Diagnosis
This region of the neck affects three areas, the hypopharynx (the lower part of the throat), the nasopharynx (the part of the throat at the back of the nose) and the oropharynx (the part of the throat at the back of the mouth). It is important to record the patient history and symptoms to isolate the lesion to one of the above-mentioned regions. An ear, nose and throat specialist (the otolaryngologist) will determine the need for further testing, which may include:
- X rays accompanied by Barium swallow will determine if there are difficulties swallowing and where the obstruction is. A chest X rays will diagnose whether the cancer has spread to the lungs or lymph nodes.
- Ultrasound is used to view inside the neck and look for signs of spread to the lymph nodes in that area.
- Panendoscopy is a study that combines endoscopic visualization of several sections of the structures of the throat and it is important because in a small percentage of people (15%), there is a secondary tumour when pharyngeal cancer is diagnosed.
- Biopsy is a small sample of the lump or lesion. The sample is sent to pathology where it is processed and examined under a microscope to give a definite diagnosis of the tumour.
- CT scan can be used to identify the lesion and guide the biopsy as well as to determine if there is spread to the surrounding tissues and organs.
- MRI (Magnetic Resonance Imaging) provides a 3D image of the lesion and the surrounding tissues and organs. It can also aid and guide the biopsy.
- PET scan (Position Emission Tomography) uses radioactive materials to identify metabolic changes in the tissues. This diagnostic is used to look for metastases and spread to the surrounding area. (Canadian Cancer Society)
- Serology is used to identify certain proteins in blood linked to the tumour.
Staging
Staging refers to a cancer classification system that tells the physician how far along the disease is. The TNM system of the American Joint Committee on Cancer is widely accepted and used across the world. T stands for size of the tumour; N refers to the spread to the lymph nodes; and M means metastasis or spread to distant organs.
T : Size of the tumour |
| T0: No evidence of primary tumour. |
| Tis: Carcinoma in situ: the cancer has affected the epithelial cells lining the cavity but the tumour is not deep. |
| T1: Tumour is 2 cm (1 cm equals 0.39 inches) or smaller. |
| T2: Tumour is larger than 2 cm but smaller than 4 cm. |
| T3: Tumour is larger than 4 cm. |
| T4: The tumour is any size and has invaded adjacent structures, such as the larynx, bone, connective tissues, or muscles. |
N: Lymph node involvement |
| N0: No metastasis in the regional lymph nodes. |
| N1: Metastasis in one lymph node on the same side of the primary tumour and smaller than 3 cm. |
| N2: Divided into 3 subgroups. N2a is metastasis in one lymph node larger than 3 cm and smaller than 6 cm. N2b is metastasis in multiple lymph nodes on the same side of the tumour, none larger than 6cm. N2c denotes one or more lymph nodes, which may or may not be on the side of the primary tumour, none larger than 6 cm. |
| N3: Metastasis in lymph node larger than 6 cm |
M : Distant metastasis |
| M0: No distant metastasis. |
| M1: Distant metastasis present. |
Santhanam, Kausalya, and Rebecca J. Frey. “Oral Cancers.” The Gale Encyclopedia of Cancer: A Guide to Cancer and Its Treatments, edited by Kristin Fust, 4th ed., vol. 2, Gale, 2015, pp. 1295-1303. Gale Virtual Reference Library.
