Diagnosis for Head and Neck Cancer

Executive Summary

Different tests are available to diagnose the development of head and neck cancer, depending on signs and symptoms, age and health status, types of tumor, and earlier medical tests. Physical examination, imaging tests, and biopsies are the diagnostic approaches for diagnosing head and neck cancer. The most common diagnosis of head and neck cancer includes a physical examination, biopsy (fine-needle aspiration biopsy, minimally invasive biopsy, surgical biopsy), imaging tests (ultrasound, X-ray, Computed tomography (CT or CAT) scan, Magnetic resonance imaging (MRI), Positron Emission Tomography or PET or PET-CT scan, bone scan, panoramic radiograph, X-ray/barium swallow), biomarker testing, and endoscopy.

Diagnosis of Head and Neck Cancer

There are numerous ways to diagnose head and neck cancer. Based on these diagnostic tests, the doctor will gather the information that will be essential for treatment and cure. The standard diagnostic methods include biopsy and several imaging tests. Everyone need not undergo all of the below mentioned diagnostic tests. It would be best to undergo the tests and scans per your doctor’s prescription.

Before deciding the diagnostic tool suitable to a person’s condition, the doctor may consider the following factors:

• The cancer type that is suspected.
• Stage and grade of the tumor.
• Symptoms and signs that you experience.
• Age.
• General health condition.
• Past medical history and results of previous medical check-ups.

The doctor will analyse all of these factors and note down all your symptoms and risk factors and then ask you to carry out anyone or some of the following diagnostic tests to check for head and neck cancer ^​1​:

Physical Examination

In a physical examination, the doctor will look for any lumps, bumps or mass that could be felt on the head, neck, cheeks, gums, or lips. The doctor may also inspect internally using light and a mirror to detect abnormal mass inside the nose, throat, tongue or mouth. Further, the doctor may prescribe various urine and blood tests to arrive at the correct diagnosis.

Biopsy

A biopsy refers to removing a tiny tissue sample from the suspected area to be examined under a microscope. A pathologist analyses these samples. A pathologist is a doctor who evaluates the cells, tissues, organs and interprets the lab tests to diagnose the underlying disease condition.

A biopsy can be of different types. We have;

Fine-needle aspiration biopsy:

It is the most common type of biopsy procedure. In this procedure, as the name suggests, an expert uses a fine thin needle to collect a tiny sample of cells or tissue from the abnormal area. The expert usually inserts this needle directly into the abnormal tissue, tumour or lymph node. Then he/she send these cells, tissue or body fluid for analysis to a laboratory in order to get them under a microscope to detect the presence of cancer cells. This type of analysis at the cell tissue level is essentially cytologic examination. 

Minimally invasive biopsy:

In this procedure, an expert uses a particular needle to extract the sample cell or tissue from the suspected area. Radiology and CT scan or ultrasound guide this needle to ensure that the tissue sampling is precise, accurate and error-free. In an image-guided needle biopsy, experts make a small incision ranging from 2-5mm, but the incision will be so small that it won’t require any sutures or stitches. The recovery duration for this procedure is within 48 hours, and the biopsy results will be available within two working days.

Surgical biopsy:

Experts make a small incision to sample the cells or tissue from the area sighted as abnormal. Since this is a mini surgical procedure, the doctor will give the patient anaesthesia to prevent any discomfort, and post-surgery, there will be a surgical scar. 

During a biopsy, an expert examines whether a person has HPV. HPV can be indicative of high-risk neck and head cancers. Determining this can also help in deciding a suitable treatment plan.

Computed Tomography or CT or CAT scan

Experts use Computed tomography or CT scan to take images of the body interior from different angles with the help of X-rays. A computer then combines these images into three-dimensional images that portray any tumour mass or abnormalities. CT scan gives a clear picture, which helps doctors arrive at an accurate diagnosis. A CT scan can also measure a tumour’s size. Sometimes, they give a special dye, contrast medium before the scan to get a detailed image. The expert either gives the dye intravenously or as a liquid or pill, in order to swallow.

Magnetic Resonance Imaging or MRI scan

In an MRI or Magnetic Resonance Imaging scan, the experts use radio waves and magnetic fields instead of X-rays (used in CT scans) to capture detailed images of the body interior, here the head and neck region. It can accurately capture images of soft tissues like the tongue base, tonsils, etc. Just like a CT scan, MRI also can measure the tumour size. In this procedure, the patient must lie flat without any movement on a padded platform, which then slides into an MRI machine, which is a tube-shaped structure. In this case, an expert sometimes gives a dye, a contrast medium intravenously or in the form of a pill or liquid to the patient before the scan to get a clear, accurate image.

