In this section we look at the different tests you may have to see if you have a head and neck cancer.
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Physical examination
Depending on your symptoms, the doctor may examine your mouth, throat, nose, neck, ears and eyes. They may gently press your tongue down to check the mouth or feel the area with a gloved finger. They will feel your neck to check the lymph nodes.
For hard-to-see areas, the doctor may use specialised equipment (endoscopy, see below), or suggest a procedure under anaesthetic (microlaryngoscopy) to fully examine the area. They may take a tissue sample to test (biopsy).
Endoscopy
An endoscopy (nasendoscopy or flexible laryngoscopy) looks at the nose and throat area using a thin, flexible tube with a light and camera on the end.
The doctor sprays a local anaesthetic (which tastes bitter) into one of your nostrils to numb the nose and throat. The tube is then gently passed into the nostril and down your throat to look at your nasal cavity, the different parts of the throat (nasopharynx, oropharynx, hypopharynx) and voice box (larynx). You will be asked to breathe lightly, and to swallow and make sounds. It may feel uncomfortable but shouldn’t hurt.
Images from the camera may be projected onto a screen and the doctor may also take a biopsy. An endoscopy takes a few minutes and is usually done in a doctor’s rooms. If you need a biopsy, it may take longer. You shouldn’t have hot drinks for about 30 minutes afterwards, but can go home straightaway.
Microlaryngoscopy
A microlaryngoscopy is done in hospital under a general anaesthetic. The doctor will look at your throat and voice box and take a biopsy. They’ll insert a stainless steel instrument called a laryngoscope into your mouth to hold the throat open, and use a telescope or a microscope to examine the throat and voice box. A microlaryngoscopy takes 30–60 minutes and you can go home after recovering from the anaesthetic. Your throat may be sore for a couple of days.
Biopsy
A biopsy is when a doctor removes a sample of cells or tissue from a suspicious sore or lump. A specialist doctor called a pathologist examines the sample under a microscope to see if it contains cancer cells, and may do special tests to help guide treatment. The sample may be taken using local anaesthetic during an endoscopy or under a general anaesthetic during a microlaryngoscopy. A needle can also be used to take a biopsy from lumps in the neck or other hard-to-reach areas. This is called a fine needle biopsy or core biopsy. It is often done using a CT scan or ultrasound to guide the needle to the correct place.
Biopsy results are usually available in about a week. If the cancer can’t be diagnosed from the tissue sample, you may have surgery to remove the mass so it can be checked for signs of cancer.
The lymph nodes in the neck are often the first place cancer cells spread to. If you have a lump in the neck or an imaging scan has shown a suspicious-looking lymph node, your doctor may recommend doing a fine needle or core biopsy of the lymph nodes. It is often done using an ultrasound or CT scan (see above) to guide the needle to the correct place.
→ READ MORE: Imaging tests for head and neck cancers
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A/Prof Martin Batstone, Oral and Maxillofacial Surgeon and Director of the Maxillofacial Unit, Royal Brisbane and Women’s Hospital, QLD; Polly Baldwin, 13 11 20 Consultant, Cancer Council SA; Martin Boyle, Consumer; Dr Teresa Brown, Assistant Director Dietetics, Royal Brisbane and Women’s Hospital, Honorary Associate Professor, University of Queensland, QLD; Dr Hayley Dixon, Head, Clinical Support Dentistry Department, WSLHD Oral Health Services, Public Health Dentistry Specialist, NSW; Head and Neck Cancer Care Nursing Team, Royal Melbourne Hospital, VIC; Rhys Hughes, Senior Speech Pathologist, Peter MacCallum Cancer Centre, VIC; Dr Annette Lim, Medical Oncologist and Clinician Researcher – Head and Neck and Non-melanoma Skin Cancer, Peter MacCallum Cancer Centre, VIC; Dr Sweet Ping Ng, Radiation Oncologist, Austin Health, VIC; Deb Pickersgill, Senior Clinical Exercise Physiologist, Queensland Sports Medicine Centre, QLD; John Spurr, Consumer; Kate Woodhead, Physiotherapist, St Vincent’s Health, Melbourne, VIC; A/Prof Sue-Ching Yeoh, Oral Medicine Specialist, University of Sydney, Sydney Oral Medicine, Royal Prince Alfred Hospital, Chris O’Brien Lifehouse, NSW.
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