Head and neck surgeon Dr. Marc Cohen talks with his patient in an MSK exam room.
MSK's Guide To

Throat Cancer Diagnosis, Types & Stages

Overview

At MSK, treatment for throat cancer starts with a correct diagnosis. We’re here to help you take the first steps toward getting the best cancer care. 

You may be reading this because you’re worried about getting throat cancer. Maybe you’re waiting for test results. Or perhaps you or someone you care about just learned they have throat cancer. 

This guide will help you understand how throat cancer is diagnosed and what your diagnosis means. Learning as much as you can may help you feel ready to talk with doctors about your care. 

Head and neck surgeon Dr. Snehal Patel examines the neck of his patient in an exam room.
The diagnosis process

A throat biopsy is the first step in diagnosing throat cancer. A surgeon will remove cells or tissue to test for cancer. You’ll also get imaging tests, such as CT or MRI scans. 

A nurse practitioner reviews head and neck images of test results with her patient.
Understanding your diagnosis

Your throat cancer diagnosis most often will describe where the cancer started, its type, and if it has spread. We use this information to create a custom care plan just for you. 

The diagnosis process

How is throat cancer diagnosed?

Throat cancer diagnosis often starts with a physical exam. Your doctor will check for anything abnormal (not normal), such as a lump in your neck.

If something does not look right, your doctor may do an endoscopy. They’ll put a scope (a thin tube with a camera) into your nose and down your throat. They’ll look for signs of cancer. 

If you have signs or symptoms of throat cancer, your diagnosis process may look like this:
  • Health record: If you have throat cancer symptoms, your primary care provider will review your health record. They’ll ask questions to find out if you have any signs or symptoms of throat cancer. 
  • Throat biopsy: Your doctor may do a biopsy. This is a procedure to remove a small sample of tissue or cells to examine under a microscope. A biopsy is the most reliable way to confirm if you have throat cancer.   
Video | 1:57 How to Prepare for Your First Appointment at MSK

Medical oncologist Dr. Devika Rao shares tips on what to expect during your first visit at MSK, and how to get ready.

We want to ensure your first visit is as productive and supportive as possible. Here are some tips on how you can best prepare.

  1. Know your medical and family history. Be ready to share your personal medical history and any significant family history of cancer or genetic conditions. This can influence treatment choices.
  2. Write down your questions. You may have many concerns. Bring a written list so we can address them all. Questions might include prognosis, treatment options, side effects, or logistics surrounding treatment. We understand that this is a new journey, so no question is trivial.
  3. Bring a support person. A friend or family member can offer emotional support, take notes, and help remember what is discussed.
  4. Be prepared for a thorough discussion. The first visit will include a detailed conversation about your diagnosis, possible treatment plans, and next steps. It may also include additional lab work or imaging. We are here to help you through every step of this process, and we’ll work together to create a care plan that fits your needs and goals.
  • Imaging tests: If cancer cells are found in your biopsy tissue sample, your doctor will order imaging tests. They may include a computed tomography (CT) scan or a magnetic resonance imaging (MRI). You may have a Panorex X-ray to get more details. This shows your full upper and lower jaw, including your sinuses. The scans can show how deep the cancer is and if it has spread. 
  • Genetic tests: A tumor genetic profiling test also is called genomic testing, molecular profiling, or next-generation tumor sequencing. Genomic testing tells us which genetic changes (mutations or variants) caused the cancer and made it grow. The test results let us target those genes to treat the tumor. The tumor’s genetic information also helps us predict the chances cancer will come back.  
THE MSK DIFFERENCE

At MSK, HPV testing is routine for many throat cancers. Many people have better treatment results if they have HPV-positive throat cancer instead of other types. We may be able to offer you a treatment plan with fewer side effects without affecting your chances for a cure. 

Understanding your throat cancer diagnosis

Learning you have throat cancer can be overwhelming. You’ll hear many medical terms you've never heard before. We’re here to help you understand what they mean and why they matter.   

