Diagnosis & Staging
Getting the right diagnosis and determining whether your cancer has spread is the first step to getting the best treatment. At Memorial Sloan Kettering, our team of experts works together to gather as much information about your cancer as possible to guide our approach to care.
Diagnosing a head and neck cancer includes one or more of the following tests:
Medical History & Physical Examination
First, the doctor or nurse will take a complete medical history, noting all symptoms and risk factors. The doctor will thoroughly examine the head and neck area, feeling for abnormalities, looking at the inside of the mouth and throat, and using mirrors and lights to examine hard-to-see areas. This is the most important part of the exam; an experienced physician may be able to detect problems that a less experienced one might not observe.
In some cases, the doctor may use a flexible, lighted tube called an endoscope to examine areas of the head and neck that are less accessible. This tube may be inserted through the nose or mouth, using a topical anesthetic (a medication applied directly to the nose and throat) to make the examination more comfortable. Depending on whether the focus of the examination is the nasopharynx, pharynx, or larynx, it is called a nasopharyngoscopy, pharyngoscopy, or laryngoscopy. Occasionally, the doctor will perform a more thorough type of endoscopic examination, called panendoscopy, while the patient is under general anesthesia.
Imaging tests such as CT, MRI, or ultrasound may be required to gain more information about the location and extent of the tumor. Doctors at Memorial Sloan Kettering also use PET scans to help diagnose head and neck cancers. PET scans are often combined with CT to determine whether the cancer has spread to lymph nodes in the neck or other areas of the body. Additional imaging tests may include panorex (a special x-ray of the jaws), barium swallow (which helps to image abnormalities in the esophagus), dental x-rays, chest x-rays, and radionuclide bone scanning (a sensitive method of measuring bone activity).
A biopsy involves removing a small amount of tissue or fluid for examination under a microscope. Depending on the size and location of the nodule or lesion, a biopsy can be performed with either a small scalpel or needle in an outpatient setting, or in the hospital while the patient is under general anesthesia.
After a diagnosis has been made, doctors will determine the stage (extent) of the tumor, using information collected from exams and diagnostic tests to describe how advanced it is, and if and where the cancer has spread. This information is used to determine the best course of treatment and to establish an estimate of the patient’s prognosis.
The Tumor, Node, Metastasis (TNM) staging system is most widely used for head and neck cancers. Head and neck physicians at Memorial Sloan Kettering helped to develop and update this staging system.