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Neck Cancers

What to Expect at Your Doctor’s Visit

Step 1: History

First, your head and neck specialist will take a thorough history of your health and address any specific concerns you may have.

Your doctor might ask questions such as:

  • How long has the problem been there?
  • Is it getting worse, better or staying the same?
  • Does it come and go?
  • Have you tried anything to make it better?
  • Is it painful?
  • Do you have numbness or tingling anywhere in your face or mouth?
  • Do you have any changes in your vision or hearing?
  • Do you have a change in your sense of smell?
  • Do you have any lumps or bumps in your neck?
  • Are you losing weight?
  • Do you have any other medical conditions?
  • Have you had any surgeries in the past?
  • What medications do you take? And do you have any allergies?
  • Have you ever been exposed to radiation in the head and neck?
  • What do you (or did you) do for a living?
  • Do you have a family history of cancer?
  • Have you been exposed to a cat?
  • Have you travelled anywhere or been around anyone with an infectious disease such as tuberculosis?

Step 2: Physical Exam

Next, your doctor will examine you. Typically, if you’re seeing a specialist in head and neck disorders, you will get a thorough physical examination focused on the area of concern.

Your doctor will look at and feel your neck to get an idea of the nature of the lump. Is it fixed or mobile? Is it tender? Are there skin changes over it?

Then you’ll get a complete examination of your face, scalp, mouth, ears, nose and throat. The throat typically takes a specialist to examine because it is difficult to see and feel by a general doctor. In general, your specialist might do some of the following:

  • Look and feel inside your mouth
  • Feel your neck extensively and carefully to check for any lumps or bumps
  • Look inside your ears
  • Look inside the front of your nose
  • Check your cranial nerves by asking you to move your face, stick your tongue out, lift your shoulders, follow his or her fingers around with your eyes, do some simple hearing tests and test your sense of touch all over your face

Depending on where the area of concern is, a few special things to expect in your physical exam might include:

  • Nasopharyngoscopy: This is a way to look deep in the back of your nose, where the nasopharynx is located. There are two primary methods to accomplish this.
    • Flexible nasopharyngoscopy: This method uses a tiny flexible camera (the same one as for flexible laryngoscopy). This is inserted into one of the nostrils and carefully slid all the way back (straight back) to look at your nasopharynx. Usually, the entire nasopharynx can be seen by putting the camera into just one nostril, but sometimes your doctor might look through both nostrils to get a really good look at a certain area. He or she will look at the back wall of the nasopharynx and the areas around the Eustachian tubes, with a focus on the Fossa of Rosenmueller, where most nasopharynx cancers start.
    • Rigid nasopharyngoscopy: In this method, a thin steel rod telescope is inserted into one of the nostrils. Then the exact same examination as flexible laryngoscopy is done. The advantage of this technique is that it is easier for your doctor to use another forceps and take a nasopharyngeal biopsy if necessary. If your doctor uses a special angled telescope, he or she might be able to look up into your nasopharynx through your mouth (behind your soft palate) as well.
  • Pharyngoscopy and/or laryngoscopy (looking at your oropharynx, hypopharynx and larynx): This can be done in a few ways, including with a headlight and mirror placed on the roof of your mouth to look down or with a flexible camera placed through your nose.
  • Flexible pharyngo-laryngoscopy: Your doctor may spray your nose with some medications and then slowly and carefully place a flexible tube-like camera through your nose down into your throat.
  • Indirect mirror examination: Your doctor will distract you while placing a small mirror into the back of your throat through your mouth. The doctor will ask you to breathe slowly and make specific sounds as he or she observes your oropharynx.

Step 3: Reviewing Tests

After getting your history and performing a physical exam, your doctor will review any imaging, laboratory work and pathology results you may have already had. Be sure to bring all of these with you to your appointment. Bring actual discs of any scans you’ve had, as well as any reports of those scans. If you are seeing a head and neck cancer specialist after a lesion was removed by a non-cancer specialist, you need a thorough review of the pathology to discuss whether additional treatment is necessary. Try to obtain the actual glass slides that were prepared by the pathologist with the specimen taken during your biopsy procedure so your doctor can conduct a complete review. You might need more tissue removed or further treatment.

Step 4: Recommendations

Finally, your doctor will make recommendations about your next steps. This will likely include reviewing some of the studies you’ve already had done or ordering more tests. Once your doctor has all the necessary information, you should be given a preliminary stage and discuss treatment plans.

References

1 Gurney JG, Young JL, Roffers SD, Smith MA, Bunin GR. SEER pediatric monograph – soft tissue sarcomas. National Cancer Institute. Page 111. http://seer.cancer.gov/publications/childhood/softtissue.pdf.

2 Fletcher CDM, Rydholm A, Singer S, Sundaram M, Coindre JM. Soft Tissue Tumours. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours: pathology & genetics WHO Classification. Lyon: IARCPress; 2005.

3 Zhang MQ, El-Mofty SK, Dávila RM. Detection of human papillomavirus-related squamous cell carcinoma cytologically and by in situ hybridization in fine-needle aspiration biopsies of cervical metastasis: a tool for identifying the site of an occult head and neck primary. Cancer. 2008;114(2):118-23.

4 Cunningham MJ, Myers EN, Bluestone CD. Malignant tumors of the head and neck in children – a 20 year review. International Journal of Pediatric Otorhinolaryngology. 1987;(13)3:279-292.

5 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Page 611.

6 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed June 20, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

7 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Soft Tissue Sarcoma V.1.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed July 17, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

8 Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.