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How is head and neck cancer diagnosed?

If a patient experiences some symptoms, he/she must visit general physician (GP) and dentist for a checkup who on evaluation can refer the patient to a specialist, only if they find any serious issues.

On the basis of symptoms, the doctor may refer some examinations, imaging tests and biopsy along with some other tests to check the spread of cancer in other parts of the body.

Physical Test

A thorough examination of neck, ears, mouth, throat, eyes and nose helps to locate and assess the physical location of the tumor.

Besides, the doctor may use a viewing equipment to examine the parts of head and neck that includes the pharynx, tongue base and nasopharynx.

Endoscope

Endoscopy for head and neck cancer diagnosis

Endoscopy is performed to examine the throat and nose by using a thin, lighted tube with a lens and camera, called endoscope.

Endoscopy is minimally invasive procedure and takes less time. It is usually done during your routine visit.

The test procedure may be a little uncomfortable, depending on the area of the body that is being examined, but it is safe.

When is endoscopy done?

Your doctor may perform endoscopy under following circumstances:

If you have symptoms such as nosebleeds or nasal congestion.
If your doctor suspects you of having head and neck cancer based on your medical history or physical exam.

How do I prepare for an endoscopy?

Depending on which area of the body is being examined, your doctor may advise you certain sets of instructions. The endoscopy can be performed in OPD, however, sometimes depending on the area under examination, a local anesthetic spray may be used to make the area numb. You can immediately go back to work/home after the procedure.

How is this test performed?

The device called endoscope is inserted into the mouth or nostrils after applying a local anesthetic. The test usually finishes in few minutes, but if combined with the biopsy then it may take a bit longer.

With the help of endoscope, the doctor is able to check the hypopharynx, nasal cavity, oropharynx, larynx and nasopharynx.

What to expect after endoscopy?

The images received from the endoscope are projected on a screen for clarity and better examination. Doctor may ask the patient to not consume any hot drink for 30 minutes after the test. There is no other precaution needed after endoscopy.

How do you receive the results of endoscopy?

After thorough examination of the images, the doctor may discuss and share the results with you. They may even advise the follow-up procedure once diagnosis is confirmed.

What is cost of endoscopy?

The cost of endoscopy will vary as the actual cost depends on which endoscopic procedure has been recommended for you. Also, the cost may add up if endoscopy is to be clubbed with the biopsy.

Panendoscopy

Panendoscopy for head and neck cancer diagnosis

Panendoscopy, also called as triple endoscopy, is a procedure that combines laryngoscopy, esophagoscopy, and bronchoscopy. This allows the doctor to thoroughly examine the entire area around the larynx and hypopharynx, including the esophagus and trachea (windpipe).

If the doctor suspects a tumor during the test, he/she may suggest the biopsy for further confirmation.

Biopsy

Biopsy for head and neck cancer diagnosis

Biopsy is a procedure in which the doctor removes a small piece of tissue from tumor or abnormal cells and examines it under a microscope for any signs of cancer. For hard to reach parts, the biopsy can be clubbed with CT scan, and the samples can be collected using a guiding needle.

When is biopsy done?

After physical examination is done for head and neck region of the patient, if the surgeon suspects of cancer, he/she may advise a biopsy to confirm the same. Also, a biopsy may be performed to see whether the person has HPV, which is linked to a higher risk for some head and neck cancers.

How do I prepare for a biopsy?

Generally, depending on the area where the biopsy is to be performed, a local or general anesthesia is administered. A biopsy can be performed using a laryngoscope or nasal endoscope wherein the doctor inserts small surgical tools through or beside the scope. The test requires no preparation as such.

How is this test performed?

For head and neck cancer examination, a biopsy is performed in three different ways:

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 cancer.
Biopsy of 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. You are allowed to go home the same day.
Fine-needle aspiration: If an enlarged lymph node or thyroid gland is identified inside the neck, then a fine needle is used to collect fluid and cells from the node for examination under a microscope for signs of cancer.
Biopsies can be safely performed with imaging tests such as ultrasound, X-ray, computed tomography (CT), or magnetic resonance imaging (MRI).

What to expect after biopsy?

Soon after the biopsy, the patient is allowed to go home. However, some patients may feel nauseatic due to the effect of sedative; they are therefore, advised to rest for a while in hospital premises.

What is cost of biopsy?

Cost of the biopsy may depend on factors such as location where biopsy has to be performed and the type of biopsy to be performed.

How do you receive the results of biopsy?

Biopsy samples are sent to the lab where they are looked closely. It may take a few days to get the results of your biopsy test.

If cancer is found, your doctor will determine how aggressive it is and if it has spread to other parts of the body.

Normally, a pathologist may take about 7-8 days to prepare your biopsy report.

Biopsy result accuracy

A biopsy is the only way to be sure if you have cancer. And it is the only way to tell what kind of cancer it is. Next step would be staging. This is done to see the extent of cancer spread.

CT

When is computed tomography (CT) scan done?

A CT scan is generally prescribed after the diagnosis of head and neck cancer. This helps to determine the size, shape and position of the tumor and also if the cancer has spread to the nearby lymph nodes, bones or other parts of the body.

How do I prepare for a computed tomography (CT) scan?

CT scan is noninvasive and painless imaging test. Doctor may ask the patient to hold breath during the scanning procedure. Sometimes, a special dye called a contrast medium is given before the scan for better detailing. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

How is this test performed?

A CT scan takes pictures of the infected area or entire head or neck using X-ray. A computer combines these pictures to get a clearer 3-dimensional image that shows presence of any abnormalities or tumors in the region.

