How is head and neck cancer diagnosed?

You doctor or dentist may do some general tests. If you need further tests, they will refer you to a specialist. These tests may include:

• medical history, and physical examination of the mouth, throat, neck, ears or eyes
• endoscopy, where a thin tube with a light and camera on the end is inserted through the nose to look for abnormal areas in the nose and throat. This may also be called a nasendoscopy or flexible laryngoscopy
• microlaryngoscopy, where a laryngoscope (a steel surgical instrument) is inserted through the mouth to hold the throat open, and a microscope is used to examine the throat and voice box
• imaging tests – for example, ultrasound, X-ray, computerised tomography (CT) scan, magnetic resonance imaging (MRI) or positron emission tomography (PET)-CT scan
• biopsy, where a small sample of tissue is removed (this may happen during an endoscopy or microlaryngoscopy) and sent to a pathologist to look for cancer cells under a microscope. A needle can also be used to take a biopsy, called a fine needle biopsy or core biopsy
• a blood test to check for blood counts, liver and kidney function, and markers for Epstein–Barr virus.

Staging

If you are diagnosed with head and neck cancer, you might have more tests to determine the stage of the disease and whether the cancer has spread to other parts of the body. Knowing the stage of the disease helps your medical team plan the best treatment for you.

Head and neck cancers are often staged using the TNM (tumour, node, metastasis) system. Numbers (or scores) are given to the size of the tumour, whether lymph nodes are affected and whether the cancer has spread. Higher scores mean that the cancer is more advanced. These scores are combined to work out the overall stage of the cancer.

There can be small differences in the way each type of cancer is staged. Also, cancers in the oropharynx (the middle part of the throat and back of the mouth) are staged differently depending on whether they are linked to HPV. In general, head and neck cancers have 4 stages, depending on the size of the tumour and whether it has spread to other organs:

• Stages I and II, or early head and neck cancer, is where the cancer is small and hasn’t spread
• Stages III and IV, or advanced head and neck cancer, is where the cancer is larger and has spread to nearby tissue or lymph nodes (locally advanced cancer), or to other parts of the body (metastatic cancer).

No standard staging system is used for metastatic squamous neck cancer with unknown primary.