How is head and neck cancer diagnosed?

HOW IS HEAD AND NECK CANCER DIAGNOSED?

It is important that your doctor establishes the diagnosis of your type of head and neck cancer, assesses the size of the cancer and whether it has spread to the lymph nodes in the neck or elsewhere in the body.

To answer these questions, your doctor will need to do the following things:

• Talk with you about your medical history. This includes signs you may have noticed, any other health conditions, medications that you are taking, and whether you smoke or drink alcohol

• Perform a physical examination by feeling and looking inside your throat and neck

• Order diagnostic tests, which may include scans.

Not everyone will need to have every test. Your doctor will recommend tests that are right for you.

TYPES OF TESTS

Audiometry (Hearing Test)
Biopsy
- Incision biopsy
- Needle biopsy - Fine Needle Aspiration (FNA)
- Lymph node excision biopsy
HPV
Imaging Tests
- CT Scan
- MRI Scan
- PET Scan
- Ultrasound Scan
Laryngoscopy
Nasoendoscopy
Pathology
Xrays

Audiometry (Hearing Test)

Sometimes radiotherapy and certain types of chemotherapy can affect your hearing. Your doctor may ask you to have a hearing test before and after your treatment to check for any hearing loss. There are many different tests that can be used to check your hearing. They are called audiometry exams. During these tests you will wear earphones attached to a machine called an audiometer. The test will play sounds at different volumes and pitches. You may also be tested to see if you can hear and understand conversations. If the tests before and after your chemotherapy or radiotherapy show that your hearing has been affected, your doctor may recommend some treatments or follow-up care options.

Biopsy

A biopsy is the removal of a small piece of tissue for testing under a microscope. Your doctor may recommend different types of biopsies to see if you have cancer and what type of cancer it is.

Some people may need a biopsy under a general anaesthetic (medicine to keep you unconscious). This is usually needed when biopsies have to be taken from the throat or voice box (examination under anaesthetic (EUA) or laryngoscopy). It lets your doctor look more closely for unusual things. This is done in a single day so you won’t need to stay in hospital overnight. The tissue taken during a biopsy is sent to a pathologist to look at under a microscope. It can take a few days or weeks to get your results.

After your biopsy, it is normal to feel a bit sore and have some bruising in the area from where the sample was taken. Speak with your doctor or nurse about your options for relieving any pain or discomfort.

Types of Biopsies

Your doctor may recommend different types of biopsies
Incision biopsy	Is when a doctor removes a small piece of tissue from the affected area using a surgical knife. This can be done in the clinic using an anaesthetic , so that you don’t feel any pain. Depending on the size and location of the biopsy, you may need stitches. There may be some bleeding after the biopsy. If you take blood thinners (e.g. warfarin), you may need to stop these for a few days before the biopsy.
Needle biopsy (Fine Needle Aspiration or FNA)	Is used when there is a lump (enlarged lymph node) in your neck that could have cancer cells in it. During the procedure, your doctor will take a small sample of cells from the lump using a needle. This is done by a radiologist or pathologist using an ultrasound to see that the needle is in the right spot. You may feel slight discomfort during the biopsy. Sometimes a larger needle is used to get more tissue in the biopsy. This is called a core biopsy. It can provide more information than needle biopsy but can be more uncomfortable. Your doctor will decide which type of biopsy is most appropriate for you.
Lymph node excision biopsy	Lymph node excision biopsy is when a whole lymph node is removed. This is often performed when the needle biopsy does not give an answer as to why the lymph node is enlarged. In some people with no swollen lymph nodes or detectable signs of cancer in the nodes, the doctor may recommend sentinel node biopsy to help determine if the cancer has spread to the lymph nodes. Sentinel node biopsy identifies the first lymph node (the sentinel node) to which cancer cells are most likely to spread from your cancer.

Download our Sentinel node biopsy and Lymph node excision fact sheet to learn more.

Human Papilloma Virus

Human Papilloma Virus (HPV) is now known to cause some head and neck cancers, mainly in the tonsil and back of the tongue (tongue base). A special tissue stain (called p16) is done on a small part of cancer tissue removed during a biopsy. This tests whether HPV could be the cause of your cancer.

It is important to know if your cancer is from HPV because those types of cancer respond well to specific treatment. It can help your doctor to choose the best treatment for you.

Download our Human Papilloma Virus fact sheet to learn more.

Imaging Tests - CT Scan, MRI Scan, PET Scan, Ultrasound Scan

Imaging tests allow the cancer care team to check for cancer and other problems inside the body.

