Head and Neck Cancer Diagnosis
Head and neck cancer can develop in the mouth, nasal passages, sinuses, throat or voice box. Most tumors begin in the squamous cells that line the moist surfaces of the head and neck. While tobacco use and alcohol consumption remain the leading causes, persistent human papillomavirus (HPV) infection has become a significant risk factor, particularly for cancers of the throat. Additional contributors can include long-term sun exposure, poor oral hygiene and certain workplace hazards, such as wood dust. Head and neck cancer is more common in men and adults older than 40, but it can affect anyone.
The early warning signs of head and neck cancer can vary; some patients develop a mouth sore that does not heal, a chronic sore throat, ear pain, trouble swallowing or vocal hoarseness. Because these symptoms can be mild and often resemble those of a less serious condition, such as a simple ulcer or the common cold, an accurate diagnosis is essential to ensure timely and appropriate treatment. Depending on the type and stage of the tumor, options may include surgery, radiation therapy, chemotherapy, targeted therapy and/or immunotherapy.
Although head and neck cancer accounts for only a small percentage of cancer diagnoses in the United States, it remains a significant health concern. Early detection can greatly improve the likelihood of successful treatment and recovery.
How is head and neck cancer detected?
Head and neck cancer can be difficult to recognize early, mainly because the symptoms are often subtle and nonspecific. Usually, the diagnostic process begins with a physical examination and medical history review. If a tumor is suspected, the physician will likely order follow-up testing, which may involve a combination of imaging scans, medical procedures and laboratory analyses.
Imaging tests used for diagnosing head and neck cancer
Imaging studies are an important first step in understanding the size, location and spread of a tumor. These critical diagnostic tests can provide the physician with a detailed view of areas of the body that cannot be fully assessed during a physical exam. Common imaging tests for head and neck cancer include:
Computed tomography (CT) scan
Computed tomography uses specialized X-rays to create cross-sectional images of the head and neck. These detailed images can allow the physician to clearly visualize internal structures and assess the exact size, shape and location of a tumor. A CT scan can also help the physician determine whether the cancer has spread to nearby lymph nodes, bones or other tissues. In some cases, contrast dye may be used to enhance the images and provide more precise information. In addition to helping the physician confirm the initial diagnosis, this imaging test can also play an important role in treatment planning and monitoring how well the cancer responds to therapy.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging uses powerful magnets and radio waves to produce high-resolution images of the head and neck. MRI can be particularly effective for evaluating soft tissues, such as muscles, nerves and blood vessels, providing more detailed information than a CT scan in certain cases. This imaging test is often used to assess tumors in the throat, tongue or areas near the skull base, where precision imaging is vital. It can help the physician determine how deeply a tumor has grown into surrounding tissues and assess the involvement of nearby critical structures. Like computed tomography, magnetic resonance imaging can also be useful for tracking treatment response over time.
Positron emission tomography (PET) scan
Positron emission tomography involves injecting a small amount of a radioactive substance (radiotracer) into the bloodstream. As the radiotracer circulates throughout the body, it will accumulate in areas of high metabolic activity, such as a tumor site. The radioactive material will then emit positrons, which will interact with electrons in the body, releasing gamma rays. A PET scanner can detect these gamma rays and use a computer to create three-dimensional (3D) images, which can help the physician evaluate the function of various organs and tissues. A PET scan may be combined with a CT scan to provide both functional and anatomical information in one test. This approach can help the physician determine whether the cancer has spread to nearby lymph nodes or distant parts of the body, making it especially valuable for staging. Positron emission tomography can also be used to evaluate how well a tumor is responding to treatment.
X-ray
An X-ray is a quick and widely available imaging test that uses low-dose radiation to produce images of internal bodily structures. While X-rays are less detailed than CT and MRI scans, they can still help the physician detect abnormalities in the bones, teeth and jaw, which may be affected by head and neck cancer. Often, X-rays are used as a first-line imaging tool or to monitor for treatment-related changes, such as dental or jawbone complications from radiation therapy.
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Schedule an AppointmentProcedures used for diagnosing head and neck cancer
In addition to ordering imaging tests, the physicians may perform a specialized procedure to directly examine a suspicious area and collect tissue samples for evaluation. These steps are critical for confirming whether cancer is present and for determining the type, stage and best treatment approach. Common diagnostic procedures for head and neck cancer include:
Endoscopy
An endoscopy uses a thin, flexible tube with a light and camera attached (endoscope), allowing the physician to see inside the nasal passages, throat, voice box or other areas of concern. Often performed in-office or under light sedation, this nonsurgical procedure can provide a close-up view of tissues that may appear abnormal. During the exam, the physician may also take small tissue samples for further testing. Endoscopy is especially important for evaluating areas that are not easily visible through a standard physical examination.
