Diagnosis of nasopharyngeal cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing nasopharyngeal cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for nasopharyngeal cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as nasopharyngeal cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of nasopharyngeal cancer.

The following tests are usually used to rule out or diagnose nasopharyngeal cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest nasopharyngeal cancer
• exposure to formaldehyde
• infection with the Epstein-Barr virus (EBV)

Your doctor may also ask about a family history of:

• head and neck cancers
• other cancers

A physical exam allows your doctor to look for any signs of nasopharyngeal cancer. During a physical exam, your doctor may:

• check the neck area for lumps or swelling
• examine the mouth, throat and nasal cavity
• check your ears and test your hearing
• examine your eyes and do a vision test

Find out more about physical exams.

Your doctor may order a blood test to check for the presence of the Epstein-Barr virus (EBV) antibodies. This may be measured before and after treatment to help show if the treatment is effective.

A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check for infection.

Find out more about a complete blood count (CBC)..

An x-ray uses small doses of radiation to make an image of parts of the body on film. It is used to look for a tumour in the nasopharynx. You may also need a chest x-ray to see if cancer has spread to the lungs or lymph nodes in the chest.

Find out more about x-rays.

An endoscopy is done when diagnosing and staging nasopharyngeal cancer. It allows a doctor to look inside the body using a flexible tube with a light and lens on the end. This tool is called an endoscope.

Different types of endoscopy may be used to look inside the pharynx (throat), collect tissue samples and find out how far the cancer has spread.

A nasopharyngoscopy may be used to look at the nasal cavity, nasopharynx, oropharynx and larynx (voice box). It is usually done by an ear, nose and throat (ENT) doctor in the doctor’s office. A topical anesthetic may be applied to the back of your throat to numb it just before the nasopharyngoscopy. During the procedure, the doctor inserts a flexible endoscope through the nose and down to the throat.

After a nasopharyngoscopy, you won’t be allowed to eat or drink until the numbness is gone and your gag reflex returns. This usually takes about 30 minutes.

A panendoscopy looks at all the structures in the throat. It combines a laryngoscopy, an esophagoscopy and sometimes a bronchoscopy. A laryngoscopy uses an endoscope to examine the larynx. An esophagoscopy uses an endoscope to examine the esophagus. A bronchoscopy uses an endoscope to examine the airways (bronchi) in the lungs.

A panendoscopy is usually done in an operating room under a general anesthetic (you will be unconscious). After the procedure, you won’t be allowed to eat or drink for about 1 hour. You will also be told to rest your voice by not speaking. Your healthcare team may give you pain-relieving drugs if you have a sore throat.

Your doctor may do a panendoscopy to thoroughly check the mouth (oral cavity), pharynx, larynx, esophagus, trachea (windpipe) and bronchi.

Find out more about endoscopies.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will show whether or not cancer cells are found in the sample.

An endoscopic biopsy is done during an endoscopy. The doctor collects tissue samples from any abnormal areas in the nasopharynx.

A fine needle aspiration (FNA) uses a very thin needle and syringe to remove a small amount of fluid or cells from the abnormal area. FNA may be used to collect cell or tissue samples from lumps and lymph nodes in the neck. An ultrasound or a CT scan may be used to guide the needle into the abnormal area if the doctor can’t feel it.

Find out more about biopsies.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• find out the size and location of a tumour
• find out how far the tumour has grown into surrounding tissues
• see if the cancer has spread to structures or lymph nodes in the neck
• help decide whether the tumour can be removed with surgery

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI is used to:

• examine soft tissues in the head and neck, such as the base of the tongue
• find out if an abnormal area is cancerous (malignant), non-cancerous (benign) or just inflamed

Find out more about MRIs.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned.

A PET scan is used to see if the cancer has spread (metastasized) to the lymph nodes in the neck or other distant sites.

Find out more about PET scans.

A PET-CT scan combines a CT scan and a PET scan. It may give the healthcare team more information about the tumour, including its location and size, if it has spread and if the cancer cells are growing quickly.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.