Otolaryngologists at The Johns Hopkins Head and Neck Cancer Center are among the most experienced in the diagnosis of head and neck cancers. These cancers are diagnosed by clinical examination, imaging tests and other specialized pathologic tests. These specialists are experts at differentiating benign from malignant tumors and accurately assessing the stage of progression.
Patients suspected of disease see a physician within a few days to be evaluated for appropriate tests. Upon receipt of the test results, the physician develops an appropriate and highly individualized treatment plan.
Our physicians perform any of several types of tests that can help to make a definitive diagnosis of a head and neck cancer and to determine the stage of the cancer, or how far it has progressed.
Physical Examination & History
First, the physician or nurse will take a complete medical history, noting all symptoms and risk factors. Then you will have a thorough examination of the head and neck area, during which the physician will feel for abnormalities and look at the inside of your mouth and throat.
The physician may use mirrors and lights to examine hard-to-see areas and may also use a flexible, lighted telescope to examine areas that are less accessible. The telescope may be inserted through the nose or mouth; an anesthetic spray may be used to make the examination more comfortable. This examination is called a nasopharyngoscopy, pharyngoscopy, or laryngoscopy, depending on which area is examined. Later, this type of examination will be done while the patient is under general anesthesia so a very thorough inspection can be done; this is called a panendoscopy.
The physician may also suggest several other tests, including imaging procedures such as a CT or computed tomographic scan (a special type of x-ray), an MRI or magnetic resonance image scan (which uses magnetic waves to produce pictures), or an ultrasound exam (which uses sounds waves to produce images). At Johns Hopkins, physicians also use PET (positron emission tomography) scans to help diagnose head and neck cancers. Currently, we are investigating whether PET scans will improve the ability to detect the spread of cancer to lymph nodes in the neck and other areas of the body. Other possible tests include a panorex (a special x-ray of the jaws), a barium swallow, dental x-rays, chest x-rays, and a radionuclide bone scan.
If a suspicious area is noted, the physician may do a biopsy: he or she will remove a small piece of tissue with either a scalpel or a needle, and send it to a laboratory for examination under a microscope. Biopsies are often done when the patient is under general anesthesia.
New Diagnostic Tools
Johns Hopkins scientists are studying new techniques including a mouth rinse to capture genetic signatures common to the disease. This research holds promise for developing tools to screen those at high risk, including heavy smokers and alcohol drinkers.