Getting to a diagnosis begins with a history and physical examination. If the symptoms that make you or your doctor suspect cancer haven’t been present for very long, or if the history and physical examination make the doctor less suspicious that your lesion is cancer, your doctor might try some medications and rehabilitation before jumping to a diagnosis of cancer.
At some point, if your doctor is not certain of a diagnosis, and if symptoms aren’t getting better (and definitely if symptoms are getting worse), your doctor should raise the possibility of starting a cancer work-up. Like with most cancers in the head and neck, this will include a combination of biopsy and imaging tests, the term that doctors use to refer to X-rays, MRIs, CT scans, etc.
If you came to a specialist after having a lesion removed and found it was cancer only after having the lesion removed, your doctor might skip some of the tests and jump to follow-up or additional treatment. Be sure to bring all the reports and images from any prior treatment with you to your appointment with your head and neck cancer specialist.
Step 1: History
First, your head and neck specialist will take a thorough history of your health and address any specific concerns you may have.
Your doctor might ask questions such as:
Step 2: Physical exam
Next, your doctor will examine you. Typically, if you’re seeing a specialist in head and neck disorders, you will get a thorough physical examination focused on the area of concern. Your doctor may see how wide you can open your mouth and then look and feel inside your mouth. The doctor is likely to feel around very thoroughly. If the tumor is located in the mouth, then palpation of the tumor and the jaw will be very important. Knowing whether the tumor is fixed to the bone will be an important part of treatment and reconstructive recommendations.
You should also expect the doctor to:
Your doctor might even put a camera in through your nose to take a look at the back of your throat and your vocal cords.
Step 3: Reviewing tests
After getting your history and performing a physical exam, your doctor will review any scans, laboratory work and pathology results you may have already had. Be sure to bring all of these with you to your appointment. Bring actual discs of any scans you’ve had, as well as any reports of those scans. If you are seeing a head and neck cancer specialist after a lesion was removed by a non-cancer specialist, you will need a thorough review of the pathology to discuss whether additional treatment is necessary. Try to obtain the actual glass slides that were prepared by the pathologist with the specimen taken during your biopsy procedure so your doctor can conduct a complete review. You might need more tissue removed or further treatment.
Step 4: Recommendations
Finally, your doctor will make recommendations about your next steps. This will likely include reviewing some of the studies you’ve already had done or ordering more tests. Once your doctor has all the necessary information, you should be given a preliminary stage and discuss treatment plans.
If the tumor is very large and is putting your breathing at risk, your doctor might recommend you undergo a tracheotomy, which is a breathing tube placed into the front part of your neck directly into your windpipe.
Also, if you are having difficulty getting enough nutrition by mouth because of a tumor, your doctor might recommend a feeding tube. This will help ensure you are able to undergo the treatment you will need to beat the cancer.
Imaging refers to radiologic studies, or scans, that create pictures of the structures inside your head and neck. Common types of imaging used in the diagnosis of head and neck cancer include computed tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans.Biopsies
A biopsy is the removal of a small piece of tissue to examine under a microscope to see if it is cancerous. There are a variety of methods your doctor may use to perform a biopsy, depending on the type and location of the lesion being tested.