Diagnosing mouth, nose & throat cancer

Monday 31 October, 2011

On this page: Physical examination | Nasendoscopy | Laryngoscopy | Examination under anaesthesia | Biopsy | Computerised tomography (CT) scan | Magnetic resonance imaging (MRI) scan | Ultrasound scan | Positron emission tomography (PET) scan | X-rays | Cancer staging | Health professionals you may see | Information reviewers

If you have symptoms, we encourage you to see your general practitioner (GP) for a check-up. Your GP will probably refer you to a specialist, who will do some tests to see if you have cancer. Depending on your symptoms, you may have one or more of the following tests.

Physical examination

The doctor will examine you carefully. They will look inside your mouth and may use a gloved finger to feel areas difficult to see. Sometimes they will need to gently use a wooden or plastic spatula inside the mouth to see more clearly. The doctor may use a special camera on the end of a pipe to obtain images of an oral cavity tumour. They will gently feel the side of your neck for abnormal lymph nodes.

Nasendoscopy

A nasendoscopy looks at your nose, pharynx and larynx using a flexible, fibre-optic tube with a light on the end (endoscope). This is the usual technique that the doctors will use to examine the tumour as the head and neck cavities are difficult to visualise.

A local anaesthetic spray is squirted gently into the nose to numb the back of your nose and throat. People often report that the spray is bitter tasting.

The doctor will insert the endoscope into your nose and look at your nasal cavity, nasopharynx, oropharynx, hypopharynx and larynx. Images from the endoscope may be projected onto a TV screen. 

The procedure is not painful as the fibre-optic tubes are soft and flexible. However, the procedure can feel unusual - as if something were in your throat. You will be asked to breathe lightly through your nose and mouth, and relaxed gentle breaths will make the procedure smoother. You may be asked to swallow. You may have to make some vocal noises. The test will take 5 to 15 minutes.

Afterwards you may not be able to eat or drink for a short period of time. Speak to your doctor or nurse if you have questions. You can go home after the test is finished.

Laryngoscopy

A laryngoscopy may be required to better visualise and access your larynx and pharynx. It is usually done under a general anaesthetic with a laryngoscope (a tube with a light on it). During the general anaesthetic, your specialist will probably take a tissue sample (biopsy).

Examination under anaesthesia

Sometimes the doctor will need to examine you while you are asleep if the area of the cancer is difficult to see comfortably when you are awake. The doctors usually will take a biopsy during this time. It is always safer to do examinations and take biopsies when you are awake, if this is possible.

Other tests

Examination of the pharynx and the larynx can be done indirectly with a mirror, but this technique is not commonly used any more. 

Biopsy

A biopsy is when the doctor removes tissue for examination under a microscope. This will show whether cancer cells are present and what type of cancer it is. A biopsy can be performed during a physical examination, nasendoscopy or laryngoscopy. You may have an anaesthetic. Results of the biopsy are usually available in about a week.

If you have a biopsy on a lump in your neck, it will probably be done with a needle, often guided by an ultrasound machine.

Computerised tomography (CT) scan

A computerised tomography (CT) scan is a procedure that uses x-ray beams to take pictures of the body. Before the scan, you may have dye called contrast solution injected into your veins. This dye will make scan pictures clearer, but you may feel flushed or hot for a few minutes. You may require a blood test first to ensure the contrast is safe for your kidneys. If you have a serious reaction, like breathing difficulties, tell your doctor immediately.

You will lie still on a table while the CT scanner, which is large and round like a doughnut, slowly moves around you. This is painless. The CT scan itself takes a few minutes, but the preparation takes 10 to 30 minutes. You can go home when the scan is complete.

Magnetic resonance imaging (MRI) scan

Magnetic resonance imaging (MRI) uses magnetism and radio waves to build up detailed cross-section pictures of the body. As with a CT scan, a different type of dye may be injected into your veins before the scan. 

You will lie in a narrow metal cylinder during the scan. If you are worried about being in a confined space, talk to your health care team. An MRI is painless and is over in about an hour. You can go home when the scan is done.

If you have a pacemaker or other metallic object in your body, you can't have an MRI scan due to the effect of the magnet. Before a CT or MRI scan, tell the doctor if you are allergic to iodine, fish or dyes.

