How head and neck cancers are diagnosed
Your GP or dentist will refer you to hospital for specialist advice, tests and treatment. You’re likely to see an oral and maxillofacial surgeon or an ear, nose and throat (ENT) specialist.
If you have a lump in your neck, you may be referred to a hospital with a neck lump clinic.
You’ll see a specialist who will ask you about your symptoms as well as any health conditions or recent illnesses. They’ll probably also ask if you’ve noticed any changes in your voice, swallowing, breathing, appetite or weight. After this, they will carefully examine your mouth, throat and neck and explain which tests you need.
Neck lump clinics are one-stop clinics where you can have all the tests needed to check for cancer in a neck lump. You’ll usually have an ultrasound scan and a sample of tissue taken from the lump using fine needle aspiration and/or a needle (core) biopsy. You may also have a nasoendoscopy.
Neck lump clinics can often give you the results of your tests on the same day, but sometimes you may need to wait longer.
This test can be done as an outpatient. A nasoendoscope is a thin, flexible tube with a light at the end that can be used to examine the back of your mouth and throat. The person doing the test will gently pass the tube up your nose and down into your throat. This lets them see your throat and voice box. You might find this a bit uncomfortable, but it only takes a few minutes.
Before the test you may be given a local anaesthetic lozenge or spray to numb the back of your throat. If so, you shouldn’t eat or drink anything after the test until the numbness has gone (which usually takes about an hour). If you try to eat or drink when your throat is numb, food or liquid could go down the wrong way and into your lungs. Or, you could burn your mouth or throat with hot food or drinks.
Ultrasound scan of the neck
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This test uses sound waves to produce a picture of your neck and lymph nodes on a computer screen. It’s painless and only takes a few minutes. Some gel is spread onto your neck and a small device, which produces sound waves, is passed over the area. The doctor will look for any changes in the size or appearance of the lymph nodes in your neck.
One of the most important tests for diagnosing cancer is a biopsy. This involves taking a sample of cells from the area that looks abnormal. A doctor, known as a pathologist, looks at the sample under the microscope and checks for any cancer.
It’s common to have some bruising and/or soreness in the area the sample was taken from for a week or so afterwards. This can usually be relieved by taking a mild painkiller.
Ask your nurse or doctor what they recommend.
If the biopsy is taken from inside your mouth or throat, you may be advised to avoid hot food and hot fluids for a few days while the tissue heals. There are different ways a biopsy can be taken from the head and neck area.
An incision biopsy means cutting a thin slice of tissue from the area to be tested. Your doctor will numb the area first with local anaesthetic. Then they cut around it using a sharp knife (scalpel) and remove a sample of tissue. Depending on the size of the piece of tissue removed, you may need to have some stitches put in to join the remaining tissue together and help it heal.
Fine needle aspiration (FNA)
This is a simple test that you can have done as an outpatient. It’s often used to check neck lumps but it can also be done to take samples from areas in the mouth or throat.
The doctor passes a fine needle into the lump to take a sample of cells. You may feel a little discomfort while this is being done. Sometimes the doctor uses an ultrasound scan to help guide the needle into the area to be sampled.
Examination under anaesthetic
Sometimes a biopsy is taken while you’re asleep under a general anaesthetic. This allows the specialist to examine the area closely and to remove a larger area of tissue and/or take samples from any other areas that look abnormal. Usually this test can be done as day surgery and most people are able to go home the same day.