The information in your diagnosis describes important details about the type of throat cancer you have. Your doctors use that information to create the best plan of care for you.  

Your throat cancer diagnosis may describe:
Where the throat cancer started
Throat cancer often starts in the squamous (SKWAY-mus) cells in your mouth. These cells line your mouth, tongue, gums, and lips. 
Where the throat cancer started

Most throat cancers are squamous cell carcinoma (SKWAY-mus sel KAR-sih-NOH-muh). Carcinoma means cancer. Squamous cells are thin, flat cells that look like fish scales. They line your lips and the inside of your mouth. 

They become cancer when they grow out of control. This often happens because of genetic changes (mutations or variants). 

Lymphoma and cancer of the minor salivary glands also can start in the throat. These are much more rare. 

The main areas throat cancer can start:

Throat cancer can start in the pharynx (FAYR-inx) and the larynx (LAYR-inx).   

The pharynx (throat) is a thin muscular tube that’s about 5 inches long. It goes from the back of your nose and mouth to the trachea (windpipe). Air and food pass through the pharynx.

The pharynx has 3 main parts: 

  • The nasopharynx is the upper part of the pharynx. Nasopharyngeal cancer affects this area. 
  • The oropharynx is the middle part of the pharynx and includes your tonsils. 
  • The hypopharynx is the bottom part of the pharynx. Hypopharyngeal cancer affects this area.

Throat cancer can start in any of these sections, but the most common area is the oropharynx.   

The larynx is the part of the throat between the base of the tongue and the windpipe. It’s also called the voice box, because it holds your vocal cords.  

Laryngeal cancer can start in any part of the larynx. The larynx has 3 main parts:    

  • The supraglottis is the upper part of the larynx above the vocal cords, including the epiglottis. 
  • The glottis is the middle part of the larynx, and includes the vocal cords.
  • The subglottis is the lower part of the larynx between the vocal cords and the windpipe.   
Where the throat cancer started

Most throat cancers are squamous cell carcinoma (SKWAY-mus sel KAR-sih-NOH-muh). Carcinoma means cancer. Squamous cells are thin, flat cells that look like fish scales. They line your lips and the inside of your mouth. 

They become cancer when they grow out of control. This often happens because of genetic changes (mutations or variants). 

Lymphoma and cancer of the minor salivary glands also can start in the throat. These are much more rare. 

The main areas throat cancer can start:

Throat cancer can start in the pharynx (FAYR-inx) and the larynx (LAYR-inx).   

The pharynx (throat) is a thin muscular tube that’s about 5 inches long. It goes from the back of your nose and mouth to the trachea (windpipe). Air and food pass through the pharynx.

The pharynx has 3 main parts: 

  • The nasopharynx is the upper part of the pharynx. Nasopharyngeal cancer affects this area. 
  • The oropharynx is the middle part of the pharynx and includes your tonsils. 
  • The hypopharynx is the bottom part of the pharynx. Hypopharyngeal cancer affects this area.

Throat cancer can start in any of these sections, but the most common area is the oropharynx.   

The larynx is the part of the throat between the base of the tongue and the windpipe. It’s also called the voice box, because it holds your vocal cords.  

Laryngeal cancer can start in any part of the larynx. The larynx has 3 main parts:    

  • The supraglottis is the upper part of the larynx above the vocal cords, including the epiglottis. 
  • The glottis is the middle part of the larynx, and includes the vocal cords.
  • The subglottis is the lower part of the larynx between the vocal cords and the windpipe.   
If the throat cancer is spreading
Some tumors stay in the place where they started. But tumors can spread to other parts of the throat or the body.   
If the throat cancer is spreading

Metastatic throat cancer is more advanced. Metastatic means cancer cells have spread beyond the throat to other parts.

