If you have concerns about symptoms of head and neck cancer, it is always worth speaking to your doctor. They can examine your mouth, throat and neck and, if needed, refer you for further tests.
Head and neck cancer can be diagnosed through a combination of physical examinations, endoscopies, imaging tests, and biopsies. Doctors usually begin with an inspection of the mouth, throat, and neck, using specialised endoscopes, followed by imaging and tissue biopsies to confirm a diagnosis.
In some cases, a diagnosis may come as a result of another routine appointment, for example, a dental check-up, a GP consultation about a persistent throat issue, or follow-up care for a recurring infection.
In this blog, we’ll look at what happens during an examination, the role of imaging and the typical timeline for head and neck cancer diagnosis.
Proton International London offers private proton beam therapy (PBT) at our treatment centre in University College Hospital in London. Read more about how PBT can help support quality of life for patients for head and neck cancer patients.
What happens during an initial head and neck examination?
An initial head and neck examination is a systematic, painless, hands-on procedure used to evaluate your head and neck structures and functions, and to look for early signs of infection, inflammation, or disease that may point to head and neck cancer.
It involves a physical assessment of the face, mouth, throat, neck, and glands, combining visual inspection with gentle touch (palpation).
To help understand your symptoms and identify any areas of concern, your doctor will work through a logical, step-by-step assessment:
Face and Jaw
Your doctor will observe your facial symmetry and function. They will gently palpate your jaw and temporomandibular joint (TMJ) as you open and close your mouth to check for clicking, popping, or discomfort.
Oral Cavity and Throat
Using a light and a tongue depressor, the examiner checks the lips, gums, tongue, floor of the mouth, and hard and soft palate for any abnormalities or sores. They will also inspect your tonsils and the back of your throat.
Neck and Lymph Nodes
The examiner will gently feel both sides of your neck, under your jawline, and around your collarbone to check for swollen or tender lymph nodes.
Thyroid Gland
You will be asked to swallow a sip of water while the doctor places their fingers on your neck to check that your thyroid gland moves up and down symmetrically without any lumps or enlargement.
Sinuses and Nerves
Your healthcare provider may also press lightly over your forehead and cheekbones to check for sinus tenderness, and briefly test your cranial nerves (coming from the brain, to supply the head and neck structures) by checking your eye movements, facial expressions, or hearing.
How are imaging tests used in diagnosing head and neck cancer?
Imaging tests are important tools in diagnosing head and neck cancer or checking for cancer cells in other specific areas. They help doctors detect tumours, determine the cancer’s exact stage (where it is located in the body), assess if it has spread to lymph nodes or distant organs, and guide surgical planning.
The following tests can support the diagnosis of head and neck cancer and help doctors assess tumours in the head and neck area:
CT Scans
Computed Tomography (CT) scans are often the first test ordered. CT scans create rapid, detailed cross-sectional pictures and are highly effective for evaluating bony structures, as well as detecting tumours in the throat and larynx while minimising breathing artefacts.
MRI Scans
Magnetic Resonance Imaging (MRI) scans using magnets and radio waves provide detailed soft-tissue contrast. They are primarily used to map tumour boundaries and determine if the cancer is spreading along nerves or invading the skull base.
PET Scans
Positron Emission Tomography (PET) scans, often combined with a CT scan (PET/CT), use a low-dose radioactive tracer (for example, FDG) to identify highly active cells. They are particularly useful in detecting small tumours, finding the primary source of a cancer which has spread to lymph nodes and it is not clear where it has started, and checking if the head and neck cancer has spread to other more distant parts of the body.
Ultrasound
Ultrasound uses sound waves to quickly evaluate neck masses or abnormalities in the thyroid and salivary glands. It is also frequently used to guide fine-needle aspiration biopsies with precision.
Is a biopsy needed to confirm head and neck cancer?
Yes, a biopsy is the main test used to confirm a diagnosis of head and neck cancer. While imaging scans (like CT, MRI, or PET) and endoscopies can help spot abnormalities that are suspicious of being a tumour or are of concern, only removing a tissue sample for microscopic analysis can confirm whether cancer cells are present.
This allows pathologists to examine the extracted tissue to confirm if it is cancerous, identify the specific type of tumour (such as squamous cell carcinoma), and detect important genetic or molecular markers, like human papillomavirus (HPV) status. HPV infections can play a role in some head and neck cancers, particularly cancers affecting the throat, tonsils and base of the tongue. You can read more in our guide to HPV and head and neck cancer.
This information helps the medical team determine the most appropriate treatment plan for the primary cancer.
How long does it take to diagnose Head and Neck cancer?
