How is oropharyngeal cancer diagnosed? 

It is important that your doctor establishes the diagnosis of oropharyngeal 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 by feeling and looking inside your throat and neck

  • order diagnostic tests, which may include scans.

Not everyone will need to have every test for oropharyngeal cancer. Your doctor will recommend tests that are right for you. 

Common tests include: 
 

Nasoendoscopy

Your doctor will look inside your nose and throat using a very thin flexible tube with a tiny light and camera on it (called an endoscope). This can be done in an office or clinic.

   

Biopsy

This involves taking a piece of tissue (sample) either from the throat or from a lymph node in the neck, if it appears to be involved by the cancer. A pathologist then looks at the sample under a microscope to check for cancer cells. This is often the only sure way to tell if you have cancer. If the suspicious area can be safely accessed through the mouth, your doctor may take a sample for biopsy in the office. However, this is often not possible because the cancer may be too far back and some patients need to be asleep under a general anaesthetic for the biopsy. This is usually done as a day procedure. 

Your doctor may order one of two types of biopsies of the lymph nodes in your neck. Both are usually done using an ultrasound scan to make sure the needle is in the right spot.
  • Needle biopsy (Fine Needle Aspiration or FNA) is used when there is a lump (enlarged lymph node) in the neck that could have cancer cells in it. During the procedure, your doctor will take some cells from the lump using a needle. It may feel a bit uncomfortable during the biopsy.
  • Core biopsy uses a bigger needle to get more cells for the biopsy. This is more uncomfortable than needle biopsy so doctors only use this if it is really needed.
 

CT (computed Tomography) scan

This uses X-rays to take pictures of the inside of the body. If a person has cancer, a CT scan can help the doctor to see where it is, measure how big it is, and if it has spread into nearby organs or other parts of your body.

 

MRI (Magnetic Resonance Imaging) scan

This uses magnetic fields, to take pictures of the inside of the body. This helps your doctor see how far a cancer has grown into the tissue around it. Not all people with oropharyngeal cancer need a MRI scan. 

 

PET (Positron Emission Tomography) scan

This is a whole body scan that uses a radioactive form of sugar which can show if the oropharyngeal cancer has spread to the lymph nodes or elsewhere in the body.