Throat cancer can spread to these places:

  • Neck
  • Trachea
  • Thyroid
  • Esophagus
  • Jaw
  • Mouth
  • Lymph nodes in the neck
  • Distant parts of the body, including the lungs, liver, or bones 
If the throat cancer is spreading

Metastatic throat cancer is more advanced. Metastatic means cancer cells have spread beyond the throat to other parts.

Throat cancer can spread to these places:

  • Neck
  • Trachea
  • Thyroid
  • Esophagus
  • Jaw
  • Mouth
  • Lymph nodes in the neck
  • Distant parts of the body, including the lungs, liver, or bones 
The stage, which explains the tumor’s size, location, and how far it has spread
The stage tells us how advanced the cancer is and guides treatment. There are 5 stages, from 0 to 4 (0 to IV). The lower the number, the less the cancer has spread.  
The stage, which explains the tumor’s size, location, and how far it has spread

The stage tells us how advanced the cancer is and guides treatment. There are 5 stages, from 0 to 4 (0 to IV). The lower the number, the less the cancer has spread. 

Here’s more information: 
  1. Stage 0 

    There are abnormal (not normal) cells that can become cancer. They’re in the lining of the throat but have not spread. 

  2. Stage 1 

    This is a very early stage of cancer. It’s only in the place where it started and has not spread.  

  3. Stage 2 

    The tumor has grown larger. Cancer has not spread to nearby lymph nodes. 

  4. Stage 3 

    The tumor has grown larger, or has spread to a lymph node in the neck. 

  5. Stage 4 

    Cancer has metastasized (spread) outside of the throat. 

Read more about throat cancer stages

The stage, which explains the tumor’s size, location, and how far it has spread

The stage tells us how advanced the cancer is and guides treatment. There are 5 stages, from 0 to 4 (0 to IV). The lower the number, the less the cancer has spread. 

Here’s more information: 
  1. Stage 0 

    There are abnormal (not normal) cells that can become cancer. They’re in the lining of the throat but have not spread. 

  2. Stage 1 

    This is a very early stage of cancer. It’s only in the place where it started and has not spread.  

  3. Stage 2 

    The tumor has grown larger. Cancer has not spread to nearby lymph nodes. 

  4. Stage 3 

    The tumor has grown larger, or has spread to a lymph node in the neck. 

  5. Stage 4 

    Cancer has metastasized (spread) outside of the throat. 

Read more about throat cancer stages

If the tumor is linked to a genetic mutation
A biopsy procedure gets a sample of tumor cells to check for cancer. We also use this sample for tumor genetic testing. Testing lets us learn about genetic changes (mutations or variants) linked to cancer. 
If the tumor is linked to a genetic mutation

MSK offers genetic testing that looks for the most common genetic mutations linked to throat cancer. The most common genetic mutations we look for are in the genes:

  • TP53
  • PIK3CA
  • CDKN2A
  • FAT1
  • NOTCH1
  • EFGR  

We also test for mutations that are less common, including in the genes:  

  • CCND1
  • MYO1B 

A tumor genetic profiling test is also called genomic testing or molecular profiling. The test uses a sample from the tumor, your blood, or both. The blood sample test is called a liquid biopsy.  

We use only the latest technology, such as MSK-IMPACT ® and MSK-ACCESS.  

  • MSK-IMPACT is a sequencing test that looks for genetic changes in 505 genes. These changes can make cancer cells grow. 
  • MSK-ACCESS looks for mutations in 129 genes that we know can cause cancer. We often use this liquid biopsy test when it’s hard to do a tumor biopsy.  

At MSK, genetic testing is a routine part of diagnosis and staging for people who have throat cancer. If we know which mutation you have, we know which drugs will work best.  

If the tumor is linked to a genetic mutation

MSK offers genetic testing that looks for the most common genetic mutations linked to throat cancer. The most common genetic mutations we look for are in the genes:

  • TP53
  • PIK3CA
  • CDKN2A
  • FAT1
  • NOTCH1
  • EFGR  

We also test for mutations that are less common, including in the genes:  

  • CCND1
  • MYO1B 

A tumor genetic profiling test is also called genomic testing or molecular profiling. The test uses a sample from the tumor, your blood, or both. The blood sample test is called a liquid biopsy.  

