Oropharyngeal Cancer

Diagnosis

The diagnosis of oropharyngeal cancer can be made through the following methods:

• Medical history and physical examination: Most of the symptoms of oropharyngeal cancer, such as ear pain, fatigue, weakness, and weight loss, are due to several other non-serious conditions. It results in ignoring these symptoms, which leads to delayed diagnosis. The symptoms of the patients are thoroughly investigated to determine their causes. The patients are asked about the occurrence, development, and progression of symptoms to determine if the condition is chronic or acute. During preliminary diagnosis, the cancer specialists enquire about the lifestyle of the patients, as smoking, taking tobacco in any other form, consuming alcohol, or smoking and consuming alcohol together increases the risk of oropharyngeal cancer. The medical history of the patients is also evaluated to determine if the patients have a history of human papillomaviruses or genetic conditions, such as Fanconi anemia or congenital dyskeratosis, as these conditions also increase the risk of oropharyngeal cancer. The patients should also inform if they have had neck or head cancer or have undergone radiation therapy for cancer treatment. Such patients are at high risk of developing oropharyngeal cancer. The neck, oral cavity, lips, ears, and jaw of the patients are checked for any abnormality.
• Blood and saliva tests: Blood tests are not diagnostic tests for oropharyngeal cancer. However, the patients are advised to undergo these tests to evaluate the overall health of the body. Salivary secretions are in close contact with the tumor. Thus, the presence of certain metabolites in the saliva may indicate the presence of abnormal cells in the oral cavity. These biomarkers include valine, lactic acid, proline, lysine, and citrulline.
• HPV test: Patients with human papillomavirus infections are at increased risk for developing oropharyngeal cancer. The patients may undergo HPV DNA tests to determine the presence of high-risk HPV types that are linked to oropharyngeal cancer.
• Endoscopy: The patients also undergo endoscopy to detect the presence of cancer cells. If the cancer cells are detected, the endoscopy also assists in staging the disease. The procedure is performed with the help of an endoscope. The endoscope is a long and thin tube with a video camera at the end. When the tube is inserted into the oral cavity and guided down to the throat, the real-time images are relayed on the monitor for analysis. The techniques used during endoscopy include nasopharyngoscopy and panendoscopy.
• Ultrasound: Ultrasound uses sound waves to detect the growth of the tumor in the lymph nodes. It also provides valuable information about the metastasis of tumors into the blood vessels of the neck, such as the carotid arteries. In some cases, ultrasound guides the needle during biopsy (ultrasound-guided biopsy).
• X-ray: X-rays are recommended in patients to determine the presence of a tumor in the oropharyngeal region. The patients, especially those with pulmonary symptoms, may undergo chest X-rays to evaluate if cancer has spread to the lungs or chest lymph nodes.
• MRI: MRI provides clear and detailed images of the abnormal head and neck tissues. It also assists in differentiating malignant and benign tumors. Further, MRI also helps in determining the size of the tumor.
• CT scan: CT scan provided detailed images of the tissues with the help of X-rays. It assists in determining the location and size of the tumor. Further, information related to the spread of the tumor to other organs or lymph nodes is also obtained with a CT scan. In some cases, CT is also used to guide biopsy (CT-guided biopsy). Chest CT may also be performed in some patients to determine if the tumor has spread into the lungs.
• PET scan: PET scans screen the complete body and detect the spread of cancer. It involves using radioactive sugar derivatives primarily taken by the rapidly growing cells (due to their high metabolism). The computer evaluates the images relayed by the scanner and makes 3D images for better analysis.
• Biopsy: Biopsy is the procedure done for confirmatory diagnosis of most cancers. During a biopsy, the samples of the abnormal cells are obtained and examined under the microscope for the presence of malignant cells. The types of biopsy include punch biopsy, endoscopic biopsy, excisional biopsy, incisional biopsy, and fine needle aspiration technique.