Head & Neck Cancer Diagnosis
It is important for head and neck cancer to be diagnosed as early and accurately as possible. This increases the chance for a successful treatment while maintaining your quality of life, including the ability to hear, speak and swallow.
The experts at MD Anderson are among the most skilled and experienced in the world in diagnosing the different types of head and neck cancer. This high level of expertise, combined with advanced diagnostic tools, allow them to accurately diagnose each cancer type and subtype. Doctors use this information to develop the best possible personalized treatment plans.
Head & Neck cancer diagnostic tests
If you have symptoms that may signal head and neck cancer, your doctor will examine you and ask you questions about your health and lifestyle, including smoking and drinking habits and family medical history.
You may then undergo diagnostic tests. These tests can be used to identify cancer and find out if it has spread. During care, some tests can monitor how you are responding to treatment.
One or more of the following tests may be used to diagnose head and neck cancer:
Physical exam: Doctors will examine the area where cancer is suspected. They may use special tools or techniques to examine areas that are hard to reach. These include:
- Indirect laryngoscopy: Your health care provider holds a small mirror at the back of the throat and shines a light on the mirror to view the throat area. A medicine to numb the back of your throat may be used.
- Fiberoptic laryngoscopy: Also called a nasolaryngoscopy, this exam uses a small flexible telescope to examine the throat. The device is passed through the nose and into the throat. This is the most common way to examine the pharynx and larynx, or voice box. Numbing medicine will be sprayed in the nose. This procedure typically takes less than 1 minute.
Biopsy: During a biopsy, a small tissue sample is removed and examined under a microscope for the presence of cancer cells. Depending on tumor location, some biopsies can be performed with just a needle and local anesthesia. Other times patients must have a surgical biopsy under general anesthesia.
Imaging exams: Imaging exams allow doctors to look inside the body without surgery. Several types of imaging exams can be used to diagnose and monitor head and neck cancer, including:
- CT scan: A CT scan uses an X-ray machine to take several pictures from different angles, providing a highly detailed image.
- MRI: Magnetic resonance imaging, or MRI, uses magnetic fields and radio waves to generate pictures of the body’s soft tissue and organs.
- Ultrasound: Ultrasound operates with high-energy sound waves that bounce off internal tissues and organs and produce echo patterns. The echo patterns create a picture referred to as a sonogram, which can be seen on an ultrasound machine.
- PET scan: During a positron emission tomography scan, or PET scan, a small dose of radioactive sugar is injected into a patient. A scanner shows where the body distributes the sugar, allowing for the creation of an image. This image can help radiologists find cancer cells in the body.
- X-Ray: X-rays use low doses of high-energy radiation that travel through the body to create an image. X-rays are used to image bones and can also help spot tumors.
Learn more about imaging exams.
Blood and urine tests: Blood and urine tests can check the patient’s hormone levels, which can be impacted by head and neck tumors like thyroid cancer and parathyroid disease. Blood and urine tests can also monitor how the cancer is responding to treatment and monitor side effects of those treatments.
Functional tests: Head and neck cancer can impact the throat, eyes and ears. Patients with a suspected cancer in one of these areas may be tested on their vision, hearing, swallowing and/or balance.
Molecular diagnosis: Different cancers have different features on the molecular level. Molecular testing identifies the features that impact treatment, helping doctors create the most effective treatment plan.
Genetic testing: Some cancers are caused by genetic conditions that can be passed down from parent to child. Genetic testing identifies patients with these conditions.
Learn more about the diagnostic tests for:
- Eye cancer
- Oral Cancer
- Parathyroid disease
- Pituitary tumors
- Retinoblastoma
- Salivary gland cancer
- Skull base tumors
- Throat cancer
- Thyroid cancer
Some cases of head and neck cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
What is a biopsy? 7 questions, answered
Many cancer patients will need a type of tissue analysis called a biopsy at some point. What is a biopsy, how does it work and what can it reveal about your condition?
We went to anatomical pathologist and Pathology Chair Victor Prieto, M.D., Ph.D., for insight.
What is a biopsy?
A biopsy is a tissue sample taken from a living patient. It can be used to determine a number of things, including the presence or absence of:
- an infection, as well as its type
- cancer cells and their type
- inflammation or an allergic reaction to medication
- abnormal material, such as a foreign object
- other diseases or conditions, such as amyloidosis
In other words, a biopsy is not only used to confirm something. It can also be used to rule something out.