We use only the latest technology, such as MSK-IMPACT ® and MSK-ACCESS.  

  • MSK-IMPACT is a sequencing test that looks for genetic changes in 505 genes. These changes can make cancer cells grow. 
  • MSK-ACCESS looks for mutations in 129 genes that we know can cause cancer. We often use this liquid biopsy test when it’s hard to do a tumor biopsy.  

At MSK, genetic testing is a routine part of diagnosis and staging for people who have throat cancer. If we know which mutation you have, we know which drugs will work best.  

How does tumor genetic testing improve throat cancer diagnosis?

Genomic testing uses a sample taken from a tumor. We also consider sending blood samples as well, to learn more about the tumor’s genes.  

We test for changes in more than 500 genes. At MSK, broad genetic testing of the tumor is a routine part of how we diagnose and treat throat cancer. We’re one of only a few cancer centers in the world to profile throat tumors as part of standard care. 

Genomic testing tells us which genetic changes caused the throat cancer and made the cancer grow. The test results let us target those genes for treatment, a method called targeted therapy. 

If we know which mutations you have, we know which treatments will work best on the tumor. Almost all of these genetic changes are only in cancer cells, not in normal cells. They cannot be passed on to your children.  

Should I get a second opinion on my throat cancer diagnosis or treatment?

If you learn you have throat, tonsil, or laryngeal cancer, we recommend you get an opinion at MSK right away. This will confirm you’re getting an accurate diagnosis and detailed information about the cancer.  

It’s best to get an opinion from MSK before surgery or any other treatment. It can help you avoid treatment you may not need. It can make sure you have the right treatment. Getting an opinion may take a few days to a week. Sometimes it takes longer.    

It’s common to get another opinion at a cancer center like MSK. There’s no need to worry you’re hurting your doctor’s feelings. They know they’re not experts in the type of cancer you have. MSK has more than 70 head and neck cancer experts. 

Video | 3:32 MSK patients offer helpful tips on becoming a new patient

Newly diagnosed? Hear advice from our patients.

MSK Recommends Bring these questions to your next appointment

When you learn you have throat cancer, you’ll have many questions for your cancer doctor at your first visit. Talking about treatment options with your doctor can help you feel better prepared to make decisions about your care. 

  • What type of throat cancer do I have, and what stage is it?
  • Did I have all the scans I need to learn the stage?
  • What genetic testing do you offer for throat cancer?
  • What are the best treatment options for the type and stage of throat cancer I have?
  • When can I start treatment?
  • Can I get treatment at MSK locations close to my home?
  • What are the risks and side effects of throat cancer treatment?
  • Are there new throat cancer drugs I can try?
  • Will I need more tests before treatment starts?
  • What experience do you have in treating my type of cancer?
  • How will MSK help me recover after treatment?
  • Will I get side effects from treatment? How can I manage them?

Types of throat cancer

What are the types of throat cancer?

There are few types of throat cancer. We’re experienced in treating them all, from the most common to the most rare. 

This information describes each type of throat cancer and explains how we classify (sort) them.

The type of throat cancer depends on the type of cell where cancer started. 

Most throat cancers are squamous cell carcinoma (SKWAY-mus sel KAR-sih-NOH-muh). Carcinoma means cancer. Squamous cells are thin, flat cells that look like fish scales. They’re in many kinds of tissues, including the lining of the throat and mouth.

There are other cancers that are much rarer. Lymphoma and cancer of the minor salivary glands (located in the voice box) also can start in the throat. 

Laryngeal cancer starts in the larynx (voice box). It’s one of the most common types of head and neck cancer.    

The larynx is at the top of your trachea (windpipe). It holds your vocal cords. 

Here are the common signs and symptoms of laryngeal cancer. 

