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FAQ
- Head and neck cancers may be discovered in multiple ways. A doctor or dentist may find the first evidence during a routine exam or oral, head and neck screening. For example, a swollen lymph node in the neck or an unexplainable red or white patch in the mouth may be seen. Most often, however, head and neck cancers are discovered only after a patient has sought treatment for symptoms that have become problematic.
- When you see your primary care doctor, you should discuss any past medical history as well as risk factors you have for head and neck cancer, such as tobacco or regular alcohol use, and the specific symptoms that you’re experiencing. Your doctor will examine your mouth, head, and neck for lumps, bumps, changes to your mouth or throat, or any problems with the nerves in and around these areas. If he or she feels you need further evaluation, you will likely be referred to an ear, nose, and throat specialist (also called an otolaryngologist) or head and neck surgeon.
- The ear, nose, and throat specialist (ENT) will perform a thorough head and neck exam. Because some parts of your throat are difficult to see, he or she may perform a pharyngoscopy. This procedure can be done in the office and does not require anesthesia. The ENT may use small, long-handled mirrors to see the deeper portions of your throat, the base of your tongue, and portions of the voice box. Alternatively, a tiny, flexible fiber-optic scope may be passed through your nose to examine areas that cannot be seen by eyes or mirrors, including the area behind the nose or the rest of your throat and voice box.
- If further investigation is required, your ENT will perform additional tests, which may include:
- Panendoscopy – This procedure is done under general anesthesia. The doctor will use scopes to thoroughly examine the throat, voice box, esophagus (tube leading to the stomach), trachea (windpipe), and bronchi (airways leading from the trachea into the lungs).
- Biopsy – In a biopsy, a sample of tissue is removed from the suspected tumor. The tissue is then examined for the presence of cancer or dysplasia (precancerous changes). Biopsies are examined in a lab by a pathologist who is specialized in cancer diagnosis. He or she is trained to distinguish between cancer cells and normal cells, as well as the type of cancer, based on the cells’ appearance. Depending on the specific situation, one or more types of biopsy may be used.
- Exfoliative cytology – The doctor collects cells from the area of the suspected cancer by scraping it with a small tool. The cells are spread onto a glass slide and examined under a microscope to look for abnormalities.
- Incisional biopsy – A piece of tissue is cut from the area of the suspected cancer. Depending on where the suspected cancer is located, this procedure may be done in the doctor’s office (the area will be numbed first) or in the operating room while you are asleep.
- Fine needle aspiration (FNA) – The doctor uses a thin, hollow needle and syringe to remove cells from the suspected tumor. The cells are then examined under a microscope. This type of biopsy is typically used to examine lymph nodes or lumps in the neck.
- HPV Testing – Tissues from a biopsy that are shown to be squamous cell carcinoma, especially when taken from the tonsil or the base of the tongue, are often tested for a genomic marker called p16, which is a sign that the cancer may be related to an HPV infection. HPV-related (p16+) cancers have been found to be significantly more responsive to treatment than those lacking p16.
- Imaging Tests – Your doctor may order imaging tests at different times during your diagnosis and treatment to look for a suspect tumor, to see if cancer has spread, to see if treatment is working, or to look for recurrence of cancer after treatment. Many different types of imaging can be used, including:
- Chest x-rays – These images are used to see if cancer has spread to the lungs.
- CT Scan – These images provide a detailed view of your organs and soft tissue. They allow your doctor to see the location of any tumors, whether a tumor is growing into nearby tissue or whether the cancer has spread to lymph nodes, lungs, or other organs. CT images also provide a detailed assessment of facial bones to see if they are affected by cancer.
- MRI – These images are useful in examining the neck and brain, as well as the extent that a tumor extends into soft tissue, such as muscle and fat or along nerves.
- PET Scan – PET scans are useful when cancer has already been diagnosed. They can help doctors see if cancer has spread to lymph nodes or other areas of the body, and it is especially useful if your doctor suspects the cancer may have spread but isn’t sure where. During a PET scan, sugar that contains a low level of radiation will be injected into your blood. Cancer cells will absorb more of this sugar than normal cells, making them more apparent on the images.