Biopsy
A biopsy is the most definitive way to confirm a diagnosis of head and neck cancer. To obtain a tissue sample for evaluation, the physician may perform an incisional or excisional biopsy. An incisional biopsy involves removing a portion of a suspicious mass, while an excisional biopsy involves removing an entire abnormal growth or lymph node. Depending on the location and amount of tissue being removed, the procedure may be performed under local or general anesthesia. Biopsy results provide critical information that can help the physician stage the cancer and plan treatment, making it a cornerstone of the diagnostic process.
Fine-needle aspiration (FNA)
FNA is a minimally invasive procedure commonly used to evaluate a lump or swollen lymph node in the neck. After inserting a thin, hollow needle into the area of concern, the physician will withdraw a small sample of cells, which will be sent to a pathology lab for microscopic examination. While FNA may not provide as much information as a full biopsy, it can be highly useful for quickly determining whether a neck mass is inflammatory, benign or cancerous. The procedure is often performed in the physician’s office with minimal discomfort to the patient.
Panendoscopy
Panendoscopy is a comprehensive procedure that may be used when head and neck cancer is suspected or already diagnosed. It involves examining multiple areas of the head and neck at once, including the throat, voice box, esophagus and windpipe, using a series of connected endoscopes. Panendoscopy is typically performed in an operating room under general anesthesia and may include biopsies of suspicious tissues. This test can be particularly valuable for detecting additional tumors, assessing the extent of the cancer and helping the physician plan surgery or other treatments.
Laboratory tests used for diagnosing head and neck cancer
Laboratory testing plays an important role in supporting the diagnosis and management of head and neck cancer. While medical imaging and procedures, such as endoscopy and biopsy, remain the primary diagnostic tools, lab work can provide valuable insights into the type of tumor, its biological behavior and the patient’s overall health. The results help the physician tailor the treatment plan and better predict the outcome.
Pathology testing
Pathology is the foundation of a cancer diagnosis. After a biopsy, a pathologist will examine the tissue sample under a microscope to confirm the presence of cancerous cells and identify the specific type of head and neck cancer. The pathologist will also evaluate how abnormal the cells appear (the tumor grade), which can provide important clues about how aggressive the cancer may be. In some cases, additional specialized pathology testing—such as immunohistochemistry or molecular profiling—may be performed to identify genetic mutations or biomarkers that can guide targeted therapies.
Human papillomavirus testing
Many cancers of the oropharynx, such as those affecting the tonsils or base of the tongue, are linked to an HPV infection. Testing for HPV is often performed on biopsy tissue to determine whether the tumor is HPV-positive. This distinction is important because HPV-related head and neck cancer generally responds better to treatment and is associated with a more favorable prognosis. Knowing the HPV status can also help the physician personalize treatment and follow-up care.
Blood testing
Blood work is not typically used to diagnose head and neck cancer directly, but it can provide essential information about the patient’s overall health. Routine blood tests can help the physician evaluate kidney and liver function, measure blood counts and check for signs of infection or anemia—all of which are important considerations when determining whether the patient is healthy enough to begin treatment. Blood tests can also be used throughout therapy to monitor side effects, track recovery and ensure that the body is tolerating treatment safely.
Emerging biomarkers and genetic testing
Advances in cancer research have introduced new laboratory tests that can provide even deeper insights into head and neck cancer. For instance, biomarker testing can reveal molecular features of a tumor that can help the physician predict how it will respond to certain therapies. Options may include:
- PD-L1 testing – This test measures the level of PD-L1 protein expression in tumor cells, which can help the physician determine whether the patient may benefit from immunotherapy with immune checkpoint inhibitors.
- Next-generation sequencing (NGS) – NGS analyzes tumor DNA for genetic mutations or alterations that can be targeted with novel therapies or clinical trials.
- Other molecular markers – In ongoing research studies, scientists are evaluating additional biomarkers that may improve early detection, predict treatment resistance or guide precision medicine approaches.
While these emerging tests are not yet standard for every patient, they represent an important step toward precision medicine and more individualized cancer care.
Why an early diagnosis of head and neck cancer matters
Detecting head and neck cancer in its earliest stages can greatly increase the likelihood of successful treatment and may allow for less aggressive therapies, reducing the risk of long-term side effects and potentially preserving important functions, such as speech and swallowing. In contrast, a delayed diagnosis can give the tumor time to grow or spread to nearby lymph nodes and other tissues, making treatment more complex and the outcome less favorable. Periodic medical checkups, prompt attention to persistent symptoms and timely diagnostic testing are all critical in identifying head and neck cancer as early as possible.
Benefit from world-class care at Moffitt Cancer Center
The researchers and clinicians at Moffitt continue to pave the way in finding new and better ways to diagnose and treat head and neck cancer. Through our robust portfolio of clinical trials, our patients have unique opportunities to be among the first to benefit from promising new therapies that are not yet readily available elsewhere.
If you would like to learn more about the diagnostic process for head and neck cancer, you can request an appointment with a specialist in the Head and Neck Cancer Program at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.
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