Oral and Oropharyngeal Cancer: Diagnosis

Approved by the Cancer.Net Editorial Board, 01/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test result

The following tests may be used to diagnose oral or oropharyngeal cancer:

Physical examination. Dentists and doctors often find lip and oral cavity cancers during routine check-ups. If a person shows signs of oral or oropharyngeal cancer, the doctor will take a complete medical history, asking about the patient’s symptoms and risk factors. The doctor will feel for any lumps on the neck, lips, gums, and cheeks. Since patients with oral or oropharyngeal cancer have a higher risk of other cancers elsewhere in the head and neck region, the area behind the nose, the larynx (voice box), and the lymph nodes of the neck are also examined.

Endoscopy. This test allows the doctor to see inside the mouth and throat. Typically, a thin, flexible tube with an attached light and view lens, called an endoscope, is inserted through the nose to examine the head and neck areas. Sometimes, a rigid endoscope, which is a hollow tube with a light and view lens, is placed into the back of the mouth to see the back of the throat in more detail. The examination has different names depending on the area of the body that is examined, such as laryngoscopy to view the larynx, pharyngoscopy to view the pharynx, or nasopharyngoscopy to view the nasopharynx. To make the patient more comfortable, these examinations are performed using an anesthetic spray to numb the area. If tissue looks suspicious, the doctor will take a biopsy (see below). Tests are often done in the doctor’s office; however, sometimes, an endoscopy must be performed in an operating room at a hospital using a general anesthesia.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. During a fine needle aspiration biopsy, cells are removed using a thin needle inserted directly into the tumor. The cells are then examined under a microscope for cancer cells by a pathologist during a cytologic examination. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

Oral brush biopsy. During routine dental examinations, some dentists are using a newer, simple technique to detect oral cancer in which the dentist uses a small brush to gather cell samples of a suspicious area. The specimen is then sent to a laboratory for analysis. This oral brush biopsy procedure is easy and can be done in the dentist’s chair with very little or no pain. If cancer is found using this method, it is recommended that a traditional biopsy be done to confirm the results.

X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A dentist may take extensive x-rays of the mouth, including a panorex (panoramic view; see below).

Barium swallow. There are two types of these tests that are generally used to look at the oropharynx and check a patient’s swallowing. The first is a traditional barium swallow. During an x-ray exam, the patient is asked to swallow liquid barium so the doctor can look for any changes in the structure of the oral cavity and throat and see whether the liquid passes easily to the stomach. A modified barium swallow, or videofluoroscopy, is used to evaluate swallowing. The patient is asked to swallow liquid barium, pudding, and a cracker coated with barium.

Panorex. This is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect bone destruction from cancer or to evaluate teeth before radiation therapy or chemotherapy.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size, help the doctor decide whether the tumor can be surgically removed, and show whether the cancer has spread to lymph nodes in the neck or lower jawbone. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This test can detect the spread of cancer to the lymph nodes in the neck, called the cervical lymph nodes.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.