This list describes options for diagnosing head and neck cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:
If a person has symptoms and signs of head and neck cancer, the doctor will take a complete medical history, noting all symptoms and risk factors. In addition, the following tests may be used to diagnose head and neck cancer:
• Biopsy
A biopsy is a sample of the abnormal cells taken from the affected area. These are then examined under a microscope in the laboratory. Your doctor can do the biopsy during a nasendoscopy using a very small needle. The biopsy will tell your doctor if the sample contains cancer cells and if so what type. In some cases, patients may need a general anaesthetic during a biopsy.
• Bone scan
A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. This test may be done to see if cancer has spread to the bones.
• Computed tomography (CT or CAT) scan
A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein or given orally (by mouth) to provide better detail.
• Endoscopy
This test allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The tube is gently inserted through the nose into the throat and down the esophagus to examine the head and neck areas. The examination has different names depending on the area of the body that is examined, such as laryngoscopy (larynx), pharyngoscopy (pharynx), or a nasopharyngoscopy (nasopharynx). When these procedures are combined, they are sometimes referred to as a panendoscopy.
• Magnetic resonance imaging (MRI)
An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. A contrast medium may be injected into a patient’s vein or given orally to create a clearer picture.
• Fine needle aspiration cytology
This test uses a fine needle and syringe to get a sample of cells from a lump. It is then sent to the laboratory to see if any cancer cells are present. The test can be uncomfortable and the area may be bruised for short while afterwards.
• Molecular testing of the tumor
Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted.
• Panorex
This is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect cancer or to evaluate teeth before radiation therapy or chemotherapy.
• Physical examination/blood and urine tests
During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. Also, the doctor will inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and a mirror for a clearer view. Blood and urine tests may be performed to help diagnose cancer. Testing for viral infections, including HPV (see the Risk Factors and Prevention of Head and Neck Cancer section), may also be done.
• Positron emission tomography (PET) scan
A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
• Ultrasound
An ultrasound uses sound waves to create a picture of the internal organs.
• X-ray
An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A barium swallow may be required to identify abnormalities along the swallowing passage. During a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray. A special type of barium swallow called a modified barium swallow may be needed to evaluate specific swallowing difficulties. A dentist may also take x-rays of the teeth and mandible and maxilla, including a panorex (panoramic view). If there are signs of cancer, the doctor may recommend a computed tomography (CT) scan.
- Age and medical condition
- Previous test results
- Signs and symptoms
- Type of cancer suspected
• Biopsy
A biopsy is a sample of the abnormal cells taken from the affected area. These are then examined under a microscope in the laboratory. Your doctor can do the biopsy during a nasendoscopy using a very small needle. The biopsy will tell your doctor if the sample contains cancer cells and if so what type. In some cases, patients may need a general anaesthetic during a biopsy.
• Bone scan
A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. This test may be done to see if cancer has spread to the bones.
• Computed tomography (CT or CAT) scan
A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein or given orally (by mouth) to provide better detail.
• Endoscopy
This test allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The tube is gently inserted through the nose into the throat and down the esophagus to examine the head and neck areas. The examination has different names depending on the area of the body that is examined, such as laryngoscopy (larynx), pharyngoscopy (pharynx), or a nasopharyngoscopy (nasopharynx). When these procedures are combined, they are sometimes referred to as a panendoscopy.
• Magnetic resonance imaging (MRI)
An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. A contrast medium may be injected into a patient’s vein or given orally to create a clearer picture.
• Fine needle aspiration cytology
This test uses a fine needle and syringe to get a sample of cells from a lump. It is then sent to the laboratory to see if any cancer cells are present. The test can be uncomfortable and the area may be bruised for short while afterwards.
• Molecular testing of the tumor
Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted.
• Panorex
This is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect cancer or to evaluate teeth before radiation therapy or chemotherapy.
• Physical examination/blood and urine tests
During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. Also, the doctor will inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and a mirror for a clearer view. Blood and urine tests may be performed to help diagnose cancer. Testing for viral infections, including HPV (see the Risk Factors and Prevention of Head and Neck Cancer section), may also be done.
• Positron emission tomography (PET) scan
A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
• Ultrasound
An ultrasound uses sound waves to create a picture of the internal organs.
• X-ray
An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A barium swallow may be required to identify abnormalities along the swallowing passage. During a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray. A special type of barium swallow called a modified barium swallow may be needed to evaluate specific swallowing difficulties. A dentist may also take x-rays of the teeth and mandible and maxilla, including a panorex (panoramic view). If there are signs of cancer, the doctor may recommend a computed tomography (CT) scan.