Head and neck cancer symptoms are often subtle at first, and many patients come to Siteman Cancer Center after weeks or months of uncertainty. If you have been diagnosed, are experiencing symptoms, or want a second opinion, you can come directly to Siteman Cancer Center. You do not need a referral to see us.
The WashU Medicine physicians in our Head and Neck Tumor Center diagnose and treat every type of head and neck cancer — including rare, advanced, and difficult-to-diagnose disease. Because our specialists see thousands of patient visits each year and care for hundreds of newly diagnosed patients annually, they have deep experience recognizing complex patterns, identifying subtle findings and distinguishing between cancers that can appear similar but require very different treatments.
That experience matters. An accurate diagnosis is the foundation of effective treatment. Our team uses advanced imaging, pathology, molecular testing, and multidisciplinary review to define the exact type and stage of disease as quickly and precisely as possible. By bringing experts together early, Siteman helps patients avoid delays, gain clarity faster, and move confidently into a personalized treatment plan designed specifically for their cancer.
What Is the First Step in Diagnosing Head and Neck Cancer?
Diagnosis begins with a thorough physical exam. Your physician will look inside your mouth, throat, and nose to check for unusual sores, lumps, or changes in tissue. This exam is painless and happens right in the office.
Your doctor may also check how well the nerves in your head, face, and neck are working. They might ask you to do simple things like shrug your shoulders or move your face in different ways. These are straightforward for you and significant ways for your physician to assess your health.
If your physician finds something that needs a closer look, they will recommend additional testing. At Siteman, our experts in imaging and pathology lead this work, getting a complete, precise picture of your cancer so your treatment plan is built on the most accurate foundation possible.
What Are the Symptoms of Head and Neck Cancer?
Because head and neck cancer can begin in many different locations, early signs and symptoms vary widely. The most common warning signs include:
- A lump that can be seen or felt through the skin*
- A change in voice quality (like hoarseness)
- Difficulty swallowing
- Pain in your mouth including tongue, teeth, or even ears
- Decreased sense of smell or a total loss of smell
- Decreased sense of taste or a total loss of taste
- Loose teeth, tooth pain, or change in how dentures fit
- A sore that does not heal on face, eyelids, nose, cheek, tongue, roof of mouth, throat, or lip
Many of these symptoms can also be caused by a common illness like a cold or sinus infection. That is why a physician’s evaluation matters. Only diagnostic testing can confirm or rule out cancer.
How long a symptom lasts is an important clue. If symptoms persist beyond two weeks or keep returning, call your doctor or dentist. Don’t wait.
*Note: A lump or mass in your neck is a symptom that always needs prompt attention. For adults with this symptom, cancer has to be ruled out through tests. Unlike other symptoms, a lump or mass is considered cancer until tests prove that it is not.
Why Choose Siteman for Your Head and Neck Cancer Diagnosis?
Your diagnosis is the foundation of everything that follows. An accurate, precise diagnosis that’s informed by research and tailored to your specific cancer determines the treatment that gives you the best possible outcome. At Siteman, our experts in imaging and pathology are among the most experienced in the country for head and neck cancers specifically.
Studying your cancer cells in our lab reveals insights that go beyond a location on a scan. We learn how your cancer grows and changes and discover its vulnerabilities. That information drives a treatment plan that is not just personalized, it is also precise.
Because WashU Medicine physician-researchers at Siteman are also studying the disease at the molecular level, your diagnosis directly benefits from the latest science. What we learn in the lab, we apply within a personalized treatment plan.
What to expect during a diagnosis
Your primary care physician or dentist may refer you to a specialist or oral surgeon for testing. They can begin your evaluation but cannot perform many of the tests a diagnosis requires. You do not need a referral to come to Siteman. Many of our patients come to us first, or come to us for a second opinion that changes their care plan.
Your Second Opinion at Siteman
Siteman wants to be your first choice for cancer care, but that might not always be possible. If you have received a cancer diagnosis, started care somewhere else, or are a physician seeking specialized care for your patient, ask us about a second opinion. You can start the process. To make it easy, our care coordinators guide scheduling for yourself or your patient.
For an accurate head and neck tumor diagnosis, we order these tests:
- Lab work and blood tests
- Internal tests like biopsies and endoscopy
- Imaging and scans like CT, MRI, PET-CT, and ultrasound
Biopsy
A biopsy takes a small tissue sample so our pathologists can examine cells for cancer. There are two primary approaches:
Needle biopsy: A thin needle removes a small number of cells. This is a quick, in-office procedure.
Surgical biopsy: When a larger sample is needed, the biopsy is performed in an operating room. If you are also having a tumor removed, the biopsy may take place at the same time to minimize the number of procedures you need.
All tissue samples are carefully examined by a WashU Medicine pathologists to make sure the diagnosis is accurate.
Endoscopy
An endoscopy uses a small camera on a flexible tube to look directly inside your nose, mouth, or throat. This gives your physician a close-up view of areas a standard exam cannot reach.
What to expect: Most patients remain awake and the exam takes place in the office. It is quick, and most patients tolerate it well. Often your specialist will use a numbing spray to keep you comfortable.
Sometimes the physician may do this test in an operating room while you’re asleep. This allows them to collect tissue samples, if needed.
Imaging tests
Imaging gives your care team a precise view of your tumor’s location, size, and spread. Different technologies are used depending on what your physician needs to see:
- CT scans – Takes detailed images with X-rays
- MRI scans – Uses magnets to create detailed images
- PET scans – Uses a special sugar solution to locate cancer cells
- PET-CT scans – Combines a CT and PET-scan for ultra precise imagery
- Ultrasound – Uses sound waves to see inside your body. These are often used for tongue tumors.
Types of Head and Neck Cancer
Most head and neck cancers originate from the same type of cells called squamous cells. But the specific diagnosis is determined by where in the body those cells begin to grow abnormally. Each location requires a different specialist and a different treatment approach.
Head and neck cancers include:
- Throat cancer
- Oral cavity cancer
- Nasal cavity cancer / Sinus cancer
- Salivary gland cancer
- Thyroid cancer
- Skin cancer
Cancers that involve the brain, eye, and along the spinal cord are not considered a kind of head and neck cancer.