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Diagnosis and Staging Work Up

To find the cause of symptoms, a surgical oncologist evaluates a person′s medical history, performs a physical examination, and orders diagnostic tests. The exams and tests conducted may vary depending on the symptoms. Examination of a sample of tissue under the microscope is always necessary to confirm a diagnosis of cancer.

Some exams and tests that may be useful are as under :

  • Physical examination may include visual inspection of the oral and nasal cavities, neck, throat, and tongue using a small mirror and/or lights. The surgical oncologist may also feel for lumps in the neck, lips, gums, and cheeks.
  • Endoscopy is the use of a thin, lighted tube called an endoscope to examine areas inside the body. The type of endoscope the Surgical Oncologist uses depends on the area being examined. For example, a laryngoscope is inserted through the mouth to view the larynx; an esophagoscope is inserted through the mouth to examine the esophagus; and a nasopharyngoscope is inserted through the nose so that the surgical oncologist can see the nasal cavity and nasopharynx.
  • Laboratory tests examine samples of blood, urine, or other substances from the body.
  • X-rays create images of areas inside the head and neck on film.
  • CT scan is a series of detailed pictures of areas inside the head and neck created by a computer linked to an x-ray machine.
  • Magnetic resonance imaging (or MRI) uses a powerful magnet linked to a computer to create detailed pictures of areas inside the head and neck.
  • PET scan uses sugar that is modified in a specific way so it is absorbed by cancer calls and appears as dark areas on the scan.
  • Biopsy is the removal of tissue. A pathologist studies the tissue under a microscope to make a diagnosis. A biopsy is the only sure way to tell whether a person has cancer. If the diagnosis of cancer is confirmed, the surgical oncologist will want to know the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anaesthesia (in the operating room), x-rays and other imaging procedures, and laboratory tests. Knowing the stage of the disease helps the surgical oncologist plan treatment.

Staging of head and neck cancer

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the extent of the cancer helps the doctors to decide on the most appropriate treatment.

A common way of staging head and neck cancers is the TNM staging system.

T describes the size of the tumour and whether it has begun to spread to nearby structures, such as the skin or muscle.

N describes whether the cancer has spread to the lymph nodes.

M describes whether the cancer has spread to another part of the body (secondary or metastatic cancer).

The staging of the different types of head and neck cancers are all slightly different. Your doctor or nurse can give you more details about the stage of your cancer.

Grading Grading refers to the appearance of the cancer cells under the microscope. The grade gives an idea of how quickly the cancer may develop. Squamous cell cancers of the head and neck are graded from 1–3.

Low-grade or grade 1 means that the cancer cells look very like normal cells in the head and neck area

In high-grade or grade 3 cancers the cells look very abnormal and are more likely to spread.

Moderate-grade or grade 2 cancers fall between these two grades and have a level of activity somewhere between.

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