Tests to diagnose head and neck cancers include examinations, biopsies and imaging tests, such as ultrasound, CT and MRI scans.
If you notice any symptoms, arrange to see your GP. You can also tell your dentist about any mouth sores, swelling or change of colour in your mouth, as they are trained to look for signs of mouth cancer. Your GP or dentist may do some general tests and then refer you to a specialist.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for head and neck cancer can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
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), or recommend a procedure under anaesthetic (microlaryngoscopy) that lets them fully examine the area. They may also remove a tissue sample (biopsy).
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.
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.
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.
A biopsy is when doctors remove a sample of cells or tissue from a suspicious sore or lump, and examine it to see if it contains cancer cells. 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 (fine needle 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.
Imaging tests give more details about where the cancer is and whether it has spread to other parts of your body. You will usually have imaging tests before a biopsy is done.
Before having scans, tell the doctor if you have any allergies or have had a reaction to dyes during previous scans. You should also let them know if you have diabetes or kidney disease, or are pregnant or breastfeeding.
Types of imaging tests
- Ultrasound – sometimes used, particularly to look at the thyroid, salivary glands and lymph glands in the neck. A small device called a transducer is coated with gel and moved over the area. The transducer sends out soundwaves that echo when they meet something dense, like an organ or tumour. A computer creates a picture from these echoes. An ultrasound is painless and takes about 15–20 minutes.
- CT scan – uses x-ray beams to create detailed cross-sectional pictures of the inside of your body. Before the scan, you may have an injection of dye (called contrast) into a vein to make the pictures clearer. The scan itself takes about 10 minutes.
- PET–CT scan – usually recommended to see if the cancer has spread. Before the scan, you will be injected with a glucose solution containing some radioactive material to help cancer cells show up brighter on the scan. PET-CT scans usually take 30–90 minutes.
- MRI scan – uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the inside of your body. A dye may be injected into a vein before the scan to help make the pictures clearer. MRI scans usually take 30–90 minutes.
- X-rays – some people have a special x-ray called an orthopantomogram (OPG) to check the jaw and teeth.
Staging head and neck cancers
Working out how far the cancer has spread is called staging. It helps your doctors recommend the best treatment for you.
In Australia, the TNM (tumour–nodes–metastasis) system is the method most often used for staging head and neck cancers. In this system, each letter is assigned a number to describe the cancer.
Based on the TNM numbers, the doctor then works out the cancer’s overall stage on a scale of 1–4. Each type of head and neck cancer is staged slightly differently, and oropharyngeal cancers are staged differently depending on whether they are linked to HPV. In general:
- stages 1–2 mean the cancer is small and hasn’t spread from the primary site (early head and neck cancer).
- stages 3–4 mean the cancer is larger and has spread (advanced head and neck cancer). It may have spread to nearby tissue or lymph nodes (locally advanced cancer) or to other parts of the body (metastatic cancer).
Ask your doctor to explain what the stage of the cancer means for you.
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about the general outlook for people with the same type and stage of cancer as you.
To work out your prognosis and advise you on treatment options, your doctor will consider:
- your test results
- the type of head and neck cancer
- your smoking history
- the cancer’s HPV status
- the rate and depth of the cancer’s growth
- the likelihood of response to treatment
- other factors such as your age, level of fitness and overall health.
In most cases, the earlier head and neck cancer is diagnosed, the better the outcome, but people with more advanced head and neck cancer may also respond well to treatment. Oropharyngeal cancers linked with HPV also usually have better outcomes.
Understanding Head and Neck Cancers
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Expert content reviewers:
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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The information on this webpage was adapted from Understanding Head and Neck Cancers - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in October 2021.