Tests for head and neck cancers

Physical examination

Depending on your symptoms, the doctor may examine your mouth, throat, nose, neck, ears and eyes. They may gently press your tongue down to check the mouth or feel the area with a gloved finger. They will feel your neck to check the lymph nodes. For hard-to-see areas, the doctor may use specialised equipment (endoscopy), or suggest a procedure under anaesthetic (microlaryngoscopy) to fully examine the area. They may take a tissue sample to test (biopsy).

Endoscopy

An endoscopy (nasendoscopy or flexible laryngoscopy) looks at the nose and throat area using a thin, flexible tube with a light and camera on the end. The doctor sprays a local anaesthetic (which tastes bitter) into one of your nostrils to numb the nose and throat. The tube is then gently passed into the nostril and down your throat to look at your nasal cavity, the different parts of the throat (nasopharynx, oropharynx, hypopharynx) and voice box (larynx). You will be asked to breathe lightly, and to swallow and make sounds. It may feel uncomfortable but shouldn’t hurt.

Images from the camera may be projected onto a screen and the doctor may also take a biopsy. An endoscopy takes a few minutes and is usually done in a doctor’s rooms. If you need a biopsy, it may take longer. You shouldn’t have hot drinks for about 30 minutes afterwards, but can go home straightaway.

Microlaryngoscopy

A microlaryngoscopy is done in hospital under a general anaesthetic. The doctor will look at your throat and voice box and take a biopsy. They’ll insert a stainless steel instrument called a laryngoscope into your mouth to hold the throat open, and use a telescope or a microscope to examine the throat and voice box. A microlaryngoscopy takes 30–60 minutes and you can go home after recovering from the anaesthetic. Your throat may be sore for a couple of days.

Biopsy

A biopsy is when a doctor removes a sample of cells or tissue from a suspicious sore or lump. A specialist doctor called a pathologist examines the sample under a microscope to see if it contains cancer cells, and to diagnose the type of cancer. They may do more tests on that sample to help guide treatment.

A biopsy may be taken using local anaesthetic during an endoscopy, or under a general anaesthetic during a microlaryngoscopy. A needle may be used for a biopsy of lumps in the neck or hard-to-reach areas. This is called a fine needle biopsy or core biopsy. It is often done using a CT scan or ultrasound to guide the needle to the correct place. If the cancer can’t be diagnosed from the tissue sample, surgery may be needed to remove the mass so it can be checked for signs of cancer.

Imaging tests

You will usually have at least one of these imaging tests, 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 and 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.

You may need to fast or follow a special diet the day before this scan, so that you get the most accurate results. Before the scan, you will be injected with a glucose solution that contains some radioactive material. Cancer cells show up brighter on the scan because they take up more glucose solution than the normal cells do.

Next, you will lie down or sit quietly for about an hour as the glucose spreads through your body. Then you have the PET scan, which will usually take about 30 minutes. The CT scan may be done before the PET scan or at the same time.

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. Before the scan, a dye may be injected into a vein 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

Many people will also have a special x-ray called an orthopantomogram (OPG) to check the jaw and teeth.