What to expect at your appointment
It is important that your doctor establishes the diagnosis of your type of Head and Neck Cancer, assesses the size of the cancer and whether it has spread to the lymph nodes in the neck or elsewhere in the body.
To answer these questions, your doctor will need to do the following things:
- Talk with you about your medical history. This includes signs you may have noticed, any other health conditions, medications that you are taking, and whether you smoke or drink alcohol.
- Perform a physical examination. The doctor will look carefully at your mouth, gums, lips, cheeks, throat, tongue, nose, and neck for any changes or lumps. They may also gently feel both sides of your neck to check your lymph nodes.
- Scopes (endoscopy). A scope is a thin, flexible tube with a light and camera on the end that is used to look for any changes in your nose, throat, voice box (larynx), and oesophagus (food pipe).
- Order diagnostic tests, which may include scans or a biopsy.
Diagnostic Procedures
Biopsy
A biopsy involves removal of a tissue sample that is then examined in detail by a specialist pathologist, under a microscope to look for cancer cells. Biopsies can often be performed in the office with local anaesthetic, but occasionally require sedation or general anaesthesia (you will be asleep and will not remember what happens during the procedure) in the operating room.
Imaging
Imaging tests allow the cancer care team to check for cancer and other problems inside the body.
Imaging tests involve sending different types of energy, such as X-rays, sound waves, magnetic fields or radioactive particles, through the body.
Energy patterns are changed by the different tissues and structures in the body and these are displayed as an image on a screen. They allow the cancer care team to see changes that may be caused by cancer.
There are four main types of imaging used to diagnose and assess Head and Neck Cancers:
- Computed Tomography (CT) scan
- Magnetic Resonance Imaging (MRI) scan</li>
- Positron emission tomography (PET) scan
- Ultrasound (US) scan
Not everyone will need to have every test. Your doctor will recommend tests that are right for you.
Computed Tomography (CT) Scan
A CT scan uses X-rays to take pictures of the inside of your body. Your doctor may order a CT scan to take a closer look at your head and neck area.
Before a CT scan, you might be given a needle (injection) of a dye that will make any tumours easier to see. You might feel a bit hot or flushed for a few minutes after you have a dye injection. For some people (particularly those with kidney problems), the dye can be dangerous. Your doctor will speak with you about your general health and decide if a dye injection is right for you.
During the CT scan, you will lie on a table while it moves through the CT machine. This will take a few minutes.
If you have a tumour, a CT scan can help measure how big it is and show if it is affecting other parts of your body.
The amount of radiation you receive is small, and the risk of harm from it is low. However, you should not have a CT scan if you are pregnant.
Before you have a CT scan, speak with your doctor about the benefits and risks and any other questions you may have.
CT scans are painless (other than a needle for the dye) and you can go home once the scan is done.
Magnetic Resonance Imaging (MRI) Scan
A MRI scan uses magnetic fields to take pictures of the inside of your body. Your doctor may order an MRI scan to take a closer look at your head and neck area but many patients do not need MRI scans.
Before an MRI scan, you might be given a needle (injection) of a dye that will help make any tumours easier to see.
The MRI machine is a powerful magnet, so you will need to remove any metal, such as jewellery. Your doctor and the staff will ask if you have any metal in your body, such as a pacemaker or rods, plates or screws holding bones in place. They will talk with you about whether it is safe to have an MRI scan.
During the scan, you will lie still on a table that moves into the MRI machine. The machine looks like a donut that moves over your body. The scan may take about 30 minutes or longer.
MRI scans are painless and have no radiation, however, they can be noisy. You may be given earplugs to help reduce the noise. Some people feel a bit uncomfortable or panicked lying in the MRI machine. You can take music to be played while you are in the MRI machine to help you feel less nervous. Remember, you can always speak to the person running the machine if you have any worries. But it is important to lie very still during the scan or the images will be blurry.
Positron Emission Tomography (PET) Scan
Before a PET scan, you will be given a needle (injection) containing a radioactive sugar (tracer). You will then need to wait between 30 and 90 minutes to let the mixture move around your body.
The radioactive sugar goes to parts of the body that have lots of cells growing, to help show where the cancer is. Because cancer cells absorb more radioactive sugar mixture than healthy cells, cancer cells show up brighter on the PET scan.
During the PET scan, you will lie on a table while it moves through the PET machine. It is important to lie still during the scan and not to talk, otherwise normal muscles will show up on the scan. It is important to know that other illnesses than cancer, such as infection, can also show up on a PET scan.
A PET scan is painless and usually take about two hours.
You will be asked to avoid hard exercise for a couple of days and to stop eating a few hours before the PET scan. If you have diabetes, you will need special instructions to get ready for the scan because high blood sugar levels can affect the result of a PET scan.
Ultrasound
An ultrasound uses sound waves to take pictures inside the body. Your doctor may want you to have an ultrasound to take a picture of your neck and all the parts of it including your lymph nodes, thyroid and salivary glands.
During the test, gel will be spread on the skin and a small device called a probe will be moved over the area. The probe makes soundwaves that can be turned into a picture on a computer. Ultrasounds are painless and you can go home once the test is done. Sometimes the use of a Ultrasound is required to obtain a biopsy.
Staging Explained
Staging describes:
- the size of your cancer (T)
- if there is cancer in your lymph nodes (N)
- if the cancer has spread to other parts of your body (M)
Cancers in the oropharynx (tongue, tonsil, and throat) are staged differently, depending on whether they are linked to HPV.
Staging is based on the results of tests that you have had, such as scans, biopsies, and surgery.
Your treatment team will use the T, N and M information to give the cancer a stage or number from 1 to 4. Stage 1 is the earliest stage and stage 4 is more advanced cancer.
Knowing the stage will help the treatment team decide on the best treatment for you.
Your doctor or another member of your treatment team will be able to give you more information about the stage of the cancer.
In general:
| T | stands for the size of the cancer. A T value can range from 1 (small cancer) to 4 (large cancer). |
| N | indicates whether the cancer has spread to the lymph nodes. An N value can range from 0 (cancer has not spread to the lymph nodes) to 3 (cancer that has spread to lymph nodes in other parts of the body). |
| M | stands for distant metastases, or whether the cancer has spread to other parts of the body outside the head and neck. An M value can be either 0 (cancer has not spread to other parts of the body) or 1 (cancer has spread to other parts of the body). |