In that case, you’d get general anesthesia so that you're asleep and don’t feel pain during the procedure.
If you have a lump in your neck, it may be a swollen lymph gland, also called a lymph node. Your doctor uses a very thin needle in a process called fine needle aspiration to see if there are cancer cells in your lymph node. This is usually done as an outpatient procedure in your doctor’s office or a clinic. You don’t generally need to stay in the hospital.
Your doctor will order tests to check blood counts and proper functioning of the liver and kidneys, as well as for levels of substances, such as calcium, sodium, potassium, and magnesium.
Getting your test results
Your healthcare provider will contact you about the results of your tests and about other tests you may need if head and neck cancer is found. Make sure you understand the results and what follow-up you need.