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How are head and neck cancers diagnosed?

If you notice any symptoms, make an appointment to see your GP. You can also mention any mouth sores, swelling or change of colour in your mouth to your dentist.

Your GP or dentist may do some general tests and then refer you to a specialist. Depending on your symptoms, tests will include examinations, tissue sampling (biopsy) and imaging tests. Further tests may be needed to work out whether the cancer has spread. The tests you have will depend on your specific situation.

Depending on your symptoms, the doctor will examine your mouth, throat, nose, neck, ears and/or eyes. They may use a thin wooden tongue depressor to see inside the mouth more clearly. The doctor may also insert a gloved finger into your mouth to feel areas that are difficult to see, and gently feel both sides of your neck to check your lymph nodes.

The doctor may use equipment to see some areas of the head and neck, such as the nasopharynx, tongue base and pharynx.

In this procedure, your doctor examines the nose and throat area using a thin flexible tube with a light and camera on the end. This device is called a nasendoscope. Before the nasendoscope is inserted, a local anaesthetic is sprayed into the nostril to numb the nose and throat.

You may find that the spray tastes bitter. The doctor will gently pass the nasendoscope into one of your nostrils and down your throat to look at your nasal cavity, nasopharynx, oropharynx, hypopharynx and larynx. Images from the nasendoscope may be projected onto a screen. This test may feel uncomfortable, but should not hurt.

You will be asked to breathe lightly through your nose and mouth, and to swallow and make sounds. The doctor may also take tissue samples (biopsy). A nasendoscopy usually takes a few minutes. If you need a biopsy, the test may take longer. You will be advised to not have any hot drinks for about 30 minutes after the procedure, but you can go home straightaway.

This procedure allows the doctor to look at your throat and voice box, and take a tissue sample (biopsy). The doctor inserts a tube with a light and camera on the end (laryngoscope) into your mouth and throat. The camera projects images onto a screen. The procedure is done under a general anaesthetic and takes 10–40 minutes. You can go home when you’ve recovered from the anaesthetic. You may have a sore throat for a couple of days.

A biopsy is when doctors remove a sample of cells or tissue from the affected area, and a pathologist examines the sample under a microscope to see if it contains cancer cells.

The sample may be taken during a nasendoscopy or laryngoscopy. A biopsy can also be taken from hard-to-reach areas using a fine needle to collect the sample. This is often done using an ultrasound or CT scan to guide the needle to the correct place. Biopsy results are usually available in about a week. If the cancer can’t be diagnosed from the tissue sample, you may have surgery to remove the mass so it can be checked for signs of cancer.

Testing lymph nodes

The lymph nodes in the neck are often the first place cancer cells spread to outside the primary site. If you have a lump in the neck or an imaging scan has shown a suspicious-looking lymph node, your doctor may recommend you have a biopsy.

Under the guidance of an ultrasound or CT, the doctor will insert a fine needle to remove a sample of tissue or fluid from the lymph node. If cancer is found in a lymph node, you may need a neck dissection or other additional treatment. Each case is different and your doctor will explain your treatment options.

Overview of lymph nodes

Lymph nodes, also known as lymph glands, are small, bean-shaped structures that are part of the lymphatic system. They are also a key part of the immune system, which helps protect the body against disease and infection. Lymph nodes are found throughout the body, including in the head and
neck area. Most of the lymph nodes in the head and neck region run down the sides of the neck and under the jaw.

You will usually have at least one of these tests to provide more details about the location of the tumour and to see if the cancer has spread to other parts of your body.

You may need x-rays to check for tumours or damage to the bones. X-rays are quick and painless, and include:

  • orthopantomogram (OPG)– used to examine the jaw and teeth of people with mouth cancer
  • chest x-ray – sometimes used to check the general health of people with mouth, pharyngeal or laryngeal cancer, or to see whether the cancer has spread to the lungs. However, most people have a CT or PET–CT scan to look at these areas.

CT scan
A CT (computerised tomography) scan uses x-ray beams to create detailed cross-sectional pictures of the inside of your body. Before the scan, you may have an injection of dye (called contrast) into one of your veins, which makes the pictures clearer. The dye may make you feel hot all over and leave a strange taste in your mouth for a few minutes.

For the scan, you will need to lie still on a table that moves in and out of the CT scanner, which is large and round like a doughnut. The scan itself takes about 10 minutes.

MRI scan
An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the inside of your body. A dye may be injected into a vein before the scan to help make the pictures clearer. During the scan, you will lie on a treatment table that slides into a large metal tube that is open at both ends.

The noisy, narrow machine makes some people feel anxious or claustrophobic. If you think you may become distressed, mention this beforehand to your doctor or nurse. You may be given medicine to help you relax, and you will usually be offered headphones or earplugs. MRI scans usually take between 30 and 90 minutes.

PET-CT scan
A positron emission tomography (PET) scan combined with a CT scan is a specialised imaging test. The CT helps pinpoint the location of any abnormalities revealed by the PET scan. A PET–CT scan is usually recommended to help diagnose oral, pharyngeal or laryngeal cancer, or to see if the cancer has spread.

Before the scan, you will be injected with a glucose solution containing some radioactive material. Cancer cells show up brighter on the scan because they take up more glucose solution than the normal cells do. You will be asked to sit quietly for 30–90 minutes as the glucose spreads through your body, then you will be scanned. The scan itself takes about 30 minutes.

An ultrasound is sometimes used, particularly to look at the thyroid, salivary glands and lymph glands in the neck.

For this scan, you will lie down and a gel will be spread over your neck. A small device called a transducer is moved over the area. The transducer sends out soundwaves that echo when they encounter something dense, like an organ or tumour. The ultrasound images are then projected onto a computer screen. An ultrasound is painless and takes about 15–20 minutes.

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Understanding Head and Neck Cancers

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This information is reviewed by

This information was last updated September 2019 by the following expert content reviewers: A/Prof David Wiesenfeld, Oral and Maxillofacial Surgeon, Director, Head and Neck Tumour Stream, The Victorian Comprehensive Cancer Centre at Melbourne Health, VIC; Alan Bradbury, Consumer; Dr Ben Britton, Senior Clinical and Health Psychologist, John Hunter Hospital, NSW; Dr Madhavi Chilkuri, Radiation Oncologist, Townsville Cancer Centre, The Townsville Hospital, QLD; Jedda Clune, Senior Dietitian (Head and Neck Cancer), Sir Charles Gairdner Hospital, WA; Dr Fiona Day, Staff Specialist, Medical Oncology, Calvary Mater Newcastle, and Conjoint Senior Lecturer, The University of Newcastle, NSW; Dr Ben Dixon, ENT, Head and Neck Surgeon, Peter MacCallum Cancer Centre and St Vincent’s Hospital Melbourne, VIC; Emma Hair, Senior Social Worker, St George Hospital, NSW; Rosemerry Hodgkin, 13 11 20 Consultant, Cancer Council WA; Kara Hutchinson, Head and Neck Cancer Nurse Coordinator, St Vincent’s Hospital Melbourne, VIC; A/Prof Julia Maclean, Speech Pathologist, St George Hospital, NSW; Prof Jane Ussher, Chair, Women’s Health Psychology, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, NSW; Andrea Wong, Physiotherapist, St Vincent’s Hospital Melbourne, VIC..