Diagnosing Head & Neck Cancer

Lymph nodes are small immune system organs located throughout the body and are often the first place head and neck cancers spread. People sometimes mistake them for glands.

If your doctor suspects you may have head and neck cancer, he or she asks about your symptoms and medical history and performs a physical exam. Your doctor may also perform imaging tests to help diagnose the condition. He or she provides customized treatment based on the location of the tumor and how advanced it is.

Your doctor may perform a laryngoscopy if you have symptoms of laryngeal or pharyngeal cancer, such as a persistent sore throat, a noticeable lump in your throat or neck, or difficulty swallowing.

During this procedure, the doctor inserts a laryngoscope—a thin, flexible tube with a lens at the tip that’s attached to a camera—into the nose, then the throat. A laryngoscopy allows the doctor to look for tumors in the back of the mouth, at the base of the tongue, the upper part of the throat (the pharynx), and the larynx, or voice box.

This procedure, which sometimes requires a local anesthetic, can be done in the doctor’s office.

If you have symptoms of sinonasal cancer, such as nosebleeds or nasal congestion, your doctor may perform a nasal endoscopy. This procedure allows doctors to examine the nasal cavity, the space above and behind the nose, and the sinuses, the air-filled cavities that surround the nasal cavity.

In this procedure, the doctor inserts a nasal endoscope—a thin, lighted tube with a lens at the tip that’s attached to a video camera—to look for tumors. Nasal endoscopy can be performed in the doctor’s office, sometimes using a local anesthetic spray to numb the nasal cavity.

If your doctor finds a suspicious growth during a nasal endoscopy or a laryngoscopy, he or she may perform a biopsy. During a biopsy, the doctor removes a small piece of tissue from the tumor, which is examined for signs of cancer under a microscope.

A biopsy can be performed using a laryngoscope or nasal endoscope. The doctor inserts small surgical tools through or beside the scope. It may be performed in the doctor’s office using local anesthesia or in the hospital with general anesthesia. You usually go home the day of the procedure. You may experience a sore throat, hoarseness, or mild bleeding for several days after the procedure.

Squamous cell cancers of the larynx and pharynx can begin as a precancerous condition called dysplasia, in which the cells look abnormal under a microscope but are not malignant.

At Perlmutter Cancer Center, pathologists also examine tumor tissue in the throat to determine whether it contains human papillomavirus, or HPV. People who have throat cancer that tests positive for HPV often respond to radiation therapy better than those whose cancer does not contain HPV. The reason for this is not entirely understood.

Biopsy of the Mouth

Many growths in the mouth can be removed with small surgical tools, using a local anesthetic. A pathologist examines the tissue for signs of dysplasia or cancer.

Biopsy of the Sinonasal Cavity

If your doctor finds a suspicious growth during a nasal endoscopy, he or she can perform a biopsy by placing an endoscope and endoscopic surgical tools through the nostrils and into the sinonasal cavity without any visible incisions. This can often be performed in the office using topical anesthesia, but sometimes it must be performed in the operating room with general anesthesia. Either way, you can go home the same day. You may experience a small amount of nasal bleeding for a few days after the procedure.

Fine Needle Aspiration

Because an enlarged lymph node is often one of the first signs of head and neck cancer, your doctor may perform a fine needle aspiration. During this procedure, a doctor uses a small needle to withdraw fluid and cells from the node for examination under a microscope for signs of cancer.

During the procedure, the doctor may use ultrasound—in which sound waves are used to create images of the body—to guide the needle with precision.

After diagnosing a head and neck cancer, doctors may order a CT or MRI scan. In a CT scan, X-rays and a computer are used to create two- or three-dimensional, cross-sectional images of the body. This can help determine if the cancer has spread to nearby lymph nodes, bones, or other parts of the body. Your doctor may inject a special dye into a vein to enhance the CT image.

An MRI scan uses a magnetic field and radio waves to create images. It can detect whether tumors are growing into the soft tissues of the head and neck. A special dye may be given to enhance the images.

If there’s a possibility that the cancer has spread, your doctor may order a PET scan, which creates images of the entire body. This test requires an intravenous (IV) infusion of radioactive glucose, or sugar, into a vein. This substance collects in cancer cells, which are detected during the scan. Sometimes, a combination of PET scan and MRI is used to detect cancer cells more accurately than as a single test.