How are head and neck cancers diagnosed?

Depending on your symptoms, the doctor will examine your mouth, throat, nose, neck, ears and/or eyes. They may use a tongue depressor for a clearer view of the mouth and feel the inside of the mouth with a gloved finger. They will also gently feel both sides of your neck to check the lymph nodes. For hard-to-see areas, the doctor may use specialised equipment (endoscopy), or recommend a procedure under anaesthetic (microlaryngoscopy) that lets them fully examine the area. They may also remove a tissue sample (biopsy).

In this procedure, your doctor examines the nose and throat area using a thin, flexible tube with a light and camera on the end. The procedure may be called a nasendoscopy or flexible laryngoscopy and it is usually done in the doctor’s rooms.

Before inserting the tube, the doctor may spray a local anaesthetic into one of your nostrils to numb the nose and throat. You may find that the spray tastes bitter. The doctor will gently pass the tube into the nostril and down your throat to look at your nasal cavity, nasopharynx, oropharynx, hypopharynx and larynx. You will be asked to breathe lightly through your nose and mouth, and to swallow and make sounds. You may find this test uncomfortable but it should not hurt. Images from the camera may be projected onto a screen and the doctor may also take tissue samples (biopsy).

An endoscopy 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 is done in a hospital while you are asleep under general anaesthetic. It allows the doctor to look at your throat and voice box and take a tissue sample (biopsy). The doctor inserts a stainless steel instrument called a laryngoscope into your mouth to hold the throat open, and uses telescopes or a microscope to examine the throat and voice box. The procedure takes 30–60 minutes and 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 a suspicious sore or lump. A pathologist examines the sample under a microscope to see if it contains cancer cells, and may do some special tests to help guide treatment. The sample may be taken using local anaesthetic during an endoscopy or under a general anaesthetic during a microlaryngoscopy. A needle can also be used to take a biopsy from lumps in the neck or other hard-to-reach areas. This may be called a fine needle biopsy or core biopsy. It is often done using an ultrasound or CT scan (see below) 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.

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 doing a fine needle or core biopsy of the lymph nodes.

You will usually have at least one of the imaging tests described below, often before a biopsy is done. These tests give more details about  where the cancer is and whether it has spread to other parts of your body.

Ultrasound – 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. A small device called a transducer is coated with gel and moved over the area. The transducer sends out soundwaves that echo when they meet something dense, like an organ or tumour. A computer creates a picture from these echoes. An ultrasound is painless and takes about 15–20 minutes.

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 a vein to make 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.

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 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.

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 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 30–90 minutes.

X-rays – Some people have a special x-ray called an orthopantomogram (OPG) to check the jaw and teeth.

Before having scans, tell the doctor if you have had a reaction to dyes during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant or breastfeeding.