Ultrasound scan

An ultrasound is a non-invasive, painless scan that uses soundwaves to create a picture of part of your body. Ultrasounds are sometimes used to diagnose pharyngeal cancer, or to see if the cancer has spread (metastasised).

You will usually be asked not to eat or drink for about four hours before an ultrasound. A gel is spread over the area of your body that will be scanned. A paddle-shaped device called a transducer is moved over your body and a picture is shown on a computer. You can usually have an ultrasound as an outpatient.

Positron emission tomography (PET) scan

A positron emission tomography (PET) scan is a special imaging test that is available at some hospitals. A PET scan is usually done to help diagnose some types of cancer, or to see if cancer has spread (metastasised). 

You will be given a radioactive glucose solution that takes 30 to 90 minutes to go through the body. Afterwards, you will be scanned for high levels of radioactive glucose: active cancer cells will have an increased uptake of this solution. 

You usually don't have to stay in hospital for the PET scan, but it will take several hours to prepare for and have the scan. If you are diabetic, the test may be affected by your sugar control. There may be delays or longer procedures. Tell your doctor if you have diabetes as this will affect your PET bookings and results.

X-rays

Your doctor may order x-rays if this is appropriate for your type of cancer. The x-rays themselves are quick, safe and painless.

Cancer staging

The tests described on previous pages show whether you have cancer. They will also show where the cancer began and whether the cancer cells have spread to other parts of your body (this is known as metastasis). This helps your doctors ‘stage' the disease so they can work out the best treatment for you.

The staging system used for cancers of the mouth, nose and throat is known as the ‘TNM system' (T=tumour, N=nodes, M=metastases). 

TNM system

T T followed by a number between 1 and 4 shows the size of the cancer. A higher number after the T (for example T3 or T4) means it is larger. 
N N plus a number from 0 to 3 describes whether the cancer has spread to lymph nodes in the area, and if so, the size of the nodes. Higher numbers are used for nodes that are more seriously affected by the cancer. ‘N0' cancers have not spread to the lymph nodes. 
M M followed by 1 shows that the cancer has spread to other organs or to lymph nodes that are not near the primary cancer. ‘M0' cancers have not spread in this way. 

 

Doctors combine this information to determine the stage of the cancer, from Stage 1 to Stage 4. For example, a cancer assessed as T1, N0, M0 (small cancer, lymph nodes not affected and no metastasis) would be called a Stage 1 cancer. Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you to choose the best treatment for your situation.

Doctors and other health professionals you may see

Your GP will usually arrange the first tests to assess your symptoms. This can be a worrying and tiring time, especially if you need several tests. If these tests do not rule out cancer, you will usually be referred to a specialist, who will arrange further tests and advise you about treatment options.

Cancer in these parts of the body often affects other areas, so you may see some of the following health professionals:

Head and neck surgeons  are ear, nose and throat surgeons or general surgeons with further specialist training 
Oral (maxillofacial) surgeons  specialist dentists trained in surgery to the mouth and jaw 
Dentists or oral medicine specialists  evaluate and treat mouth and teeth
Prosthodontists  dentists who specialise in replacing any missing teeth 
Reconstructive plastic surgeons  restore, repair or reconstruct the appearance and function of your body using surgery
Dietitians  will recommend the best diets to follow during and after treatment 
Gastroenterologists  diagnose and treat people with diseases of the digestive system, and insert a feeding tube if required 
Speech pathologists  help people with speech and swallowing problems 
Audiologists  diagnose and treat hearing problems 
Medical oncologists  are responsible for chemotherapy
Radiation oncologists  are responsible for radiotherapy  
Nurses and general practitioners  will help you through all stages of your cancer 
Social workers, psychologists and counsellors  will advise you on support services and help you get back to normal activities 
Palliative care physicians  will assist with symptom management and emotional support for you and your family 
"Never be afraid to ask your doctor or health professional about things you don't understand. Far too often, patients are hesitant to seek information regarding what is in store and what is involved. I went into my operation knowing very little of what was in store." — (Bob, 54)

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This is called a multidisciplinary team. A multidisciplinary team can greatly improve your quality of life.

 

Information reviewed by: Dr Annette Lim, Medical Oncology Fellow, Peter MacCallum Cancer Centre; Members of the Western and Central Melbourne Integrated Cancer Service Head and Neck Tumour Group. 


Back to top

for