What to expect after computed tomography (CT) scan?

CT scan gives 360 degree view of the cancer affected area. This allows a doctor to assess the severity of cancer and its spread around the nearby areas.

CT scan tests are used to study a mass or lump in the head and neck area or to check larger glands or lymph nodes inside the neck.

How do you receive the results of computed tomography (CT) scan?

The radiologist reviews and interprets the CT scan after the test is completed in 15 minutes. He then generates the test report within 24 hours along with the scanned images.

What is cost of computed tomography (CT) scan?

The cost of CT scan may vary as it depends on various factors such as the area to be examined, etc.

Computed tomography (CT) scan result accuracy

CT is the first line imaging modality for staging the cancer.

Tumors of the oropharynx, larynx, and hypopharynx are primarily imaged with CT, which is less affected by breathing and swallowing artifacts and thus gives better results.

MRI

MRI for head and neck cancer diagnosis

MRI can detect whether tumors are growing into the soft tissues of the head and neck. A special dye may be given to enhance the detailing of the images.

When is head and neck MRI done?

If your doctor suspects the spread of cancer from nearby parts of the head and neck after physical examination and other tests, he/she can advise for a MRI scan to be double sure and gain more clarity.

Sometimes, head and neck MRI scans are also administered to detect and stage certain types of cancer.

How do I prepare for a head and neck MRI?

You should not have to do too much to prepare for a head and neck MRI. Unless you are told otherwise, you may be able to eat, drink and take your medications as usual. Make sure to remove all metal clothing and accessories, including jewelry, eyeglasses, and hair clips prior to a MRI scan.

Sometimes a contrast material is administered intravenously prior to the scan to highlight the targeted area. In that case, patients may be advised not to eat or drink before the scan.

How is this test performed?

During the MRI procedure, the patient lies on the examination table which moves through the MRI unit several times, capturing images from the magnetic signals. The test usually takes approximately 45 minutes. MRI exams generally include multiple runs.

What to expect after head and neck MRI?

Unlike CT and X-ray scans, MRIs do not use ionizing radiation beams so there is virtually no risk except anxiety or claustrophobia.

If the sedative is given before the test, then you may be transferred to recovery room and asked to rest for an hour or so before leaving.

MRI exams are usually painless, and it typically takes only a few seconds to a few minutes at a time.

How do you receive the results of head and neck MRI?

The scans are reviewed and interpreted by the radiographer and the documented results along with scans are provided within 24-48 hours under normal conditions.

Head and neck MRI result accuracy

MRI scan is the most sensitive type of imaging test capable of detecting abnormalities that cannot be seen with the other imaging tests.

An MRI scan enables the physician to examine nearly every type of structure, including bone and soft tissue through one noninvasive test. Besides, MRI is the preferred modality for assessment of nasopharyngeal, sinonasal, and parotid tumors, because of better contrast resolution.

MRI is also preferred for tumors confined to the oral tongue, and possibly for other oral cavity locations.
Right from classification to localization, MRI may help oncologists in making treatment decisions for their patients.

PET Scan

PET for head and neck cancer diagnosis

If there’s a possibility that the cancer has spread, your doctor may order a PET scan, which creates images of the entire body. PET scan is used for staging, diagnosis, and recurrence of cancer.

Sometimes, a combination of PET scan and MRI is used to detect cancer cells more accurately.

When is positron emission tomography (PET) scan done?

PET imaging is highly recommended for the diagnosis of stages II, III and IV cancer, however stage I cancer patients can be exempted from the test. PET helps to identify abnormal activity within the body and to precisely pinpoint its location.
A combined PET/CT scan can be used to identify the extent of the cancer, plan treatment, and assess treatment response.

How do I prepare for a positron emission tomography (PET) scan?

Before PET, you are advised to refrain from eating or drinking anything, except having water for 6 hours before the exam. Also, you may have routine medications, unless you have been instructed otherwise. If you are diabetic, tell your doctor in advance.

Besides, to perform PET, a contrast is injected into a vein to better define the images throughout the body.

How is this test performed?

This test requires an intravenous (IV) infusion of radioactive contrast or sugar into a vein. Within few minutes this starts traveling throughout your bloodstream and into your tissues. Cancerous cells soak up the sugar, virtually lighting them up during the scanning process. The PET scanner detects the energy from these radiotracers and a computer turns this information into 3-D pictures.

Often the images from PET are combined with MRI to create special image results or are used in conjunction with computed tomography (CT) scans to locate cancers in the body. These combined tests are often used to detect cancer cells more accurately than as a single test.

What to expect after positron emission tomography (PET) scan?

Though PET is a noninvasive and safe procedure, some patients may experience temporary nausea, vomiting, dizziness and headache, which is manageable after some rest or medication.

Also, the trace amount of radioactive sugars injected into your body is naturally flushed out and are not known to cause any lasting harm. However, you can accelerate this process by drinking plenty of water following your test.

How do you receive the results of positron emission tomography (PET) scan?

After testing is done and images are produced, a certified radiologist and nuclear medicine specialist reviews and interpret the scans. You can expect test results within a span of two to three days.

Positron emission tomography (PET) scan result accuracy

PET scans are capable of changing the course of treatment for patients of head and neck cancer. But PET scans must be interpreted carefully because sometimes noncancerous conditions can look like cancer.

For imaging of treated head and neck cancer, PET scans offer higher sensitivity than MRI or CT imaging test.

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