Imaging tests involve sending different types of energy, such as X-rays, sound waves, magnetic fields or radioactive particles, through the body.
Energy patterns are changed by the different tissues and structures in the body and these are displayed as an image on a screen. They allow the cancer care team to see changes that may be caused by cancer.

There are four main types of imaging used to diagnose and assess head and neck cancers:

Ultrasound (US) scans
A probe is placed on the skin surface that uses sound waves to look in detail at soft tissues of the body. Ultrasound usually looks at smaller regions like the thyroid gland. It is not used for looking at bone or tissue with air in or around it, like the lungs. Ultrasound does not use radiation and is safe during pregnancy and for children.

Computed tomography (CT) scans
X-ray beams are used to create a detailed view of the body. CT can look at large areas of the body very quickly and is very good for examining bone. Intravenous dye is often used to help show blood vessels and cancers during a CT scan. CT scans use radiation and should be avoided during pregnancy and in children where possible.

Magnetic resonance imaging (MRI) scans
A very strong magnetic is used to create a detailed view of the body. MRI scans can look at large areas of the body but they are quite slow and noisy. Many people also find them claustrophobic. MRI is very good for looking at many different types of tissue but it is important to lie very still during the scan. Intravenous dye is often used to help show blood vessels and cancers during an MRI scan. MRI can be dangerous in people with metal in their body because the magnet can make the metal move – let the radiographer know if you do but not all types of metal are affected. MRI does not use radiation and is safe during pregnancy and for children.

Positron emission tomography (PET) scans
A special glucose solution containing some radioactive material (known as a radiotracer) is injected into the body. The radiotracer accumulates in the cells that use more energy, including cancer cells, making these show up as ‘hot spots’ on the images. PET scans are very good at detecting cancers that grow quickly but not ones that grow slowly. PET scans can also give false readings due to inflammation or muscle movement (even talking or chewing). PET uses radiation and should be avoided during pregnancy and in children where possible.

Download our Imaging Tests fact sheet to learn more.

Laryngoscopy

A laryngoscopy is a test that lets your doctor look at your throat and voice box. This is usually only needed for patients where biopsies have to be taken from the throat or voice box or the area needs to be inspected more closely to look for cancer. It is done in hospital with you asleep under a general anaesthetic. You will stay in hospital for the day and then go home. It doesn't usually require you to stay in hospital overnight.

During the test, the laryngoscope is moved through your mouth to the back of your throat. Sometimes a tiny camera or microscope is used to give a close-up view of your throat and voice box. It's normal to have a sore throat for a few days after the test.

Nasoendoscopy

A nasoendoscopy helps your doctor to see inside your nose and throat using a thin, bendy tube with a camera and light on the end (an endoscope). The tube is quite narrow, less than the width of your little finger. The nasoendoscopy is usually done in your doctor's office.

You may be given a spray to numb the area at the back of your throat. Then, the nasoendoscope will be gently passed through your nose and down your throat. This gives your doctor a close-up view of your throat and voice box so they can look for any signs of cancer.

The test isn't painful but you may feel uncomfortable. It will only take a few minutes, often much less.

After the test, your throat might still feel numb. You should wait until the numbness has gone before you eat or drink anything.

Download our Nasoendoscopy fact sheet to learn more.

Pathology Tests

Pathology tests involve the laboratory testing of blood, body fluids and tissues. There are three common pathology tests for head and neck cancer.

Three common pathology tests for head and neck cancer
Cytology	Cytology uses a needle to remove cells so they can be looked at under a microscope. It is often used if you have swollen (enlarged) lymph glands, neck cysts and thyroid nodules.
Histopathology	Histopathology is when part or all of the cancer cells are looked at under a microscope. The cancer cells are usually collected during a biopsy and sent to a doctor trained in looking at cells in the body (pathologist) for testing. The pathologist will be able to tell your doctor the type of cancer, its grade, and other details that will help your doctor work out the best treatment for your type of cancer.
Blood tests	Blood tests are not typically used to diagnose of screen for most types of head and neck cancer. There are some blood tests that can be used to look for certain types of thyroid cancer. Sometimes your healthcare team will ask you to have blood tests to make sure that your blood, kidneys, and liver are working normally.

X-rays

X-rays take pictures of solid structures in the body, like bones. The main reason you might need an X-ray is to get a detailed picture of your jaw and teeth (dental X-ray) which can be affected by radiation therapy.

An X-ray is quick and painless.

IN THIS SECTION

What is head and neck cancer
Screening
Signs and symptoms
How is head and neck cancer diagnosed?
Understanding your diagnosis
Staging and Grading
Understanding Prognosis
What does 'incurable cancer' mean
The cancer care team
Questions to ask

FURTHER INFORMATION