Pre-Treatment Evaluation

As part of the pre-treatment evaluation process, your doctor may order some tests to help determine your treatment plan and confirm your diagnosis.

Patients may visit a head and neck cancer specialist for a variety of reasons and symptoms. In general, patients seek out this type of doctor if they (or another doctor) are worried that the patient may have a cancer in the head and neck region. Many initial steps will be required before an initial diagnosis can be determined. This will usually start with the doctor taking the patient’s history and performing a physical examination.

It is important for patients to arrive at their first doctor’s appointment with any relevant documents, previous pathology reports, or imaging studies that might be useful for their doctor. If possible, the patient should bring a CD with the actual imaging scans, as well as the biopsy material, so that it can be reviewed to confirm the diagnosis.

Medical History

At a patient’s first visit to a head and neck specialist, the doctor will take a thorough overview of the patient’s health history, including any past treatments, medical conditions, and current complaints. Doctors call this process ‘taking a history’.

The doctor will likely ask some of the following questions:
  • What is the current problem or complaint?
  • How long has the problem been there?
  • Is it getting worse, better, or staying the same?
  • Does it come and go or is it constant?
  • Have you tried anything to make it better?
  • Is it painful?
  • Do you have numbness or tingling anywhere in your face or mouth?
  • Do you have any lumps or bumps in your neck?
  • Are you losing weight?
  • Do you have any other medical conditions?
  • Have you had any surgeries in the past?
  • What medications do you take? 
  • Do you have any allergies?
  • Have you ever been exposed to radiation in the head and neck?
  • What do you (or did you) do for a living?
  • Do you have a family history of cancer?

Physical Exam

After completing the patient’s history, the doctor will perform a physical exam. This will involve a full head and neck exam that is focused on the area of concern. If the patient has a visible tumor, the doctor will feel, or palpate, the tumor and the surrounding area. It will be important for the doctor to determine what the tumor feels like, and whether or not it is adherent to surrounding structures.

The doctor will likely do the following:
  • Look inside the patient’s ears.
  • Look inside the patient’s nose.
  • Thoroughly examine the patient’s mouth and throat.
  • Feel the patient’s neck thoroughly to check for any lumps or bumps.
  • Check the patient’s cranial nerves by testing facial sensation and asking patients to move their face, stick out their tongue, lift their shoulders, and move their eyes in all directions.

In some cases, the doctor may use a small camera (a flexible fiberoptic scope) to look at the back of the throat and vocal cords by passing it carefully through the patient’s nose.

Reviewing Tests

After taking the patient’s history and performing a physical exam, the doctor will review any scans, laboratory work, or pathology results that the patient may already have. It is important for the patient to bring all of these with them to the appointment, including the actual discs of any scans as well as any reports of those scans. 

Recommendations

Finally, the doctor will make recommendations about the patient’s next steps. If the patient’s symptoms have not been present for very long, the patient’s history and physical examination is not concerning, or the patient’s growth does not appear cancerous, the doctor may want to observe the lesion for a period of time or try some medications before prescribing any further cancer workup.

If the doctor is suspicious of cancer, they may want more information and may order additional tests such as imaging (MRI, CT scan, X-ray, etc.), a biopsy, or blood tests. Once the doctor has all of the necessary information, they will be able to determine a preliminary diagnosis (as well as potentially the type, grade, and/or stage of the cancer) and discuss possible treatment plans (which will be specific to each type of cancer).

Other Evaluations

Before proceeding with any form of treatment, the patient will first need to undergo a few more evaluations.

Speech & Swallow Evaluation

A speech-language pathologist (SLP) will assess how well the patient is currently able to speak and swallow, and also take certain measurements such as how wide a patient is able to open their mouth.  The SLP will also go over strategies for maintaining effective swallowing preoperatively, postoperatively, and during any adjuvant treatment. The preoperative speech and swallow assessment will also help guide doctors on how well a patient will tolerate certain treatments and what functional status can be expected after treatment. 

Nutritional Evaluation

Some patients may also undergo a nutritional assessment from a dietitian.  This can be helpful for patients to ensure they are consuming an adequate amount of calories before, during, and after treatment. 

Dental Clearance

A dentist will assess the health of the patient’s jaw and teeth, which will be particularly important for patients with cancer in the mouth, throat, or jaw, especially in patients who may require radiation therapy as a part of their treatment.  If radiation treatment is anticipated, the dentist may make fluoride trays that will be used to protect a patient’s teeth following radiation. Fluoride applications are advisable for the rest of a patient’s life following radiation therapy. 

Medical Clearance

A primary care doctor will need to assess the patient and ensure they are medically fit to undergo surgery and general anesthesia.  They may also refer the patient to other specialists, such as a cardiologist or a pulmonologist, if further investigation of medical issues is necessary.

When a Patient Experiences Extreme Symptoms

There some cases in which the patient is already experiencing extreme symptoms, the doctor may recommend immediate action.

Tracheostomy

If the patient has a very large tumor that is making it difficult for them to breath, the doctor may recommend a tracheostomy, which is a breathing tube placed into the front part of the neck directly into the windpipe to bypass the area of obstruction and allow the patient to breathe until a definitive surgery can be performed.

Feeding Tube

If the patient is having difficulty getting enough nutrition by mouth because of a tumor, the doctor may recommend a feeding tube. This will help ensure that the patient is able to undergo the treatments required to treat their cancer without losing too much weight or becoming malnourished.