Positron Emission Tomography or PET or PET-CT scan

A Positron Emission tomography is another imaging test that uses a special radioactive dye (radioactive sugar substance) called a tracer to generate pictures of different tissues and organs. An expert injects this dye into the patient’s body, and the cells that use the most energy absorbs this radioactive sugar substance. Since cancer cells use energy vigorously, it absorbs most of the sugar substance, thereby helping detect cancerous cells amidst normal cells. The substance carries only very little radiation causing no harm. A scanner detects the sugar substance and produces images of the body interior. PET scan can detect disease conditions much before it shows up in other imaging procedures. Sometimes experts club a PET scan with a CT scan to get accurate results. This combination, in other words, is PET-CT scan.

Biomarker testing of the tumour 

To detect whether a tumour or mass is cancerous, sometimes the doctor will recommend running several lab tests to identify specific proteins, genes and other factors that define the tumour’s nature. Determining the tumour characteristics can also aid in deciding the treatment options.

Ultrasound

An ultrasound uses sound waves to generate body tissues and organs images. Experts consider this procedure to be a non-invasive method of cancer diagnosis and evaluation. They use ultrasound in follow-up examinations after they detect an abnormal mass or lump during physical examination or imaging tests. They also use it to guide the fine needle in a fine-needle aspiration biopsy. 

Bone scan

A bone scan uses a radioactive tracer to watch the interior of bones. The radioactive material contains significantly less radiation to cause any harm. An expert injects it into the patient’s body through the vein. The substance accumulates in the bones, and a special camera detects them. Healthy, normal bones will appear lighter and those abnormal or injured, cancerous parts will stand out, clearly in the camera. This test can help detect whether cancer has metastasised to the bones.

Panoramic radiograph

In other words, panorex. A panoramic radiograph is a panoramic or rotating scanning dental X-ray of the lower and upper jaws. It helps detect cancer in these regions. Sometimes the experts use this procedure to evaluate the teeth before any treatment procedures like chemo or radiation therapy. It can give a two-dimensional image of the mouth from ear to ear.

X-ray/barium swallow 

Using X-rays to detect disease conditions or abnormalities is a standard age-old procedure. X-rays use a small amount of radiation to identify abnormalities, tumours, or bumps. A barium swallow is an imaging test that uses X-rays and barium to generate images of the upper gastrointestinal (GI) tract. A barium swallow can help identify those abnormalities and cancerous growths present along the swallowing passage. To carry out the procedure, a person must ingest a liquid containing barium, and after that, X-rays are taken. Barium coats the stomach, intestines, and oesophagus lining, making it easier for x-rays to detect any tumours or masses. Sometimes an expert requires a modified barium swallow to notice any unusual swallowing problems. If a doctor detects cancerous signs, he/she will recommend a CT scan for obtaining a clear, accurate result.

Endoscopy

An endoscopy is a procedure that allows the doctor to view the body interior using a thin, lighted, flexible tube known as an endoscope. During this procedure, the expert sedates the person. They gently insert a tube into the throat and down the oesophagus through the nasal cavity to examine the head and neck region in detail.

Depending on the body area that is examined, the procedure’s name can vary. Suppose it is used to examine the pharynx; in that case, it is called pharyngoscopy. If the larynx is reviewed, it is called laryngoscopy, and in the case of reviewing the nasopharynx, it is called nasopharyngoscopy. Panendoscopy is the name collectively given to these procedures mentioned above. 

Endoscopy types:

In the case of head and neck cancer, the experts perform mainly two types of endoscopies. They are direct laryngoscopy and office-based fiberoptic laryngoscopy. They perform these in an operating chamber. In a direct laryngoscopy, the surgeon places a special endoscope called a laryngoscope into the mouth and throat. A laryngoscope can take tiny samples from the mouth, throat and voice box for examination. In fact, this procedure is considered a vital staging procedure that can determine the gravity and extent of the cancer condition, thereby deciding the best treatment plan.

In a flexible fiberoptic laryngoscopy, a flexible, lighted tube with a camera attached to it is inserted through the nose and carried out to the back of the throat. As a result, this gives the doctor a clear view of the throat, nasal cavity and larynx or voice box.

Diagnostic tests help detect disease conditions and allow doctors to decide the suitable treatment strategy based on the diagnosis ^​2​. Doctors or the healthcare team will use various diagnostic tools to detect abnormalities or diseases. Diagnosis can help see the gravity of cancer and whether or not it has metastasised or invaded into other body parts. 

Once the diagnosis is made, the doctor will analyse the test results and discuss them with you. If upon diagnosis, cancer is detected, the doctor will explain your condition, i.e., its type, stage and grade. The health care team will design the best treatment strategy based on these.

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