This cancer is sometimes spotted during routine checkups.
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.
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Once we see someone in the office
who's been referred, because there's some
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concern about the possibility of head and
neck tumor, a very thorough and detailed
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history is obtained to try and focus
in on were the primary site might be.
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And there's a thorough
evaluation of the oral cavity
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which is performed very simply,
then there is additional examination.
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Focusing both on the nasal cavity and
the nasal pharynx,
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as well as the back of the throat
called the oral pharynx and
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the larynx which is the voice box,
using specialized fiber optic or
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other types of high resolution scopes that
we can easily visualize the areas that
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might be potentially involved and get an
idea if there's a tumor developing there.
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We do a complete and
a comprehensive head and neck examination.
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There could potentially be more
than one tumor that's developed and
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only one of the tumors
might be systematic, and
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it's not uncommon to get
what we call a field effect.
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Where the squamous mucosa, which is the
area that develops the great majority of
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these tumors, can't have any
carcinogenic type of effects and
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we wanna make sure that we can
get a thorough evaluation,
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as well as make sure that there's not
potentially a second tumor in the area.
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In addition, we would also
examine the neck to see if there
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are any lymph nodes involved at
the same time, because obviously that's
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an important issue if there's any spread
of tumor beyond the primary site.
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Once a tumor is identified and
once it's identified as being a cancer,
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then there are several tests that are done
to what we call "stage" the tumor.
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To basically define, number one,
the extent of the primary tumor.
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Number two, is there any
evidence of metastatic disease or
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spread of tumor to the lymph
nodes of the neck?
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And the third staging we
have to be careful of is,
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is there any metastatic disease
beyond the head and neck.
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Perhaps the lungs, the liver, the bone.
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These all increase the staging if there is
increasing involvement of those particular
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Typically there are four stages.
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Stage one, hopefully being an early
carcinoma, and early cancer.
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And stage four is a more advanced disease.
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The proper diagnosis and staging is
very important as a starting point.
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To determine how best to go forward and
hopefully effect a cure.
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Head and neck cancers. Bethesda, MD: National Cancer Institute. (Accessed on March 18, 2019 at https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet.)
If you have head or neck cancer. Atlanta, GA: American Cancer Society, 2018. (Accessed on March 18, 2019 at https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/if-you-have-head-or-neck-cancer.html.)
Overview of the diagnosis and staging of head and neck cancer. Waltham, MA: UpToDate, 2019. (Accessed on March 18, 2019 at https://www.uptodate.com/contents/overview-of-the-diagnosis-and-staging-of-head-and-neck-cancer.)