Diagnosis and Stages of Oral and Oropharyngeal Cancer

To diagnose oral and oropharyngeal cancer, your healthcare provider will begin by asking about your symptoms and medical history, including any past head and neck cancer or radiation therapy. They'll also inquire about lifestyle factors like tobacco use. Many patients with oropharyngeal cancer first notice a neck mass. If you have a neck mass lasting more than two weeks, you should see an otolaryngologist for a full examination to diagnose the underlying cause, which in some cases is due to cancer.

Types of Diagnostic Tests

• Physical Examination: The provider will inspect the inside of your mouth and feel around your mouth, head, face, and neck for signs of cancer or pre-cancer.
• Biopsy: This procedure involves removing tissue samples to examine under a microscope for abnormal cells. This is sometimes called an incisional Biopsy where small tissue pieces are removed to be examined.
• Direct (Flexible) Pharyngoscopy and Laryngoscopy: An endoscope, a thin tube with a light and lens, is used to view areas of your throat and mouth.
• Computed Tomography (CT) Scan: This noninvasive test takes detailed images of internal organs to detect abnormalities.
• Ultrasonography: Uses high-frequency sound waves to create images of internal organs.
• Positron Emission Tomography (PET)/CT Scan: Uses radioactive dyes to detect cancer in the body.
• Magnetic Resonance Imaging (MRI): Produces detailed images of soft tissues, like the tonsils and tongue base, and helps determine tumor size.
• Barium Swallow: Also called an upper GI series, this test checks for swallowing abnormalities as these may result from oral or oropharyngeal cancers. You'll drink a chalky solution while X-rays are taken.

After a diagnosis, the cancer is staged to determine its extent, which helps in planning treatment. Your healthcare provider will decide which tests are necessary for your specific case.

Being diagnosed with oral cancer can be overwhelming, but your healthcare team is there to support you and answer any questions you may have. Learn more about your healthcare team and how to cope with a new diagnosis.

Stages

After being diagnosed with oral cavity or oropharyngeal cancer, doctors will determine if and how far the cancer has spread. This process, called staging, assesses the severity of the cancer and guides treatment decisions.

The most commonly used staging system for these cancers is the American Joint Committee on Cancer (AJCC) TNM system, which evaluates three key factors:

• Tumor Size (T): This measures the size of the primary tumor and identifies which tissues of the oral cavity or oropharynx it has invaded.
• Lymph Node Involvement (N): This checks if the cancer has spread to nearby lymph nodes, how many are affected, their size, and their location relative to the cancer's origin.
• Metastasis (M): This looks for cancer spread to distant organs, such as the lungs.

Numbers or letters following T, N, and M give more specifics about these factors, with higher numbers indicating more advanced cancer. Once the T, N, and M categories are determined, they are combined in a process called stage grouping to assign an overall stage to the cancer.

The staging may vary depending on whether the oropharyngeal cancer is associated with HPV. Other factors in staging include the size of the tumor and whether the cancer has spread to nearby lymph nodes or distant parts of the body.

Learn more about oral cancer stages here.