Head and Neck/Oral Cancers: Diagnosis

What investigations may I need for diagnosis and treatment planning?

During a physical exam, the physician will examine the patient, checking for lumps on the neck, mouth and throat. A fiberoptic nasopharyngoscopic exam (thin camera through the nose) may be needed to perform a complete clinical examination of the head and neck area.

The following imaging tests may also be ordered to determine the location and extent of the cancer.

Computed Tomography (CT) scans take many different x-rays to produce detailed, cross-sectional images of the liver and other organs. CT scans can help locate tumors or determine their types, detect swelling or bleeding, and evaluate the effects of treatments. Injections of iodine dye (contrast material) may be used to enhance the visibility of abnormal tissue.

Magnetic Resonance Imaging (MRI) scans use radio waves and strong magnets instead of x-rays to take pictures of the body. MRIs map the location, size, and sometimes even the type of tissue contained in the tumor, and are useful tools for planning biopsies. MRI can clearly show tumors near bones, smaller tumors, and brainstems masses. It uses a magnetic field rather than x-rays (radiation).

Positron Emission Tomography (PET) scans create images based on the metabolic activity of cells in the body. A small amount of radio-labeled glucose is injected into the bloodstream. The glucose is taken up and metabolized by the tissues. Since cancer cells metabolize more glucose than normal cells, they "light up" more brightly on the PET scans. This test is most useful after diagnosis to help determine the grade of a tumor or to distinguish between cancerous and dead or scar tissue.

Endoscopy An endoscope is long lighted tube that is passed through the patient’s nose into the cavities of the head and neck, allowing the physician to explore these areas without surgery.

Biopsies To confirm if the diagnosis, the physician may perform a biopsy, removing tissue from any suspicious lump or mass. This will then be analyzed underneath a microscope to determine if any cells in the lips, gums, tongue, salivary glands and the roof or floor of the mouth are malignant.

Fine Needle Biopsy A physician may perform a needle biopsy (fine needle aspiration, or FNA), injecting a needle into the tumor and then suctioning out cells to be examined under a microscope. If the patient’s lymph nodes are enlarged, this same technique will be employed to assess whether there is any cancer present.