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Diagnosis and Clinical Evaluation of Oropharyngeal Cancer
An essential part of the diagnosis and evaluation of oropharyngeal cancer is a thorough history and physical examination by a head and neck specialist. Symptoms relating to swallowing, breathing, and overall health are surveyed. A comprehensive survey is made of the patient’s past medical problems, treatment, habits and family history.
Head and neck specialists can directly examine the throat and oropharynx for signs of the primary tumor and its extent. This examination can be done through the mouth with an angled dental mirror and headlight or through the nose with a flexible fiberoptic endoscope.
Although the tumor may arise within the throat, nearly 80% of all patients with oropharyngeal cancer present with some kind of spread to the lymph nodes of the neck. Therefore, the neck is examined for signs of enlarged or abnormal lymph nodes.
After the physical examination, imaging is often obtained to more fully evaluate the extent of the tumor. A variety of imaging studies can be used, including:
A biopsy is necessary to confirm the suspected diagnosis. Sometimes, a piece of the tumor can be taken through the mouth in the office under only local anesthesia and minimal discomfort. Other times, a brief surgical procedure is required called an exam under anesthesia or direct laryngoscopy or pharyngoscopy. A patient undergoes general anesthesia and a head and neck surgeon can more carefully examine the throat and the tumor’s extent. A small surgical instrument can gently remove tissue from the tumor to confirm the diagnosis.
Often though, a diagnosis can be made by performing a "fine needle aspiration" (FNA) biopsy. In this procedure, a doctor administers local anesthesia and then using a small caliber needle withdraws tissue from an enlarged lymph node in the neck.
Regardless of the route, tissue from the tumor or lymph node metastasis is then given to a pathologist. A pathologist is a doctor who can perform a variety of tests and examine this tissue under a microscope to confirm or to rule out cancer.
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