The diagnosis of nasopharyngeal cancer can be difficult and overwhelming. Further testing will be necessary to obtain a diagnosis and determine the best course of treatment. A combination of endoscopy, imaging, and biopsy is generally the standard diagnostic approach. Patients can expect their doctor to have a discussion with them about the risks, benefits, and alternatives of each of the following approaches.
Endoscopy
An endoscope is a device that allows doctors to examine inside the body. It is made up of a thin tube with a camera and light attached on the end. The lenses inside the endoscope provide magnification, allowing doctors to detect even small changes in the lining of the nose and throat. “Endoscopy” is simply the process of using an endoscope to visualize a particular part of the body. Either a flexible or rigid endoscope will be used in the clinic to visualize and diagnose a mass in the nasopharynx, as this area is not visible otherwise. Read more about endoscopy procedures here and learn how they can be used to diagnose nasopharyngeal cancer.
Biopsy
A biopsy is the removal of a small piece of tissue to examine under a microscope to see if it is cancerous. A biopsy of a suspicious growth in the nasopharynx is needed prior to treatment. A nasopharyngeal biopsy will generally consist of a “transnasal rigid endoscopic biopsy.” This procedure refers to the passage of an endoscope from the front to the back of the nose in order to visualize the location and the tissue to be biopsied. This can be performed in the office or in the operating room, depending on the size and location of the mass and the tolerance of the patient.
In some cases, a fine needle aspiration (FNA) biopsy of any suspicious lymph nodes in the neck may also be helpful. When performing a biopsy on a neck mass, doctors should test for certain viruses such as human papillomavirus (HPV) and Epstein-Barr Virus (EBV). They can also test for proteins related to these viruses (e.g. P16 because it relates to HPV infection). Cancerous lymph nodes that have the HPV virus (or P16 protein) are more likely to be related to a primary cancer in the oropharynx; whereas, the primary tumor is much more likely to be in the nasopharynx if the lymph node is EBV positive. Learn more about different kinds of biopsies.
Imaging
Imaging scans, also known as radiologic studies, provide the doctor with an inside view of the body. Imaging of the head and neck will be required to determine the size, location, and behavior of a growth. This is a vital step prior to treatment of any tumor in the nasopharynx. The most common initial imaging tests used are CT and MRI scans. A more advanced imaging study called a PET/CT will likely also be performed to evaluate if a nasopharyngeal cancer has spread to other sites in the body as well as to determine if lymph nodes in the neck are likely to harbor cancer cells. Learn more about different kinds of imaging.
