Diagnosis of oropharyngeal cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing oropharyngeal 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 oropharyngeal 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 oropharyngeal cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of oropharyngeal cancer.

The following tests are usually used to rule out or diagnose oropharyngeal 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:

• tobacco use
• alcohol use
• infection with human papillomavirus (HPV)

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 oropharyngeal cancer. During a physical exam, your doctor may:

• feel the neck area for lumps or swelling
• check the inside of the mouth, including the cheeks and lips
• feel the floor of the mouth and the base of the tongue
• examine the roof of the mouth, back of the throat and nasal cavity
• check your ears and test your hearing
• examine your jaw and mouth to see if they move normally

Find out more about physical exams.

A human papillomavirus (HPV) DNA test is a lab test that looks for the DNA of high-risk types of HPV linked to oropharyngeal cancer. The HPV DNA test can be done using a sample of cells collected during a biopsy.

Blood tests may be done to determine your overall health before treatment starts. These tests can help diagnose such things as malnutrition, a low blood cell count and problems with organs such as your kidneys and liver.

An endoscopy is done when diagnosing and staging oropharyngeal 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 (metastasized).

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

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 oropharynx or other parts of the throat.

A punch biopsy is used to take a sample from the mucosal layer of the pharynx. The doctor uses a special tool to collect a biopsy sample of an abnormal area along with a small amount of normal tissue around it.

An incisional biopsy removes only a small sample of the tumour or abnormal tissue. The doctor makes a small cut (incision) through the skin of the throat or in the mucous membrane in the pharynx to collect a sample from a lump.

An excisional biopsy is a type of biopsy in which the doctor makes a cut in the pharynx and removes the entire lump or abnormal area along with a small amount of normal tissue around it.

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 see or feel it.

Find out more about biopsies.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to:

• check if cancer has spread to lymph nodes in the neck (cervical lymph nodes)
• check if the tumour has grown into major blood vessels in the neck, such as the carotid arteries
• guide a needle during a fine needle aspiration

Find out more about ultrasounds.

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 oropharynx. You may 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 upper GI series may also be called a barium swallow. You will swallow a thick, chalky liquid (barium) and then have x-rays of the esophagus, stomach and upper small intestine (upper GI tract). The barium coats the inside of these organs and shows their outlines on an x-ray. An upper GI series can show any abnormalities in the throat when you swallow, so it is often the first test done if you have trouble swallowing.

Find out more about an upper gastrointestinal series.

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 inflamed
• find out the size of a tumour

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 can give the healthcare team a more complete image of the tumour, including its location and size and if it has spread.

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