Being diagnosed with head and neck cancer

You will go into hospital to see a specialist surgeon, or an ear, nose and throat specialist. They will examine you and explain the tests you need. These can include:

  • an ultrasound scan – this produces a picture of the area
  • a nasendoscopy – a thin, flexible tube with a light at the end that is passed up your nose and into your throat
  • examination under anaesthetic (EUA) – you have a general anaesthetic and a thin tube is passed down your throat to examine it and take a biopsy
  • a trans-nasal flexible laryngo-oesophagoscopy (TNFLO) – if you can’t have a general anaesthetic, the doctor can pass a thin tube up your nose and into your throat to look at this area and your oesophagus (gullet)
  • a biopsy – a doctor takes a sample of cells or tissue from the lump or area that looks abnormal.

If you have a lump in your neck, you may be sent to a neck lump clinic to have an ultrasound and biopsy on the same day.

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 and no specific symptoms of a head and neck cancer, you may be referred to a hospital with a neck lump clinic (see below).


At the hospital

The specialist will ask you about your symptoms as well as any health conditions or recent illnesses. They’ll probably also ask you 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 clinic

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 a fine needle aspiration and/or a needle (core) biopsy. You may also have a test called a nasendoscopy to look at the back of your mouth, nose and throat. There is more information about these tests and biopsies below.

Neck lump clinics can often give you the results of your tests on the same day, but you may need to wait longer.


Ultrasound scan of the neck

This test uses soundwaves to produce a picture of your neck and lymph nodes on a computer screen. It’s painless and only takes a few minutes. The doctor will put some gel on to your neck and pass a small device which produces soundwaves over the area. The doctor will look for any changes in the size or appearance of the lymph nodes in your neck.


Nasendoscopy

This test can be done as an outpatient. It is used to look at the back of your mouth, nose, pharynx and larynx.

The person doing the test will gently pass a thin, flexible tube with a light at the end (nasendoscope) up your nose and down into your throat. This lets them see your throat and voicebox. This will be 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. You shouldn’t eat or drink anything until the numbness has gone (usually 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 drinks.


Examination under anaesthetic (EUA)

If the doctor sees anything unusual, or if they can’t see the area clearly with the nasendoscope, they will suggest that you have a general anaesthetic. This will allow them to look at the area closely using an endoscope. An endoscope is a thin, flexible tube with a light at the end.

The doctor passes the endoscope down your throat. They can pass a camera down the tube or attach a microscope and look at the area very closely. During the examination the doctor can take samples from any areas that look abnormal (biopsy). This test can usually be done as day surgery and most people are able to go home the same day.


Trans-nasal flexible laryngo-oesophagoscopy (TNFLO)

A TNFLO is sometimes used instead of an endoscopy if you aren’t fit enough to have a general anaesthetic. It allows the doctor to look at your nose, throat, voicebox and gullet (oesophagus).

A thin tube (endoscope) is inserted into your nose and to the back of your throat. Your nose and throat are numbed using an anaesthetic spray and you will be awake. It takes about 30 minutes.


Biopsy

One of the most important tests for diagnosing cancer is a biopsy. This is when a doctor takes a sample of cells from the area that looks abnormal. A doctor, called a pathologist, looks at the sample under the microscope and checks for any cancer cells.

There are different ways of taking a biopsy from the head and neck area.

Incision biopsy

Your doctor will numb the area to be tested with an injection of local anaesthetic. They will take a thin slice of tissue using a sharp knife (scalpel). Depending on the size of the piece of tissue removed, you may need to have some stitches.

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 happens. Sometimes the doctor uses an ultrasound scan to help guide the needle into the area to be tested.

It’s common to have some bruising and/or soreness in the area the sample was taken from. The soreness may last for a week or so. 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 told to avoid hot food and hot fluids and to eat only soft foods for a few days while the tissue heals.

It’s hard to imagine how you will cope with the diagnosis of cancer. It has become a familiar word to all of us, but its meaning is highly personal.

Christine

Back to How head and neck cancers are diagnosed