People with aplastic anemia, a rare blood disorder, may be more likely to get laryngeal cancer. 

Treatment for laryngeal cancer may include surgery, radiation therapy, or chemotherapy

For more advanced (stage 3 or 4) laryngeal cancer which has spread, you may need chemotherapy, targeted therapy, or immunotherapy.   

Tonsil cancer is a type of oropharyngeal cancer. It starts when cells in the tonsil grow out of control and form a tumor. 

The main cause is the human papillomavirus (HPV). HPV-positive tonsil cancer is very curable.

A common symptom is one tonsil getting bigger. If both tonsils are growing, it’s less likely to be cancer. Talk with your doctor to be sure. 

You can still get tonsil cancer if your tonsils were taken out. Cancer can start in the tissue that was left behind. 

Treatment may include radiation therapy, surgery, chemotherapy, targeted therapy, or immunotherapy.   

The oropharynx is in the middle of the throat, starting at the back of the mouth. It includes the tonsils, soft palate, and base of the tongue. 

Cancer starts when cells in the oropharynx grow out of control and form a tumor. A common sign is a lump in the neck or throat.

The main cause is HPV. MSK tests all oropharynx cancers for HPV. Many people have better treatment results if they have HPV-positive throat cancer instead of other types. 

Treatment for oropharyngeal cancer may include radiation therapy, chemotherapy, targeted therapy, immunotherapy or surgery. Many tumors can be removed by surgery. 

The hypopharynx is the lowest part of the throat, where it meets the trachea (windpipe) and esophagus. 

Cancer starts when cells in the hypopharynx grow out of control and form a tumor.

Here are the common treatments for hypopharyngeal cancer:

Your doctor may recommend getting chemotherapy and radiation at the same time (chemoradiation). It may help the tumor respond better to treatment. 

For more advanced cancer, you may need chemotherapy, targeted therapy, or immunotherapy.   

The nasopharynx is in the top part of the throat (pharynx). It connects the mouth and nose. Nasopharyngeal cancer starts when cells in the nasopharynx grow out of control and form tumors or lesions. The most common symptom is a lump in the neck.  

Nasopharyngeal cancer is most common in parts of Asia, such as southeast China. 

Radiation is the most common treatment. Your doctor may recommend getting chemotherapy and radiation at the same time (chemoradiation). It may help the tumor respond better to treatment. Some people may have surgery if the cancer comes back after treatment. 

THE MSK DIFFERENCE

Tobacco is a main cause of throat cancer. Our Tobacco Treatment Program offers treatment options to help you quit, such as counseling and medicine. It’s open to people who never had cancer or a disease linked to tobacco. Learn why it’s never too late to quit using tobacco.    

Throat cancer stages 0, 1, 2, 3, and 4

A cancer’s stage tells us how advanced the cancer is. Staging describes traits such as the tumor’s size, location, and whether it has spread. 

There are 5 stages of throat cancer, including tonsil and laryngeal, from 0 to 4 (0 to IV). The lower the number, the less the cancer has spread. Your doctor may add a letter (A, B, or C) to these stages to give even more information.    

Staging helps your doctor choose the best treatment options for you. The stage also helps them predict the outcome (result) of your treatment. Based on the stage, you also may be able to join a clinical trial.  

The stage is based on:

  • The size and location of the original tumor (also called the primary tumor).
  • If the cancer has spread to nearby lymph nodes.
  • If the cancer has spread to other parts of the body. 
What is the TNM staging system?

Your doctor may use letters and numbers from the TNM system to describe the stage:  

  • T is the size of the tumor. 
  • N is whether the cancer has spread to the lymph nodes. 
  • M is whether the cancer has metastasized (spread) to other areas.  

N0 means cancer is not in lymph nodes. N1, N2, or N3 means it’s spread to nodes.  

M0 means cancer has not spread. M1 means it’s spread to distant organs, muscles, or bones.  

What are the stages of throat cancer?