Head and neck cancers
Diagnosing head and neck cancers
Head and neck cancers are diagnosed through a combination of tests, depending on the symptoms. Learn how these tests work, what the results mean, and how staging guides treatment decisions.
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Sources and references 
If you notice any symptoms, see your GP. You can tell your dentist about any mouth sores, swelling or colour change in your mouth – they are trained to look for signs of mouth cancer. Your GP or dentist may do some general tests and refer you to another specialist. Tests may include biopsies (testing tissue samples) and ultrasound, CT or MRI scans.
Physical examination
Depending on your symptoms, the doctor may examine your mouth, throat, nose, neck, ears and eyes. They may gently press your tongue down to check the mouth or feel the area with a gloved finger. They will feel your neck to check the lymph nodes. For hard-to-see areas, the doctor may use specialised equipment (endoscopy), or suggest a procedure under anaesthetic (microlaryngoscopy) to fully examine the area. They may take a tissue sample to test (biopsy).
Endoscopy
An endoscopy (nasendoscopy or flexible laryngoscopy) looks at the nose and throat area using a thin, flexible tube with a light and camera on the end. The doctor sprays a local anaesthetic (which tastes bitter) into one of your nostrils to numb the nose and throat. The tube is then gently passed into the nostril and down your throat to look at your nasal cavity, the different parts of the throat (nasopharynx, oropharynx, hypopharynx) and voice box (larynx). You will be asked to breathe lightly, and to swallow and make sounds. It may feel uncomfortable but shouldn’t hurt.
Images from the camera may be projected onto a screen and the doctor may also take a biopsy (see below). An endoscopy takes a few minutes and is usually done in a doctor’s rooms. If you need a biopsy, it may take longer. You shouldn’t have hot drinks for about 30 minutes afterwards, but can go home straightaway.
Microlaryngoscopy
A microlaryngoscopy is done in hospital under a general anaesthetic. The doctor will look at your throat and voice box and take a biopsy (see below). They’ll insert a stainless steel instrument called a laryngoscope into your mouth to hold the throat open, and use a telescope or a microscope to examine the throat and voice box. A microlaryngoscopy takes 30–60 minutes and you can go home after recovering from the anaesthetic. Your throat may be sore for a couple of days.
Biopsy
A biopsy is when a doctor removes a sample of cells or tissue from a suspicious sore or lump. A specialist doctor called a pathologist examines the sample under a microscope to see if it contains cancer cells, and to diagnose the type of cancer. They may do more tests on that sample to help guide treatment.
A biopsy may be taken using local anaesthetic during an endoscopy, or under a general anaesthetic during a microlaryngoscopy. A needle may be used for a biopsy of lumps in the neck or hard-to-reach areas. This is called a fine needle biopsy or core biopsy. It is often done using a CT scan or ultrasound to guide the needle to the correct place. If the cancer can’t be diagnosed from the tissue sample, surgery may be needed to remove the mass so it can be checked for signs of cancer.
Imaging tests
You will usually have at least one of the imaging tests described below, often before a biopsy is done. These tests give more details about where the cancer is and whether it has spread to other parts of your body.
Ultrasound – An ultrasound is sometimes used, particularly to look at the thyroid, salivary glands and lymph glands in the neck. For this scan, you will lie down and a small device called a transducer is coated with gel and moved over the area. The transducer sends out soundwaves that echo when they meet something dense, like an organ or tumour. A computer creates a picture from these echoes. An ultrasound is painless and takes about 15–20 minutes.
CT scan – A CT (computerised tomography) scan uses x-ray beams to create detailed cross-sectional pictures of the inside of your body. Before the scan, you may have an injection of dye (called contrast) into a vein to make the pictures clearer. The dye may make you feel hot all over and leave a strange taste in your mouth for a few minutes. For the scan, you will need to lie still on a table that moves in and out of the CT scanner, which is large and round like a doughnut. The scan itself takes about 10 minutes.
PET–CT scan – A positron emission tomography (PET) scan combined with a CT scan is a specialised imaging test. The CT helps pinpoint the location of any abnormalities revealed by the PET scan.
