Diagnosing Head and Neck cancer
If your GP or dentist thinks that your symptoms may be caused by cancer, or they are not sure what the problem is, you will generally be referred on a 2-week or rapid diagnostic pathway to a specialist Ear, Nose and Throat (ENT) or Maxillofacial clinic.
The assessment will involve taking a history of your symptoms, clinical examination and planning further diagnostic tests.
If you or someone you know has recently been diagnosed you may find our WhatTo Expect guides useful. These are written by patients for patients. You should use these as guides only and always ask your medical team for specific information as every person’s cancer and cancer experience will be different.
Diagnostics and Tests
Diagnostics and Tests in clinic may include:
- A nasendoscopy is a thin, flexible tube with a camera at the end which is used to look for tumours at the back of your mouth, nose, pharynx and larynx. This is often performed at your clinic visit.
- A trans-nasal flexible laryngo-oesophagoscopy (TNFLO) may be used instead of an endoscopy if the patient is unable to have a general anaesthetic. It allows the doctor to look at your nose, throat, voice box and oesophagus.
Further diagnostics may include:
- Scanning with CT, MRI (and sometimes PET) will be required to assess the tumour and any local or distant spread of the disease.
- An ultrasound uses soundwaves to produce a picture of your neck and allows the radiographer to review the lymph nodes on a screen. Under ultrasound guidance a tissue sample may also be taken with a fine needle.
Procedures under sedation or General Anaesthesia:
- An upper gastrointestinal GI endoscopy is a longer endoscope that may be required to identify tumours further down in the upper oesophagus.
- Microlaryngoscopy / pharyngoscopy/ oesophagoscopy under a General Anaesthetic may be required for further assessment and to take tissue samples (biopsies) for diagnosis.
Cancer Stages Explained
Staging of your cancer is important in understanding how advanced the disease is and which treatment options are available. Staging is often referred to in stages 1-4, and in most cases will depend on:
- T: The stage or size of the primary Tumour and extent of spread into surrounding structures
- N: Local spread to nearby lymph nodes
- M: Distant spread to areas of the body or organs (known as Metastasis)
For example: T3N1MO means stage/size 3 tumour, one lymph node affected and no spread to other areas of the body.
When you are diagnosed you will receive a TNM number after the multi-disciplinary team review. This TNM number should be explained to you in detail and will have an impact on the treatments to be used.
However, it is important to note that prognosis does not relate solely on staging, but also the cancer type, location affected, and more general medical factors. To gain a more accurate understanding of what your cancer stage means, you should discuss this with your medical team.
Squamous Cell Carcinoma (SCC)
The majority of Head and Neck cancers (aside from those in the thyroid and salivary glands) are squamous cell carcinomas. About 9 out of 10 head and neck cancers (90%) start in squamous cells.
Some types of squamous cells can be found on the outer layer of the skin, while others line the inside of the nose, mouth and throat. Cancers that begin in the squamous cells are called squamous cell carcinomas. Cancers can begin in other kinds of cells in the head and neck area, though these are less common.
Other carcinoma cell types
In addition to different locations within the Head and Neck areas that cancer can present there are also many different cancer cell types. You should speak to your medical team or a Head and Neck cancer Oncologist to learn more about a specific type of cancer that you want to know more about.
The most common types of Salivary Gland cancers are:
- Mucoepidermoid carcinomas. Mostly common in the parotid glands.
- Two types of cancer are abbreviated as ACC so it is important to use the full name to avoid confusion:
- Adenoid Cystic Carcinoma (more aggressive). Sometimes it can form in other parts of the body, including your skin, breast tissue, cervix or prostate gland.
- Acinic Cell Carcinoma (less aggressive)
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