Tests for head and neck cancer
You may have tests to diagnose a head and neck cancer to help plan your treatment. Your doctor and specialist nurse will explain the tests you need.
If you have symptoms of a head and neck cancer, you usually start by seeing your GP or dentist. If they think your symptoms could be linked to cancer, they refer you straight away to see a specialist doctor.
At the hospital
You will usually see a specialist within 2 weeks. This is usually an oral and maxillofacial surgeon, or an ear, nose and throat (ENT) specialist surgeon.
They will ask you about your symptoms, and examine your mouth, throat and neck. You also usually have blood tests, to check your general health.
If your only symptom is a lump in your neck, you may be referred to a hospital that has a neck lump clinic. You can have all the tests needed to check for cancer in a neck lump on the same day.
Your doctor and specialist nurse will explain the tests you need.
If you have an abnormal-looking area that can be seen and is easy to reach, you usually have a biopsy first. A biopsy is when your doctor removes a small piece of tissue or some cells from the area.
A doctor (called a pathologist) looks at the sample under the microscope. They check for any cancer cells.
There are different ways of taking a biopsy from the head and neck area. You may have a biopsy taken during some of the following tests or on its own.
If you have a swelling or lump in your neck you usually have an ultrasound scan. It uses sound waves to produce a picture of your neck and lymph nodes on a screen.
The scan is painless and only takes a few minutes. The person doing the scan puts some gel onto your neck and moves a small device (ultrasound probe) over the area. The probe produces the soundwaves that build up a picture.
The person doing the scan looks for any changes in the size or appearance of the lymph nodes in your neck. During the scan, they may use a fine needle to remove some cells from the lump into the syringe. This is called a fine needle aspiration biopsy.
An endoscope is a long, thin, flexible tube with a light and camera on the end. Images from the camera are shown on a screen. Different types of endoscopy may be used to look at the mouth, nose and throat. You can have this test in the outpatient clinic.
Before the test, your doctor may spray your nose and throat with an anaesthetic to numb the area.
After the test, you should not eat or drink anything for about 1 to 2 hours, until the anaesthetic spray wears off. This is to make sure you do not burn your mouth or throat. It also prevents a drink going down the wrong way into your lungs when you swallow.
A nasendoscope allows your doctor to look inside your nose, the back of your nose and your throat.
The doctor gently passes a thin, flexible tube called a nasendoscope into your nose, over the back of your tongue and down into your upper throat. You might find this stage a bit uncomfortable, but it only takes about a minute.
Before the test, your doctor may numb your throat with an anaesthetic spray. Some people prefer to have the test done without the anaesthetic spray.
If you have the spray do not eat or drink anything for about 1 to 2 hours, until the anaesthetic spray wears off. This is to make sure you do not burn your mouth or throat. It also prevents a drink going down the wrong way into your lungs when you swallow.
This test itself only takes a few minutes. If you are also having a biopsy, it could take longer.
Endoscope examination under general anaesthetic
Your doctor may suggest you have a general anaesthetic so they can look at an area more closely using a larger endoscope. This test is sometimes called a panendoscopy.
You may have this test if your doctor could not see the area clearly or saw something unusual during a nasendoscopy.
During the examination, the doctor can take biopsy samples from any abnormal looking areas. You can usually have this test in a day surgery unit. Most people can go home on the same day.
If you are not able to have a general anaesthetic, you may have this test. It allows the doctor to look at your nose, throat, voicebox and gullet (oesophagus). It is sometimes called a trans-nasal flexible laryngo-oesophagoscopy (TNFLO).
You will be asked not to eat or drink for a few hours before the test. The doctor gently passes the endoscope into your nose, to the back of your throat and into your gullet. This sounds uncomfortable, but most people cope well with it. It does not usually cause problems with gagging. You usually have a biopsy taken during this test.
You may have a biopsy on its own. There are different ways of taking a biopsy from the head and neck area. You can usually have these in an outpatient clinic.
Fine needle aspiration (FNA)
You may have this test to check a neck lump, or to take cells from the mouth or throat. The doctor passes a fine needle into the lump. They withdraw (aspirate) some cells into the syringe. Sometimes they use an ultrasound scan to help them guide the needle into the area.
Needle (core) biopsy
Your doctor injects some local anaesthetic into the area to numb it. Then they use a special needle to take small pieces of tissue from the lump or abnormal area. You may feel uncomfortable and have a feeling of pressure for a short time during the biopsy.
Your doctor numbs the area with an injection of local anaesthetic. They take a thin slice of tissue using a sharp knife (scalpel). You may need some stitches after this test, depending on the amount of tissue that was removed.
After the biopsy
If the biopsy is taken from inside your mouth or throat, it will take a few days for the tissue to heal. During this time, you may be asked to:
- avoid hot food and hot fluids
- only eat soft foods.
It is common to have some bruising or soreness in the area the sample was taken from. The soreness may last for a week or so. Taking mild painkillers should help. Ask your nurse or doctor what they recommend.
Below is a sample of the sources used in our head and neck cancer information. If you would like more information about the sources we use, please contact us at email@example.com
Machiels J.-P, Leemans C. R. et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx. EHNS- ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020. Volume 31, Issue 11, Pages 1462-1475.
National Institute for Health and Care Excellence (NICE). Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. NICE guideline NG36 2016 (updated 2018).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.
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