You may need to fast or follow a special diet the day before this scan, so that you get the most accurate results. Before the scan, you will be injected with a glucose solution that contains some radioactive material. Cancer cells show up brighter on the scan because they take up more glucose solution than the normal cells do.
Next, you will lie down or sit quietly for about an hour as the glucose spreads through your body. Then you have the PET scan, which will usually take about 30 minutes. The CT scan may be done before the PET scan or at the same time.
MRI scan – An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the inside of your body. Before the scan, a dye may be injected into a vein to help make the pictures clearer. During the scan, you will lie on a table that slides into a large metal tube that is open at both ends.
The noisy, narrow machine makes some people feel anxious or claustrophobic. If you think you may become distressed, mention this beforehand to your doctor or nurse. You may be given medicine to help you relax, and you will usually be offered headphones or earplugs. MRI scans usually take 30–90 minutes.
X-rays – Many people will also have a special x-ray called an orthopantomogram (OPG) to check the jaw and teeth.
Staging head and neck cancers
The tests described on this page help show whether you have a head and neck cancer and whether it has spread. Working out how far the cancer has spread is called staging. It helps your doctors recommend the best treatment for you.
In Australia, the TNM system is the method most often used for staging head and neck cancers. TNM stands for tumour–nodes–metastasis. In this system, each letter is assigned a number to describe the cancer.
Based on the TNM numbers, the doctor then works out the cancer’s overall stage on a scale of 1–4 (usually written in Roman numerals as I, II, III or IV). Each type of head and neck cancer is staged slightly differently, and oropharyngeal cancers are staged differently depending on whether they are linked to HPV.
In general, stages 1–2 mean the cancer is small and generally hasn’t spread from the primary site (early head and neck cancer). Stages 3–4 mean the cancer is larger and has spread (advanced head and neck cancer). It may have spread to nearby tissue or lymph nodes (locally advanced cancer) or to other parts of the body (metastatic cancer).
It is worth noting that compared to other cancers, stage 4 head and neck cancers can often be given curative treatment successfully. The stage 4 category can be split into multiple groups, and only one of these subtypes is unlikely to be cured. Ask your doctor to explain what the stage of the cancer means for you.
Prognosis
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about the general outlook for people with the same type and stage of cancer.
To work out your prognosis and advise you on treatment options, your doctor will consider your test results, the type of head and neck cancer, your smoking history, the cancer’s HPV status (if relevant), the rate and depth of the cancer’s growth, the likelihood of response to treatment, and other factors such as your age, level of fitness and overall health.
In most cases, the earlier head and neck cancer is diagnosed, the better the outcome. People with more advanced head and neck cancer may also respond well to treatment. Oropharyngeal cancers linked with HPV also usually have better outcomes compared with non-HPV oropharyngeal cancers.
TNM staging system
T (tumour) | Indicates the size of the primary tumour. Generally, the higher the number, the larger the cancer or the deeper it has grown into the tissue. |
N (nodes) | Shows if the cancer has spread to nearby lymph nodes. N0 means the cancer has not spread to the lymph nodes; the more nodes affected or the more cancer there is within the nodes, the higher the number. |
| M (metastasis) 0–1 | Shows if the cancer has spread (metastasised) to other parts of the body. M0 means the cancer has not spread; M1 means the cancer has spread. |
Key points about diagnosing head and neck cancers
Main tests
- Your doctor will examine your mouth, throat, nose, neck, ears and eyes.
- An endoscopy uses a thin flexible tube with a light and camera to look for abnormal tissue in the nose and throat area.
- Sometimes people need an examination under general anaesthetic. This is known as microlaryngoscopy. It allows the doctor to fully examine the throat and voice box for abnormal tissue.
- When a tissue sample (biopsy) is removed, a pathologist examines the sample under a microscope to see whether cancer is present and, if so, what type of cancer it is.
Other tests
- You may have imaging tests such as an ultrasound; CT, PET–CT and MRI scans; and x-rays.
- These scans help show where the cancer is and whether it has spread to other parts of the body.
Staging and prognosis
- The cancer will be given a stage to describe how far it has spread in the body. This allows your doctors to recommend the best treatment for you.
- Each type of head and neck cancer is staged slightly differently.
- Prognosis is the expected outcome of a disease. In general, earlier stages have better outcomes.
