Head and Neck Cancer Diagnosis and Staging

A thorough, accurate diagnosis of head and neck cancer is the first step in developing a personalized treatment plan.

At UT Southwestern Medical Center, our head and neck cancer experts bring together years of experience to give patients the most exact diagnosis possible and determine whether the cancer has spread.

We use state-of-the-art imaging that’s reviewed by radiologists with special expertise in head and neck cancer. Our advanced equipment provides more details about each patient’s condition, which helps us create a better treatment plan.

Diagnosing Head and Neck Cancer

To diagnose head and neck cancer, we first ask for a patient’s medical history and then perform a physical examination and discuss symptoms.

Next, we usually perform imaging tests. We might ask a patient to repeat a test already completed elsewhere to lead us to a more precise diagnosis and better understanding of the situation.

Our advanced imaging techniques include:

Computed tomography (CT) scan: Specialized X-ray equipment to create detailed 3D images of the mouth, neck, throat, or other areas of the body
Magnetic resonance imaging (MRI): Technology that uses a powerful magnet and radio waves to create detailed images of the head and neck
Nuclear imaging/positron emission tomography (PET) scan: Technology that uses small amounts of radioactive medicine to produce detailed images of the lymph nodes and other organs
Ultrasound: A scan that uses high-frequency sound waves to show the thyroid, salivary glands, and lymph nodes in the neck

We might also examine less accessible areas of the head and neck using an endoscope, which is a thin, lighted tube that goes through the nose and into the throat.

In addition, we take a biopsy (removal of a sample of tissue) so we can study the affected tissue under a microscope.

Stages of Head and Neck Cancer

Once we have a head and neck cancer diagnosis, we determine the stage (extent) of the cancer. The stage tells us how advanced the cancer is, which is critical in helping us determine the best course of treatment.

The Tumor, Node, Metastasis (TNM) staging system is most widely used for head and neck cancers. Using this system, we will assign a T, N, and M value to the tumor.

T refers to the size of the tumor.
N describes any involvement of the lymph nodes of the head and neck.
M indicates if the cancer has metastasized (or spread) to other areas of the body.

Traditionally, the stages of head and neck cancer were:

Stage 1: The tumor is 2 centimeters or smaller.
Stage 2: The tumor is larger than 2 and less than or equal to 4 centimeters.
Stage 3: The tumor is larger than 4 centimeters, or it’s any size and has spread to one nearby lymph node and is smaller than 3 centimeters.
Stages 4 (several stages): Cancer has spread to nearby structures, to multiple lymph nodes or those larger than 3 centimeters, or to distant parts of the body.

Recently we have adjusted our staging systems according to advances in understanding of head and neck cancer. The latest staging systems are specific to the cause of cancer (such as HPV-mediated oropharyngeal cancer) and the location (oral cavity, larynx, or nasopharyngeal cancer).

Equipped with this information, patients have the most accurate details about their cancer and can move quickly toward treatment decisions with their team of doctors.