The diagnosis of oropharyngeal cancer can be difficult and overwhelming. Further testing will be necessary to confirm a diagnosis and determine the best course of treatment.
Endoscopy, imaging, and biopsy are generally standard diagnostic approaches. Patients can expect their doctor to have a discussion with them about the risks, benefits, and alternatives to 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 flexible or rigid 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 throat. “Endoscopy” is simply the process of using an endoscope to visualize a particular part of the body.
Read more about different kinds of endoscopies here.
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 oropharynx or throat is usually needed prior to treatment. In some cases, a fine needle aspiration (FNA) biopsy of any suspicious lymph nodes in the neck may also be helpful. There are generally three standard ways to biopsy a suspicious area in the oropharynx:
- Incisional biopsy, performed in the office
- Transnasal flexible endoscopy with biopsy
- Direct laryngoscopy with biopsy
Read more about different kinds of biopsies here.
In cases where the site of the primary tumor is unknown, special testing for p16 or HPV viral DNA can be performed on the FNA from the neck mass. If this testing is positive, there is a greater than 90% chance that the primary tumor is located in the oropharynx. This testing can help guide further evaluation.
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 extent as well as the behavior of a growth, and is a vital step prior to treatment of any tumor in the oropharynx or throat. 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 an oropharyngeal 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.