Diagnosing head and neck cancer typically takes 1 to 4 weeks from the moment a specialist evaluates your symptoms. However, the total time from first noticing an unusual symptom (like a persistent sore throat or neck lump) to receiving a confirmed diagnosis can take anywhere from 2 to 4 months, depending on when you first seek medical advice.
This timeline is divided into key phases:
Pre-Diagnosis Phase (Days to Months)
Patient Appraisal: The time it takes for you to notice a symptom (e.g., a mouth ulcer, a lump in the neck, or voice changes) and decide to see a doctor. This typically ranges from 1 week to 1 month.
Specialist Referral: Once you see a general practitioner (GP), a referral to an ENT (Ear, Nose, and Throat) or oral and maxillofacial specialist usually takes about 2 weeks. In the UK, urgent referral targets typically stipulate a diagnostic result within 28 days of the GP referral being received.
Clinical Evaluation and Imaging (Days)
Physical Exam: Checking the mouth, throat, and neck.
Endoscopy: A quick, in-office procedure using a thin, flexible tube to view areas like the nasal cavity, throat and larynx (voice box).
Imaging: X-rays, CT scans, MRIs, or PET scans to pinpoint tumour locations and assess how far it may have progressed.
The Biopsy Phase (Days to 1 Week)
A biopsy, where a small sample of tissue is surgically removed or extracted via a needle, is the only way to confirm a head and neck cancer diagnosis.
- Minor biopsies (like those of the mouth) can be done quickly in the clinic.
- Deeper biopsies (often taken via a microlaryngoscopy) are done in the hospital under general anaesthetic and take 30–60 minutes.
- Once the tissue is sent to a lab for pathological testing, results generally take 3 to 7 days to become available.
What happens after Head and Neck Cancer is diagnosed?
After a head and neck cancer diagnosis, your doctor or medical team will conduct staging tests to determine tumour size and if it has spread. This is followed by a multidisciplinary team discussion of your case, designing a personalised treatment plan which may include surgery, radiation therapy, and chemotherapy, depending on your diagnosis and individual needs. This may then be followed by essential rehabilitation for speech, swallowing, and nutrition.
Staging and Evaluation
Following an initial diagnosis, your medical team will perform additional tests to understand the extent of the disease. This process, called staging, may involve imaging scans such as CT, MRI or PET, dental exams, and biomarker testing of the biopsy.
Multidisciplinary Team Planning
Since head and neck cancer treatment is complex, and these cancers can affect important functions such as breathing, speaking, and swallowing, you may need to consult with several specialists to create an integrated plan. These include:
- Surgical Oncologists: Experts in safely removing the tumour while preserving vital structures.
- Radiation Oncologists: Doctors who use targeted radiotherapy beams to destroy cancer cells.
- Medical Oncologists: Specialists who manage chemotherapy and targeted therapies.
Treatment and Rehabilitation
Your treatment plan may involve one or more modalities. Because head and neck treatments can impact daily living, early rehabilitation is a very important next step, involving:
- Swallowing and Speech Therapy: Speech and language therapists help manage dysphagia (difficulty swallowing) and voice changes, aiming to improve your quality of life.
- Nutritional Support: Registered dietitians give advice on your diet, and ensure you receive adequate calories. Some patients may require a temporary feeding tube into the stomach during more intensive phases of treatment.
- Dental Care: Pre-treatment dental work and ongoing oral care are important to help reduce the risk of severe dry mouth and bone damage from radiation.
Survivorship and Long-Term Follow-Up
Once primary treatment is complete, a regular follow-up plan is scheduled to monitor for recurrence. This includes regular clinical examinations, imaging scans, and addressing any long-term side effects such as fatigue or lymphoedema (soft tissue swelling due to fluid retention).
Why Early Cancer Diagnosis Matters
Early cancer diagnosis matters because it can improve outcomes, support less invasive treatment, and help preserve your quality of life. When cancer is found at an earlier stage, there may be more treatment options available and a greater chance of those treatments being effective.
Research indicates that certain head and neck cancers detected at an earlier stage are more likely to respond well to treatment. Cancers found early may also require less intensive treatment, which can help reduce the impact on healthy surrounding tissue.
Find out more about proton beam therapy
Proton beam therapy (PBT) can be beneficial for some head and neck cancers because it delivers radiation very precisely, helping to treat the tumour while reducing exposure to nearby healthy tissues involved in swallowing, speech and breathing.
Proton International London treats private patients diagnosed with a range of head and neck cancers. To understand whether PBT may be a suitable option for you or a loved one, to seek a private second opinion, or start the referral process, please contact us.
Further reading: What are the signs of head and neck cancer?
