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 camera and a light at the end is passed up your nose, over the back of your tongue and into your throat
  • an 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 cannot have a general anaesthetic, the doctor passes a thin, flexible tube with a camera and a light at the end up your nose and into your throat
  • 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

You usually start by seeing your GP or dentist. If they think that cancer could be causing your symptoms, or if they are not sure what the problem is, they will refer you to a specialist doctor. You will see the specialist at the hospital for advice, tests and treatment. You are likely to see an oral and maxillofacial surgeon or an ear, nose and throat (ENT) specialist surgeon.

If your only symptom is a lump in your neck, you may be referred to a hospital that has a neck lump clinic.


At the hospital

The specialist doctor will ask you about your symptoms, as well as any health conditions or recent illnesses. They will probably also ask you if you have any changes in your voice, swallowing, breathing, appetite or weight. They will carefully examine your mouth, throat and neck and explain what tests you need.


Neck lump clinic

This is a one-stop clinic where you can have all the tests needed to check for cancer in a neck lump.

You will usually have an ultrasound scan. A sample of tissue will be taken from the lump using a fine needle aspiration or needle (core) biopsy. You may also have a test called a nasendoscopy to look at the back of your mouth, nose and throat.

The clinic may give you the results of your tests on the same day. But you may need to wait up to 7 to 10 days.


Ultrasound scan of the neck

This test uses sound waves to produce a picture of your neck and lymph nodes on a computer screen. Lymph nodes are part of the lymphatic system, which helps to protect us from infection and disease.

The scan is painless and only takes a few minutes. The doctor puts some gel onto your neck and moves a small device which produces sound waves over the area. They look for any changes in the size or appearance of the lymph nodes in your neck.


Nasendoscopy

You may have this test in an outpatient clinic. It is used to look at the back of your mouth, nose, pharynx and larynx.

Your doctor uses a thin, flexible tube called a nasendoscope. They pass it into your nose, over the back of your tongue and down into the upper part of your throat. The tube has a camera and a light at the end to help the doctor get a better view of the back of your mouth and throat. You might find this 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 this done without the anaesthetic spray.

If you have the spray, you should not eat or drink anything for about an hour after the test, or until the numbness wears off. There is a risk that food and drink may go down the wrong way and into your lungs when you swallow. You could also burn your mouth or throat with hot food or drinks.

I have check-ups and an ultrasound every six months. I tell myself that if it comes back it can be treated and sorted well.

Dave


Examination under anaesthetic (EUA)

Your doctor may suggest that you have a general anaesthetic if they:

  • see anything unusual
  • cannot see the area clearly with the nasendoscope.

This allows them to look at the area more closely using an endoscope. An endoscope is a thin, flexible tube with a camera and a light at the end.

When you are asleep under the anaesthetic, your doctor passes the endoscope down your throat. They can use the camera or attach a microscope to the end of the tube to closely look at the area.

During the examination, the doctor can take samples from any areas that look abnormal. This is called a biopsy. You can usually have this test in a day surgery unit. Most people can go home the same day.


Trans-nasal flexible laryngo-oesophagoscopy (TNFLO)

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

A thin, flexible tube with a camera and a light at the end (endoscope) is inserted into your nose and to the back of your throat. Before the test, your doctor sprays your nose and throat with an anaesthetic to numb it. You are awake during the test. It takes about 30 minutes.

You should not eat or drink anything for about an hour after the test, or until the numbness wears off. This is because there is a risk that food and drink may go down the wrong way and into your lungs when you swallow. You could also burn your mouth or throat with hot food or drinks.

Ashley doing some gardening

Watch: all about Ashley's experiences

Read Ashley's story

Watch: all about Ashley's experiences

Read Ashley's story


Biopsy

To make a diagnosis, your doctor needs to remove a small piece of tissue or some cells from the area that looks abnormal. This is called a biopsy. A doctor who specialises in analysing cells (called a pathologist) looks at the sample under the microscope. They check the sample for any cancer cells.

If the biopsy is taken from inside your mouth or throat, it will take a few days for the tissue to heal. While it does, you may be told to:

  • avoid hot food and hot fluids
  • eat only soft foods.

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

Needle (core) biopsy

Your doctor uses a needle to take small pieces of tissue from the lump or abnormal area. Before taking the biopsy, they inject some local anaesthetic into the area to numb it. You may feel uncomfortable and have a feeling of pressure for a short time during the biopsy.

Incision biopsy

Your doctor numbs the area with an injection of local anaesthetic. They 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 as an outpatient. It is often used to check neck lumps. But it can also be done to take samples from the mouth or throat.

The doctor passes a fine needle into the lump. They withdraw (aspirate) some cells into the syringe. Sometimes the doctor uses an ultrasound scan to help guide the needle into the area.

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.

After the test, a doctor examines the sample under a microscope to check for cancer cells.

Back to How head and neck cancers are diagnosed