Dharamshila Narayana Superspeciality Hospital

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Diagnosis

You will be examined by your GP who will refer you to a hospital to be seen by a specialist doctor.

The specialist will examine your oropharynx by using a small mirror and light. A thin, flexible tube with a light at the end (nasendoscope) may be passed into your nostril in order to get a better view of the back of your mouth and throat. This can be uncomfortable, and you may be given a local anaesthetic spray to numb your nose and throat.

If you have a local anaesthetic to your throat, you may be told not to eat or drink for about an hour afterwards, or until the numb feeling has gone.

To make a diagnosis, a piece of affected tissue will be removed and then examined under a microscope (biopsy). This is usually carried out under a general anaesthetic so you may need to spend the night in hospital.

Further tests

You’ll have blood tests and possibly a chest x-ray to check your general health. There are several other tests that may be used to help diagnose your cancer and to check whether it has spread. The results of your tests will help the specialist to decide on the best type of treatment for you.

MRI (magnetic resonance imaging) scan

This test uses magnetism to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan.

Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly.

During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones.

CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10–30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and won′t harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it′s important to let your doctor know beforehand.

Bone scan

This test shows up any abnormal areas of bone. A small amount of a mildly radioactive substance is injected into a vein, usually in the arm. About 2–3 hours later, a scan is taken of the whole body. Any abnormal areas show up on the scan as highlighted areas (sometimes known as hot spots).

This scan will not make you radioactive, and it’s perfectly safe for you to be with other people afterwards.

Staging and grading

Staging

The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment for you.

TNM staging

The most commonly used staging system is called the TNM system:

T refers to the tumour size.

N refers to whether or not lymph nodes are affected

M refers to whether or not the cancer has spread to other parts of the body (metastases).

The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.

The exact details of the T, N and M will depend on the type of cancer.

Number staging

In addition to TNM staging, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type.

Stage 1 describes a cancer at an early stage when it′s usually small in size and hasn’t spread, whereas stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in between these stages.

The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0.

Number stages may also be further subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer may differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.

Talking about staging

In the last few years, staging systems have become increasingly complex and they now describe the size and spread of different types of cancer in much greater detail. This can be very helpful in planning the details of treatment or predicting outcomes.

However, doctors will often use a much simpler approach when talking about staging. They might use words like ‘early’ or ‘local’ if the cancer hasn′t spread, ‘locally advanced’ if it has begun to spread into surrounding tissues or nearby lymph nodes, or ‘advanced’ or ‘widespread’ if it has spread to other parts of the body. Your doctors can give you more information about the stage of your particular cancer.

Grading

Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how the cancer may behave. Low-grade means that the cancer cells look like normal cells. High-grade means the cells look abnormal.

A low-grade tumour will usually grow more slowly and be less likely to spread than a high-grade tumour.

OROPHARYNGEAL CANCER DIAGNOSIS

You will be examined by your GP who will refer you to a hospital to be seen by a specialist doctor.

The specialist will examine your oropharynx by using a small mirror and light. A thin, flexible tube with a light at the end (nasendoscope) may be passed into your nostril in order to get a better view of the back of your mouth and throat. This can be uncomfortable, and you may be given a local anaesthetic spray to numb your nose and throat.

If you have a local anaesthetic to your throat, you may be told not to eat or drink for about an hour afterwards, or until the numb feeling has gone.

To make a diagnosis, a piece of affected tissue will be removed and then examined under a microscope (biopsy). This is usually carried out under a general anaesthetic so you may need to spend the night in hospital.

Further tests

You’ll have blood tests and possibly a chest x-ray to check your general health. There are several other tests that may be used to help diagnose your cancer and to check whether it has spread. The results of your tests will help the specialist to decide on the best type of treatment for you.

MRI (magnetic resonance imaging) scan

This test uses magnetism to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan.

Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly.

During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones.

CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10–30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and won′t harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it′s important to let your doctor know beforehand.

Bone scan

This test shows up any abnormal areas of bone. A small amount of a mildly radioactive substance is injected into a vein, usually in the arm. About 2–3 hours later, a scan is taken of the whole body. Any abnormal areas show up on the scan as highlighted areas (sometimes known as hot spots).

This scan will not make you radioactive, and it’s perfectly safe for you to be with other people afterwards.

Staging and grading

Staging

The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment for you.

TNM staging

The most commonly used staging system is called the TNM system:

T refers to the tumour size.

N refers to whether or not lymph nodes are affected

M refers to whether or not the cancer has spread to other parts of the body (metastases).

The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.

The exact details of the T, N and M will depend on the type of cancer.

Number staging

In addition to TNM staging, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type.

Stage 1 describes a cancer at an early stage when it′s usually small in size and hasn’t spread, whereas stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in between these stages.

The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0.

Number stages may also be further subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer may differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.

Talking about staging

In the last few years, staging systems have become increasingly complex and they now describe the size and spread of different types of cancer in much greater detail. This can be very helpful in planning the details of treatment or predicting outcomes.

However, doctors will often use a much simpler approach when talking about staging. They might use words like ‘early’ or ‘local’ if the cancer hasn′t spread, ‘locally advanced’ if it has begun to spread into surrounding tissues or nearby lymph nodes, or ‘advanced’ or ‘widespread’ if it has spread to other parts of the body. Your doctors can give you more information about the stage of your particular cancer.

Grading

Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how the cancer may behave. Low-grade means that the cancer cells look like normal cells. High-grade means the cells look abnormal.

A low-grade tumour will usually grow more slowly and be less likely to spread than a high-grade tumour.

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