Diagnosing Head and Neck Cancers

Symptoms of head and neck cancer can include

• difficulty swallowing
• sore throat or mouth
• ear pain
• neck pain
• hoarse voice
• difficulty breathing
• a lump in the neck

Because these symptoms can be associated with many other conditions, patients will usually be evaluated by an ear, nose and throat specialist (an ENT). An endocrinologist will investigate hormone abnormalities if tumors of the thyroid, parathyroid or pituitary glands are suspected.

Several diagnostic tests may be performed, including some of the following:

• flexible or direct nasopharyngoscopy or laryngoscopy – in which a scope is inserted through the nose or mouth to look more closely at the inside of the mouth and throat. If a tumor is discovered, a small sample will be taken for examination.
• biopsy – removal of a small tissue sample to determine if it is cancerous
• computed tomography (CAT) scan – a special type of X-ray used to evaluate the head and neck. Checking for abnormal lymph nodes or masses helps to determine if cancer is present or has spread.
• magnetic resonance imaging (MRI) scan – an imaging study that uses a magnetic source rather than X-rays to see body structures. MRI scans may give a better picture of a tumor or abnormal lymph nodes, and may be useful in planning radiation therapy.
• positron emission tomography (PET) scan -  a nuclear medicine scan that uses sugar to identify areas in the body that may have cancer. PET scans are sometimes used to determine the stage of a cancer, the response to chemotherapy or radiation treatment, or to guide radiation therapy.
• blood and urine tests – to determine hormone concentrations.

Once head and neck cancer is diagnosed, it is then staged:

Early Stage Cancers (Stages I-II, T1-2 NO MO)
Tumors less than 4 cm in size that have not spread to the lymph nodes are usually treated with surgery or radiation therapy. Cure rates for these treatments are fairly high.

Higher Stage Cancers (Stages III-IV, T3-4 N1-3 MO)
Tumors more than 4 cm in size, often with spread to the lymph nodes, require treatments including chemotherapy, radiation and sometimes surgery to remove the main tumor or lymph nodes in the neck. About 60% of patients with head and neck cancer are diagnosed with stage III or IV disease.

Cure rates for higher-stage disease lag behind those for early-stage disease but have been improving with combined treatment approaches and advanced radiation technology. For example, Intensity Modulated Radiation Therapy (IMRT) improves the accuracy of treatment with guided imagery and reduces treatment-related side effects. Transoral endoscopic CO2 laser resection is often an option for even larger tumors. The advantage is much better preservation of function.

For more information about Beaumont's Head & Neck Cancer Multidisciplinary Clinic call 877-BEAT-CANCER (877-232-8226)