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When you go to the doctor with symptoms, he or she will get a full medical history and do a complete physical exam. The doctor will also do a thorough examination of your head and neck. The exam may include a pharyngoscopy or a laryngoscopy. These tests use a flexible tube with a light at the end or a small mirror to help the doctor see the throat (pharynx), base of the tongue, and larynx, which is your voice box.
A biopsy is the only definitive way to know if you have cancer. During a biopsy, a sample of tissue is removed from the tumor. Then a pathologist — a specialist who examines tissue samples in a lab — looks at the tissue under a microscope to check for cancer cells. It usually takes a few days for the results of your biopsy to come back. A biopsy can sometimes be done in your doctor’s office or it may need to be done in the hospital with surgery. In that case, you’d get general anesthesia so that you fall asleep and don’t feel pain during the procedure.
If you have a lump in your neck, it may be in a lymph gland, also called a lymph node. Your doctor uses a needle in a process called fine needle aspiration to see if there are cancer cells in your lymph node. This is usually done as an outpatient procedure in your doctor’s office or a clinic. You don’t generally need to stay in the hospital.
Once the diagnosis of head and neck cancer has been made, more tests are needed to find out how far the cancer has spread. Here are some of the tests you may need to have:
This is an X-ray of your jaw that shows if the cancer has spread into the bone. It also shows if your teeth require dental intervention prior to radiation treatments.
This is an important test to evaluate if head and neck cancer has spread to your lungs. If so, it is said to have metastasized. If you are a smoker, you are also at risk for lung cancer, which may be found on a chest X-ray.
Ultrasonography uses sound waves to make a picture of the inside of your body. Echoes of the sound waves make patterns that are called a sonogram. If your symptoms suggest liver involvement, this test is sometimes used to see if the tumor has spread to the liver.
In order to see the tissues of the mouth, throat, larynx, and other structures that may be affected, a thin, flexible tube may be inserted in your mouth and passed through your throat. A light and a camera in the tube allows your doctor to see these tissues directly.
In this test, an X-ray beam takes a series of pictures of your body from many angles. These images are then combined by a computer, giving a detailed three-dimensional picture of your body. The CT scan can be used to evaluate the head and neck and is sometimes used to evaluate the chest instead of a chest X-ray.
Magnetic resonance imaging (MRI)
This test uses magnets and radio waves to take pictures of the inside of your body, much like a CT scan. MRIs do not use X-rays and are better than CT scans at showing details of soft tissue, such as muscles, tendons, fat, nerves, and joints.
For this test, a small amount of a radioactive substance is injected into your veins. This radioactive material travels through your bloodstream and collects in areas of abnormal bone growth. A machine scans your body for the places where the substance has collected.
Positron emission tomography (PET) scan
This test measures the metabolic activity of the tissues. A radioactive material is injected into your vein. Then a machine takes pictures of your entire body that show “hot spots” where the activity of the injected material is increased. A PET scan may be combined with a CT scan (PET-CT scan) to provide more information.
Your doctor will order tests to check blood counts and proper functioning of the liver and kidneys, as well as for levels of substances, such as calcium, sodium, potassium, and magnesium.
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