If you have any symptoms of tonsil cancer, see your doctor as soon as possible. An otolaryngologist (or an ear, nose and throat doctor, also known as an ENT) will conduct a physical examination, take your medical history, and ask you about symptoms and risk factors. Your doctor will examine your head and neck for any lumps or masses, and the inside of your mouth and throat for any precancerous lesions or asymmetry or firmness of your tonsils. Your doctor may also order blood and urine tests to check for any conditions that may be related to cancer. If your doctor finds anything out of the ordinary, he or she will order more diagnostic tests to see if it is related to cancer. These tests may include:
Tumor HPV Testing
HPV positive head and neck cancer is significantly increasing in the United States; HPV infection usually correlates with oropharyngeal cancers like tonsil or base of tongue cancer.
The doctor uses an endoscope, a thin tube with a camera and light on the end, to examine the inside of the mouth and throat and search for any irregularities. If your doctor notices an abnormality, he will pass a special tool through the endoscope and use it to take a tissue sample. A pathologist must examine this tissue under a microscope to determine whether or not you have cancer.
An ultrasound uses high-frequency sound waves to create images that allow doctors to see how deep the tumor has grown through tissues.
Fine Needle Aspiration (FNA) Biopsy
The doctor uses a fine needle connected to a syringe to extract a tissue sample from a tumor or suspicious area. The needle is passed through the skin and into the tumor. The tissue sample is then examined in a laboratory to determine if it contains cancer cells. The doctor may also perform this type of biopsy to determine if swollen lymph nodes are related to the spread of cancer or another cause.
A panorex is a panoramic X-ray of your teeth and jawbone commonly used by dentists. Doctors use panoramic X-rays to help find cancer and to evaluate dental health prior to radiation therapy.
In a fiberoptic laryngoscopy, the doctor uses a laryngoscope (a thin tube with a camera and light on the end) inserted into the mouth or throat to examine the larynx and nearby structures. In a direct rigid laryngoscopy, the doctor uses a metal tube to examine the throat while a patient is asleep in the operating room. In an ‘indirect’ laryngoscopy, the doctor uses small mirrors inserted into the mouth and a powerful light from a head lamp to examine the back of the mouth and the top of the larynx. This illustration represents a direct laryngoscopy in the operating room.
The doctor may recommend a chest X-ray to determine if the cancer has spread to the lungs or other organs in the chest.
Computed Tomography (CT) Scan
If symptoms or examination raise concerns for the presence of cancer, your doctor may order a CT scan. A CT scanner rotates around your body taking pictures, and produces detailed cross-sectional images of your body. It allows doctors to pinpoint the exact size and location of the tumor and check for cancer spread.
Magnetic resonance imaging (MRI) scan
Magnetic resonance imaging (MRI) uses radio waves and a powerful magnet to produce detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show “slices” of the body. This test is very useful for examining specific areas of the body, especially the soft tissues in the head and neck region.
Positron emission tomography (PET) scan
For a PET scan, the doctor injects a radioactive substance into the patient’s bloodstream. This substance collects in malignant (cancerous) cells in the patient’s body. The doctor then uses a PET scanner to detect these areas of radioactivity and to find the exact location of cancer in the patient’s body.
If any of these diagnostic tests indicate that you might have cancer, your doctor will conduct a biopsy to be certain. A biopsy is a procedure in which the doctor removes a tissue sample and has a pathologist examine it under a microscope to determine if it contains cancer cells. A biopsy is the only way to be certain if you have cancer. Your doctor will most likely remove a tissue sample for a biopsy while performing an endoscopy. Doctors also commonly perform fine needle aspiration biopsies when an enlarged lymph node is present in the neck and the suspicion for cancer is high. In this procedure, the doctor removes a tissue sample using a thin needle and a syringe. Either way, the biopsy procedures for tonsil cancer are minimally invasive and will not cause much discomfort.