Exams and Tests

Cancers of the mouth and throat are often found on routine dental examination. If your dentist should find an abnormality, he or she will probably refer you to a specialist in ear, nose, and throat medicine (an otolaryngologist) or recommend that you see your primary health care provider right away.

If you have symptoms that suggest a possible cancer, or if an abnormality is found in your oral cavity or pharynx, your health care provider will immediately begin the process of identifying the type of abnormality.

• The goal will be to rule out or confirm the diagnosis of cancer.
  
  
• He or she will interview you extensively, asking questions about your medical and surgical history, the medications you take, your family and work history, and your habits and lifestyle, focusing on the risk factors for oropharyngeal cancers.

At some point during this process, you will probably be referred to a physician who specializes in treating cancers of the mouth and throat.

• Many cancer specialists (oncologists) specialize in treating cancers of the head and neck, which includes cancers of the oropharynx.
  
  
• It is your right to seek treatment where you wish.
  
  
• You may want to consult with two or more specialists to find one who makes you feel most comfortable.

You will undergo a thorough examination of the head and neck to look for lesions and abnormalities. A mirror exam and/or an indirect laryngoscopy (see below for explanation) will most likely be done to view areas that are not directly visible on examination, such as the back of the nose (nasopharyngoscopy), the throat (pharyngoscopy), and the voice box (laryngoscopy).

• The indirect laryngoscopy is performed with the use of a thin, flexible tube containing fiberoptics connected to a camera. The tube is moved through the nose and throat and the camera sends images to a video screen. This allows your physician to see any hidden lesions.
  
  
• In some cases, a panendoscopy may be necessary. This includes endoscopic examination of the nose, throat, and voice box as well as the esophagus and airways of the lungs (bronchi). This is done in an operating room while you are under general anesthesia. This gives the most exhaustive possible examination and can permit biopsies of areas suspicious for malignancy.
  
  
• The complete physical examination will look for signs of metastatic cancer or other medical conditions that could affect the diagnosis or treatment plan.

No blood tests can identify or even suggest the presence of a cancer of the mouth or throat. The appropriate next step is biopsy of the lesion. This means to remove a sample of cells or tissue (or the entire visible lesion if small) for examination.

• There are several techniques for taking a biopsy in the mouth or throat. The sample can be simply scraped from the lesion, removed with a scalpel, or withdrawn with a needle.
  
  
• This can sometimes be done in the medical office; other times, it needs to be done in a hospital.
  
  
• The technique is dictated by the size and location of the lesion and by the experience of the person collecting the biopsy.
  
  
• If you have a mass in your neck, that may be sampled as well, usually by fine-needle aspiration biopsy.

After the sample(s) is removed, it will be examined by a doctor who specializes in diagnosing diseases by examining cells and tissues (pathologist).

• The pathologist looks at the tissue under a microscope after treating it with special stains to highlight certain abnormalities.
  
  
• If the pathologist finds cancer, he or she will identify the type of cancer and report back to your health care provider.

If your lesion is cancer, the next step is to stage the cancer. This means to determine the size of the tumor and its extent, that is, how far it has spread from where it started. Staging is important because it not only dictates the best treatment but also your prognosis for survival after treatment.

• In oropharyngeal cancers, the stage is based on the size of the tumor, involvement of the lymph nodes in the head and neck, and evidence of spread to distant parts of the body.
  
  
• Like many cancers, cancers of the oral cavity and pharynx are staged as 0, I, II, III, and IV, with 0 being the least severe (cancer has not yet invaded the deeper layers of tissue under the lesion) and IV being the most severe (cancer has spread to an adjacent tissue, such as the bones or skin of the neck, to many lymph nodes on the same side of the body as the cancer, to a lymph node on the opposite side of the body, to involve critical structures such as major blood vessels or nerves, or to a distant part of the body).

Stage is determined from the following information:

• Physical examination findings
  
  
• Endoscopic findings
  
  
• Imaging studies - X-rays (including a Panorex, a panoramic dental x-ray), CT scan, MRI, and, occasionally, a nuclear medicine scan of the bones to detect metastatic disease