Which health professionals will I see?
Your GP will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist, who will arrange further tests. If head and neck cancer is diagnosed, the specialist will consider treatment options. Usually these will be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting.
During and after your treatment, you will see a range of health professionals who specialise in different aspects of your care. It’s recommended that complex head and neck cancer is treated in a specialist centre. If you have to travel a long way for treatment, transport and accommodation assistance may be available to you. Call Cancer Council on 13 11 20 for details.
Health professionals you see may include:
- ENT (ear, nose and throat) specialist – treats disorders of the ear, nose and throat
- head and neck surgeon – diagnoses and treats cancers of the head and neck; may be an ENT, general, plastic, or oral and maxillofacial surgeon
- oral (maxillofacial) surgeon – performs surgery and treats disorders of the mouth, face and jaws
- reconstructive (plastic) surgeon – performs surgery that restores, repairs or reconstructs the body’s appearance and function
- oral medicine specialist – evaluates and treats the mouth, face, jaw and salivary glands, which can be affected by cancer treatment
- medical oncologist – treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (systemic treatment)
- cancer care coordinator – coordinates your care, liaises with MDT members, and supports you throughout treatment
- radiation oncologist – prescribes and oversees a course of radiation therapy
- radiation therapist – plans and delivers radiation therapy
- radiologist – analyses and interprets diagnostic scans
- nurse, clinical nurse consultant/specialist – administer drugs and provides care, information and support throughout treatment
- speech pathologist – evaluates and treats communication, voice and
swallowing difficulties during and after treatment - dietitian – helps with nutrition concerns and recommends changes
to diet during treatment and recovery - social worker – links you and your family to support services and helps
with emotional, practical and financial issues - Aboriginal and Torres Strait Islander liaison officer – supports Aboriginal and Torres Strait Islander people and their families during treatment and recovery
- physiotherapist, exercise physiologist – help restore movement and mobility; improve fitness and wellbeing; physiotherapists also help with breathing and airway clearance and managing lymphoedema
- occupational therapist – assists in adapting your living and working
- psychologist – helps you manage your emotional response to cancer
- dentist – evaluates and treats teeth when affected by treatment
- pharmacist – dispenses and gives advice about medicines and drugs
Sources and references
This edition has been developed by Cancer Council NSW on behalf of all other state and territory Cancer Councils as part of a National Cancer Information Subcommittee initiative.
We thank the reviewers of this booklet: Dr Malinda Itchins, Thoracic Medical Oncologist, Royal North Shore Hospital and Chris O’Brien Lifehouse, NSW; Dr Cynleen Kai, Radiation Oncologist, GenesisCare, VIC; Dr Naveed Alam, Thoracic Surgeon, St Vincent’s Hospital, Epworth Richmond, and Monash Medical Centre, VIC; Helen Benny, Consumer; Dr Rachael Dodd, Senior Research Fellow, The Daffodil Centre, NSW; Kim Greco, Specialist head and neck cancers Nurse Consultant, Flinders Medical Centre, SA; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Marco Salvador, Consumer; Janene Shelton, xxx Foundation Australia – Specialist head and neck cancers Nurse, Darling Downs Health, QLD; Prof Emily Stone, Respiratory Physician, Department of Thoracic Medicine and xxx Transplantation, St Vincent’s Hospital Sydney, NSW; A/Prof Marianne Weber, Stream Lead, head and neck cancers Policy and Evaluation, The Daffodil Centre, NSW.
We would also like to thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
References
- National Comprehensive Cancer Network (US), NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers, Version 2.2025.
- J-P Machiels et al., “Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment
and follow-up”, Annals of Oncology, vol. 31, iss. 11, 2020, pp. 1462–75. - P Bossi et al., “Nasopharyngeal carcinoma: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up”, Annals of Oncology, vol. 32, iss. 4, 2020, pp. 452–65.
- C Resteghini et al., “Sinonasal malignancy: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up”, ESMO Open, vol. 10, iss. 2, 2025.
- Australian Institute of Health and Welfare (AIHW), Cancer Data in Australia 2025, AIHW, Canberra, viewed 29 October 2025, aihw.gov.au/reports/cancer/cancer-data-in-australia.
Head and neck cancers
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