Head and Neck Cancer Testing and Diagnosis

Doctors use screening tests, such as mammograms for breast cancer, to look for some types of cancer before symptoms start. Unfortunately, there currently aren’t screening tests for head and neck cancers, but your providers can look for signs during your yearly physical and dental exams.

If you’ve already had head and neck cancer or you’re at high risk for other reasons, your health care provider may recommend chest X-rays and more frequent physical exams.

Tests for head and neck cancer

Based on your symptoms, you may be referred to a provider called an oral and maxillofacial surgeon. This doctor specializes in surgeries treating the face, mouth, teeth, jaws and neck. Or you may be referred to an ear, nose and throat specialist (otolaryngologist or ENT).

To diagnose head and neck cancer, your health care provider will start by asking you about any symptoms. They may also recommend: 

• Physical exam of your head and neck, feeling for lumps and looking inside your mouth, throat and nose.
• Blood and urine testing to look for the Epstein-Barr virus, assess your overall health and spot any possible problems.
• Endoscopy, where a thin, flexible tube with a camera is put into your mouth or nose to see inside your throat, nose or larynx (voice box).
• Biopsy (removing a small amount of tissue for lab testing to see if it’s cancerous).
• Fine needle aspiration, which takes fluid from a lymph node to see if there are signs of cancer.
• Molecular (genetic) testing of the tumor.
• Imaging tests such as X-rays, CT and PET scans and MRIs to spot tumors and see how big they are.
• Panoramic radiograph (Panorex), a rotating X-ray of the upper and lower jawbones
• Ultrasound, which uses sound waves to create images of parts inside the body.
• Bone scan, to check if cancer has spread to the bones.

Head and neck cancer staging

Health care providers use a staging system to help identify the size, location and spread of cancer:

• Stage 0: Abnormal cells in the lining of the affected area may become cancerous.
• Stage 1: The cancer is small and has not reached the lymph nodes.
  • For HPV disease cancer may have spread to the lymph nodes in Stage 1. 
• Stage 2: The cancer is larger than in stage 1, but still has not reached the lymph nodes.
• Stage 3: The cancer is larger than in stage 2 or has spread to a nearby lymph node.
• Stage 4: The cancer has spread to multiple lymph nodes and/or spread to other parts of the body, like the lungs.

The stage of the cancer helps your providers make treatment decisions. For early-stage cancers, surgery may be effective. More advanced cancers might need a combination of surgery, radiation therapy, chemotherapy or other treatments.

What is the prognosis for head and neck cancer?

If head and neck cancer is found early, the prognosis is good – especially if you are younger and healthy. 

However, many people do not show symptoms in the early stages – in fact, about 66% of head and neck cancers are found in stages 3 and 4. In these cases, treatment may need to be more aggressive and may be less helpful. 

Some types of head and neck cancer have a better prognosis (chance of recovery) than others. Your provider can explain more based on your cancer staging, the type of cancer you have and your general health. 

Learn about treating head and neck cancer.  

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