Diagnosing Head and Neck Cancers: What Doctors Look For

This cancer is sometimes spotted during routine checkups.

Loading the player...

As with many types of cancer, head and neck cancers often do not cause noticeable symptoms in the early stages. Plus, the symptoms that do appear—such as a persistent sore throat or difficulty swallowing—can easily be mistaken for something else.

Consequently, many people with head and neck cancers don’t realize they have it until it’s caught during routine checkups with a doctor or dentist, according to the American Cancer Society (ACS). You might be referred to an otolaryngologist (also called an ENT doctor or head and neck surgeon).

If head and neck cancers are suspected, your doctor may evaluate your medical history, perform a physical exam, and order diagnostic tests. "A very thorough and detailed history is obtained to try and focus on where the primary site [of cancer] might be," says Mark Persy, MD, otolaryngologist and surgeon at NYU Langone Health in New York City.

Tests used to diagnose head and neck cancers include:

  • Complete head and neck exam: This physical exam is checking for abnormalities such as swollen lymph nodes. "There could potentially be more than one tumor that's developed, and only one of the tumors might be symptomatic," says Dr. Persky.

  • Panendoscopy: This is a type of endoscopy—using small cameras attached to a tiny tube to see down the esophagus—to check for abnormalities inside the nose, mouth, and throat.

  • Biopsy: This is when doctors remove a small piece of tissue from an abnormal area to check for cancer cells under a microscope. Biopsies are often taken during the panendoscopy.

  • CT Scan: This is a type of X-ray that can help determine if cancer has spread to lymph nodes or other organs.

  • MRI: Instead of X-rays, MRIs use radio waves and strong magnets. MRIs can help detect tumors and determine the size and progression of the cancer.

  • Barium swallow: The patient drinks liquid with barium in it, which shows up on the X-ray to see how the throat looks while you swallow.

  • Chest X-rays: Doctors may use a chest X-ray to see if cancer has spread to the lungs.

  • PET scan: The patient ingests a special type of sugar that can be seen inside the body using a unique camera. The sugar shows up as “hot spots” if cancer cells are present, so a PET scan is useful for determining if and where cancer has spread.

Staging and Type of Head and Neck Cancers

If doctors believe you have a head and neck cancer, they will also diagnose what type and what stage of cancer. "Once a tumor is identified ... there are several tests that are done [to] stage the tumor," says Dr. Persky. Staging the tumor helps determine the size and extent of the tumor, status of lymph node involvement, or evidence of metastasis to distant organs in the body.

"The proper diagnosis and staging is very important as a starting point to determine how best to go forward," says Dr. Persky.