Head and neck cancer diagnosis and detection

A thorough and accurate diagnosis is the first step in developing a head and neck cancer treatment plan. A multidisciplinary team of cancer experts uses a range of tests and tools designed for diagnosing head and neck cancer, evaluating the disease and planning each patient's individualized treatment. During treatment, imaging and laboratory tests track the size of the tumors and monitor the patient's response to treatment.

Tests to detect head and neck cancer

Types of procedures that may be used for diagnosing head and neck cancer include those listed below.

Indirect pharyngoscopy and laryngoscopy

These procedures are often used to examine the back of the throat and check for signs of head and neck cancer. During an indirect pharyngoscopy and laryngoscopy, the care team places small mirrors at the back of the patient's mouth to clearly examine his or her throat, the base of the tongue and part of the larynx.

Endoscopy

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

Panendoscopy

The care team may perform this procedure if they suspect 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 may provide 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. For example, the types of biopsies typically used for diagnosing oral cancers are listed below.

• 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 the 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): 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 the patient does 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 are 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 allows tumors to be better seen during an X-ray.

Imaging tests

Imaging tests that may be used to diagnose head and neck cancer include those listed below.

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)/CT scan: For patients who have been diagnosed with head and neck cancer, a PET/CT 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 (referred to as metastasis).

Can a neck CT scan or an MRI of the neck detect cancer?

Imaging tests like CT, MRI or PET/CT scans on their own cannot definitively diagnose a patient with cancer. However, they may provide the care team with information that helps during the diagnostic process.

Next topic: How is head and neck cancer treated?