In this section we look at the different tests you may have to see if you have a head and neck cancer.
Learn more about these tests for head and neck cancers:
Physical examination
Depending on your symptoms, the doctor will examine your mouth, throat, nose, neck, ears and/or eyes. They may use a tongue depressor for a clearer view of the mouth and feel the inside of the mouth with a gloved finger. They will also gently feel both sides of your neck to check the lymph nodes.
For hard-to-see areas, the doctor may use specialised equipment (endoscopy, see below), or recommend a procedure under anaesthetic (microlaryngoscopy) that lets them fully examine the area. They may also remove a tissue sample (biopsy).
Endoscopy
In this procedure, your doctor examines the nose and throat area using a thin, flexible tube with a light and camera on the end. The procedure may be called a nasendoscopy or flexible laryngoscopy and it is usually done in the doctor’s rooms.
Before inserting the tube, the doctor may spray a local anaesthetic into one of your nostrils to numb the nose and throat. You may find that the spray tastes bitter. The doctor will gently pass the tube into the nostril and down your throat to look at your nasal cavity, nasopharynx, oropharynx, hypopharynx and larynx. You will be asked to breathe lightly through your nose and mouth, and to swallow and make sounds. You may find this test uncomfortable but it should not hurt. Images from the camera may be projected onto a screen and the doctor may also take tissue samples (biopsy).
An endoscopy usually takes a few minutes. If you need a biopsy, the test may take longer. You will be advised to not have any hot drinks for about 30 minutes after the procedure, but you can go home straightaway.
Microlaryngoscopy
This procedure is done in a hospital while you are asleep under general anaesthetic. It allows the doctor to look at your throat and voice box and take a tissue sample (biopsy). The doctor inserts a stainless steel instrument called a laryngoscope into your mouth to hold the throat open, and uses telescopes or a microscope to examine the throat and voice box. The procedure takes 30–60 minutes and you can go home when you’ve recovered from the anaesthetic. You may have a sore throat for a couple of days.
Biopsy
A biopsy is when doctors remove a sample of cells or tissue from a suspicious sore or lump. A pathologist examines the sample under a microscope to see if it contains cancer cells, and may do some 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 may be called a fine needle biopsy or core biopsy. It is often done using an ultrasound or CT scan 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 outside the primary site. 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.
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A/Prof Richard Gallagher, Head and Neck Surgeon, Director of Cancer Services and Head and Neck Cancer Services, St Vincent’s Health Network, NSW; Dr Sophie Beaumont, Head of Dental Oncology, Dental Practitioner, Peter MacCallum Cancer Centre, VIC; Dr Bena Brown, Speech Pathologist, Princess Alexandra Hospital, and Senior Research Fellow, Menzies School of Health Research, QLD; Dr Teresa Brown, Assistant Director, Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, QLD; Lisa Castle-Burns, Head and Neck Cancer Specialist Nurse, Canberra Region Cancer Centre, The Canberra Hospital, ACT; A/Prof Ben Chua, Radiation Oncologist, Royal Brisbane and Women’s Hospital, GenesisCare Rockhampton and Brisbane, QLD; Elaine Cook, 13 11 20 Consultant, Cancer Council Victoria; Dr Andrew Foreman, Specialist Ear, Nose and Throat Surgeon, Royal Adelaide Hospital, SA; Tony Houey, Consumer; Dr Annette Lim, Medical Oncologist and Clinician Researcher – Head and Neck and Non-melanoma Skin Cancer, Peter MacCallum Cancer Centre and The University of Melbourne, VIC; Paula Macleod, Head, Neck and Thyroid Cancer Nurse Coordinator, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Dr Aoife McGarvey, Physiotherapist and Accredited Lymphoedema Practitioner, Physio Living, Newcastle, NSW; Rick Pointon, Consumer; Teresa Simpson Senior Clinician, Psycho-Oncology Social Work Service, Cancer Therapy Centre, Liverpool Hospital, NSW.
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