Tissue samples range from skin and bone to muscle, brain and more. But the sample has to be tissue; it can’t be blood, urine, saliva or any other bodily fluid. Those are processed at a different type of laboratory.
How do biopsies work?
Once a tissue sample is obtained, it’s sent to a pathology lab for analysis. There, the tissue is processed in one of two ways:
- It’s frozen.
- It’s dehydrated and glazed with wax.
Either way, the goal is to make the sample hard enough to be easily sliceable. In order for a pathologist to examine the sample under a microscope, it has to be very thinly sliced. The slices must be thin enough for light to pass through them. Our sections are just five microns across, so thin that you could fit 200 in a single hair.
After slicing the tissue and placing it on a glass slide, we use dyes to give color to different structures. The center of the cell (the nucleus) becomes purple, for instance, while the surrounding area (the cytoplasm) takes on other colors. This allows our pathologists to distinguish between different types of cells and help determine whether they’re benign or malignant.
We also use different stains to change the colors of various structures and special techniques that allow us to detect them. The ones we use most often enable us to detect antigens, which are structures made of proteins and sugars that are sometimes unique to one disease. Some lung cancer antigens, for example, are different from colon cancer antigens.
Other techniques allow us to detect genetic materials (DNA/RNA) that also help in cancer diagnosis and treatment. Lung cancer, for example, could have a specific mutation called EGFR that makes patients eligible to receive certain treatments. Also, some cancers that contain the antigen PD-L1 may be treated with immunotherapy, using anti-PDL-1 medications such as pembrolizumab or nivolumab.
How do doctors decide which processing method to use?
The freezing process is usually done when you need an answer right away. If a patient is in the operating room, for instance, you might need an immediate assessment of tumor tissue or a lymph node to decide how the surgery should proceed. You can obtain results using this process in as little as 20 minutes.
The other processing method is considered more standard, so that’s what most patients experience. It takes at least 24 hours to get results, but sometimes longer, depending on the type of tissue.
How many different types of biopsies are there?
There are four general biopsy categories.
- Curettage: This involves scraping cells from the surface of something, whether it’s skin, the cervix, the lining of the uterus or another structure. This category includes “shave biopsies,” in which a blade is used parallel to the skin to remove tissue, such as a mole.
- Punch: Also known as “tru-cut,” these biopsies are core samples usually obtained by using cylinders of various sizes that have a serrated edge. The end of the cylinder is applied to the surface of the tissue and twisted down to cut into it, then removed with the sample inside. This category includes fine-needle aspirations (essentially, very thin tissue samples) and is also used to extract bone marrow. Samples obtained using needles from deeply located tissues are called needle core biopsies.
- Blade: This type of biopsy is normally performed during open or endoscopic surgery, as it requires direct access to whatever is being sampled. Tissue samples are obtained by cutting the tissue and obtaining fragments in different shapes.
- Larger specimens: This category includes tumors or organs that have been surgically removed from the body (such as during a lumpectomy or a colectomy), as well as amputations.
Do biopsies hurt?
Cutting or scraping any part of the body can cause pain or discomfort. But a physician or nurse should be able to numb the area being biopsied so that the procedure won’t hurt.
During curettage and punch biopsies, for instance, some combination of topical and local anesthesia is often used. General anesthesia is used for some of the more invasive biopsy procedures, like the amputation of a digit.
Are certain types of biopsies used to diagnose particular cancers?
Bone marrow biopsies are used to look for blood cancers like leukemia and lymphoma.
Punches are used for skin cancers like melanoma, as well as breast, liver, kidney and soft tissue cancers.
Why might your doctor order a biopsy?
To confirm a cancer diagnosis, we have to examine tissue under a microscope. That’s the main reason behind the vast majority of biopsies we perform here at MD Anderson. If you already know you have cancer, a scan might be sufficient to determine if it’s metastasized or returned. Similarly, a biopsy may be needed to rule out an infection (e.g., bacterial, fungal) or a reactive process (such as a drug allergy).
The second reason we perform biopsies is to personalize our patients’ care plans. To determine what type of cancer treatments someone is eligible for, we need to know the particular characteristics of the cells in their tumors, so we analyze them at the molecular level to look for genetic mutations. Those are things we still can’t obtain from any type of imaging.
Personalized treatment plans lead to better outcomes. So, accurate diagnoses also ensure that patients will get the right treatment for their specific diagnoses.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.