What is the Workup of Suspected Head and Neck cancer?

By: Dr. Stefanie Horne, MD
Southwest Ohio ENT Specialists

A biopsy is required to diagnose the cancer and to test tissues for cancer markers. This can be done in the office or under anesthesia depending on the location of the cancer. Office biopsies can be done with topical or local anesthesia. In some cases, a needle biopsy is done of an enlarged lymph node in the neck. In many cases, an exam under anesthesia is required to determine the extent of the cancer in the throat or mouth and to reach the tumor for a biopsy. The biopsies are evaluated by a Pathologist.

CT scan of the neck (and sometimes chest) evaluates the extent of the cancer in the throat and determines if the lymph nodes in the neck appear abnormal. This helps to determine if the cancer has metastasized from the throat to the lymph nodes in the neck. This is reviewed by your ENT and read by a Radiologist.

PET CT scan is performed in most cases depending on the size and location of the cancer. This is a “cancer localizing” scan that evaluates the entire body. It helps to determine the extent of cancer and if there are metastases (areas where the cancer has spread). This is reviewed by your ENT and read by a Nuclear Medicine Physician.

Consultation with the appropriate specialists (see below) is best done once the “staging workup” is completed. The staging work up includes biopsies, CT and PET CT. Most patients are evaluated by an Otolaryngologist (ENT surgeon), Radiation Oncologist and Oncologist.

Video strobe and functional endoscopic evaluation of swallowing are often performed when head and neck cancer is suspected or soon after it is diagnosed. A video strobe is helpful to see the primary tumor (where the cancer started) and take baseline videos and photos of the primary tumor. This is used as a comparison for monitoring the cancer after treatment. A functional endoscopic evaluation of swallowing (FEES) is done prior to treatment to evaluate for swallowing dysfunction and formulate a plan for swallowing therapy based on your specific issues and cancer location.

Audiogram (hearing test) should be done before starting cancer therapy if treatment will require chemotherapy. Some chemotherapy drugs can cause hearing loss or tinnitus (ringing in the ears) over the course of therapy. Having a baseline audiogram is useful as a reference to see if the therapy has affected your hearing.

Dental examination should be scheduled if radiation will be required as part of head and neck cancer treatment. Your dentist will evaluate the health of your teeth and make sure that dental extractions are not required before starting radiation therapy. This is done to avoid infections of the teeth or mandible (jaw bone) during or after treatment.
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