The doctor will give you a patient listening and ask you questions regarding your duration and progression of your symptoms, general health conditions, addictions, and other details. A thorough physical examination of the head- neck will be done. If the person's individual history, risk factors and physical examination provide a physician with enough suspicious information then additional tests, like endoscopies, scans and biopsies will be required. Endoscopies and biopsies can be planned in the clinic/OPD itself in most cases. Imaging tests such as USG, CT and MRI give an indication of the depth and extent of disease, and hence the stage. The patient will be requested to get this done from any reputed facility as convenient for the patient. Occasionally, the patient may be requested to get a PET-CT done if indicated.
Endoscopies are procedures done to see into hidden corners of the head neck area, which are not directly visible to the eye. Endoscopes are sophisticated equipment consisting of narrow flexible or rigid tubes with a light and camera attachment, which are introduced through the nose or mouth. The flexible scopes consist of an eyepiece and a fiber-optic light enclosed in a thin, flexible tube. The scope looks like a strand of black spaghetti with a tiny light on the end of it. Rigid endoscopes, on the other hand are fine rods with similar attachments. The scope is inserted through the nose, and can be moved around to help the doctor see all areas of nasal passages and throat. They can look into the various nooks and corners, and project a picture on a computer screen.
The flexible laryngoscopyis done after applying a topical anesthetic (directly to the nose to numb it) and decongestant (to open up swollen nasal passages). Because the anesthetic and the decongestant are the only medications needed, the flexible laryngoscopy can be done right in the doctor’s office during your appointment. The patient is instructed to breathe through the mouth while the scope is placed into nostril. The doctor can view the back of your nose and down your throat. It helps him/her check the area for abnormal growths or other problems.
Nasal endoscopy is a procedure to look at the nasal and sinus passages. This is done after putting local anaesthesia and decongestant into the nose to make the lining numb, and to open up the nasal airway. A rigid scope is usually used, and can go right upto the back of the nose and transmit clear pictures on a screen. This can aid in the diagnosis. Small tools may be used to take tiny samples of tissue.
FNAC is the short form for Fine Needle Aspiration Cytology. A fine needle is introduced into the lump, and some tissue fluid is aspirated out. The fluid is smeared onto a glass slide, and the slide is sent for testing to a pathologist, who examines it to confirm the diagnosis.
A biopsy is a sample of tissue taken from the body in order to examine it more closely. It is done when initial tests suggests an area of tissue is abnormal.Most biopsies can be done in the clinic under local anesthesia. The patient can go home after an hour or so, and take soft bland diet and some pain killers. Some biopsies cannot be done in the clinic, and need admission in the hospital where the biopsy is done under general anaesthesia in the operating room.
It is only after the receipt of the reports that the doctor can explain to the patient and the attenders about the site, stage and type of cancer and the treatment options available to him/her.