Diagnosis and Staging of head and neck cancer
-To find the cause of the signs or symptoms of a problem in the head and neck area, a doctor evaluates a person’s medical history, performs a physical examination and orders diagnostic tests.
-The exams and tests may vary depending on the symptoms.
-Examination of a sample of tissue under a microscope is always necessary to confirm a diagnosis of cancer.
-If you have symptoms that suggest oral cancer, your doctor or dentist will check your mouth and throat for red or white patches, lumps, swelling, or other problems.
-A physical exam includes looking carefully at the roof of your mouth, back of your throat, and insides of your cheeks and lips.
-Your doctor or dentist also will gently pull out your tongue so it can be checked on the sides and underneath. The floor of your mouth and lymph nodes in your neck will also be checked.
-If your doctor or dentist does not find the cause of your symptoms, you may be referred to a specialist.
-An ear, nose, and throat specialist can see the back of your nose, tongue, and throat by using a small, long-handled mirror or a lighted tube.
-Sometimes pictures need to be made with a CT scan or MRI to find a hidden tumor.
-The removal of a small piece of tissue to look for cancer cells is called a biopsy. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if the abnormal area is cancer.
-If oral cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment.
-When oral cancer spreads, cancer cells may be found in the lymph nodes in the neck or in other tissues of the neck. Cancer cells can also spread to the lungs, liver, bones, and other parts of the body.
-Doctor may order one or more of the following tests to stage the disease:
.X-rays
.CT scan
.MRI
.Endoscopy
.PET scan
-X-rays: An x-ray of your entire mouth can show whether cancer has spread to the jaw. Images of your chest and lungs can show whether cancer has spread to these areas.
-CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your body. You may receive an injection of dye. Tumors in your mouth, throat, neck, lungs, or elsewhere in the body can show up on the CT scan.
-MRI: A powerful magnet linked to a computer is used to make detailed pictures of your body. An MRI can show whether oral cancer has spread
-Endoscopy: The doctor uses a thin, lighted tube (endoscope) to check your throat, windpipe, and lungs. The doctor inserts the endoscope through your nose or mouth.
-PET scan: A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.
Staging of oral cancer
-Doctors describe the stage of oral cancer based on the size of the tumor, whether it has invaded nearby tissues, and whether it has spread to the lymph nodes or other tissues:
-Early cancer: Stage I or II oral cancer is usually a small tumor, and no cancer cells are found in the lymph nodes.
-Advanced cancer: Stage III or IV oral cancer is usually a large tumor (as big as a lime). The cancer may have invaded nearby tissues or spread to lymph nodes or other parts of the body.
Diagnosis of laryngeal cancer
-If you have symptoms that suggest laryngeal cancer, your doctor may do a physical exam.
-Your doctor looks at your throat and feels your neck for lumps, swelling, or other problems.
-You may have one or more of the following tests:
.Indirect laryngoscopy
.Direct laryngoscopy
.Biopsy
Indirect laryngoscopy
-Your doctor uses a small mirror with a long handle to see your throat and larynx.
-Your doctor will check whether your vocal cords move normally when you make certain sounds.
Direct laryngoscopy
-Your doctor uses a lighted tube (laryngoscope) to see your throat and larynx.
-The lighted tube can be flexible or rigid:
.Flexible: Your doctor puts a flexible tube through your nose into your throat.
.Rigid: Your doctor puts a rigid tube through your mouth into your throat. A tool on the rigid tube can be used to collect tissue samples.
Biopsy
-The removal of a small piece of tissue to look for cancer cells is called a biopsy.
-Usually, tissue is removed with a rigid laryngoscope under general anesthesia. A pathologist then looks at the tissue under a microscope to check for cancer cells.
-A biopsy is the only sure way to know if the abnormal area is cancer.
Staging of Laryngeal cancer
-To learn whether laryngeal cancer has invaded nearby tissues or spread, doctor may order one or more tests:
.Chest x-ray
.CT scan
.MRI
-Doctors describe the stage of laryngeal cancer based on the size of the tumor, whether the vocal cords move normally, whether the cancer has invaded nearby tissues, and whether the cancer has spread to other parts of the body
Stages of Laryngeal cancer
Early cancer
-Stage 0, I, or II laryngeal cancer is usually a small tumor, and cancer cells are rarely found in lymph nodes.
Advanced cancer
-Stage III or IV laryngeal cancer is a tumor that has invaded nearby tissues or spread to lymph nodes or other parts of the body.
-Or the cancer is only in the larynx, but the tumor prevents the vocal cords from moving normally.
Diagnosis of pharyngeal cancer
Physical exam of the throat
-An exam in which the doctor feels for swollen lymph nodes in the neck and checks for anything else that seems unusual.
Nasoscopy
-A procedure to look inside the nose for abnormal areas. A nasoscope is inserted through the nose. A nasoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
Neurological exam
-A series of questions and tests to check the brain, spinal cord, and nerve function.
-The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work.
CT scan
-A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
MRI (magnetic resonance imaging)
-A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
X-rays
-An x-ray of the organs and bones. An x-ray is a type of energy beam that can go through the body and onto film, making pictures of areas inside the body.
PET scan
-A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Endoscopy
-A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through the patient’s nose or mouth to look at areas in the throat that cannot be seen during a physical exam of the throat.
Bone scan
-A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
Barium esophagogram
-An x-ray of the esophagus. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken.
Esophagoscopy
-A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. Tissue samples may be taken for biopsy.
Bronchoscopy
-A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.
Biopsy
-The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.
Diagnosis of Paranasal sinuses and nasal cavity
cancer
The following tests and procedures may be used to diagnose paranasal sinuses and nasal cavity cancer
Physical exam and history
-X-rays of the head and neck
-MRI
-Nasoscopy
-Laryngoscopy
-Biopsy
Diagnosis of salivary gland cancer
The following tests and procedures may be used to diagnose salivary gland cancer
Physical exam and history
-MRI
-CT scan
-PET scan
-Ultrasound exam
-Endoscopy
-Biopsy
Head and neck cancer staging
-Head and neck cancer staging involves both the size of the tumor and whether or not it has spread to other parts of the body such as the lymph nodes.
-Staging helps doctor to determine whether or not to try a particular treatment.
-Stages of head and neck cancer start at 0 and go up to 4 (I–IV)
-Generally, a lower number means the cancer has spread less. A higher number means the cancer has spread more.
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