Tests for mouth and oropharyngeal cancer

You usually have a number of tests to check for mouth and oropharyngeal cancer. Mouth cancer is also called oral cancer.

Mouth cancer can start in different parts of the mouth. This includes the:

  • lips

  • gums

It can also start in the front part of the tongue. This is called tongue cancer. We have separate information about the tests you might have to check for tongue cancer.

Oropharyngeal cancer starts in the oropharynx. The oropharynx is the part of the throat just behind the mouth. It also includes the tonsils. We have separate information about the tests you might have for tonsil cancer.

You have tests if you have symptoms that could be due to mouth or oropharyngeal cancer. These tests will find out what is causing them and whether it is cancer or not.

Tests your GP or dentist might do

Most people with symptoms start by contacting their GP or dentist. The first appointment with your GP is often a telephone appointment. Your GP then might arrange for you to go in and see them.

Your GP or dentist can do some tests to help them decide if you need to see a specialist. This usually includes an examination of your mouth and neck. Your GP may also ask you to have some blood tests done. 

Examining your mouth and neck

Your doctor or GP looks inside your mouth and feels around your neck. They feel for any areas that might be swollen or not feel normal. If you have any pain, they will feel those areas as well.

Your GP may also listen to your chest and tummy (abdomen) to find out if they sound normal.

Blood tests

Blood tests can check your general health including:

  • how well your liver and kidneys are working
  • the number of blood cells such as platelets Open a glossary item and red blood cells Open a glossary item

Tests your specialist might do

Your GP or dentist might refer you to a specialist doctor at the hospital. It depends on the results of your tests. This is usually a head and neck doctor or ENT specialist. ENT stands for ear, nose and throat. 

Your specialist doctor usually does more tests. These include:

  • a test to look at the inside of your nose, mouth and throat. This is a nasoendoscopy
  • taking a sample of tissue called a biopsy
  • checking your lymph nodes Open a glossary item for cancer
  • CT scan
  • MRI scan
  • an x-ray of the mouth and jaw. This is an orthopantomogram (OPG)
  • PET-CT scan
  • a barium swallow

Nasoendoscopy

A nasoendoscopy is often the first test you have at the hospital. You have this in the outpatient clinic.

Your doctor passes a thin, flexible tube through your nose and into your throat. This is called a nasoendoscope. The tube has a camera and a light at the end. This can be uncomfortable but does not usually hurt. It only lasts a few minutes.

Biopsy

To diagnose mouth and oropharyngeal cancer, your doctor needs to take a sample of tissue from the abnormal area. A specialist doctor called a pathologist Open a glossary item looks at the tissue under a microscope to check for cancer cells.

There are different ways to take a biopsy of your mouth and oropharynx. These include:

  • an incisional biopsy
  • a panendoscopy

Incisional biopsy

An incisional biopsy means cutting out a small piece of tissue from the abnormal area. You have this under local anaesthetic Open a glossary item. You are likely to have this if the abnormal area is easy to reach. This could be your:

  • lips

  • tongue

  • cheek

You usually have an incisional biopsy as an outpatient. The biopsy only takes a few minutes but you will be in the hospital for longer. This is so your nurse or doctor can check that you are well afterwards.

To have the biopsy, you usually lie on a couch. Your doctor then injects some local anaesthetic into the area to numb it. They then cut around the area using a scalpel. You may need to have a few stitches afterwards. These are often dissolvable and will disappear on their own.

Panendoscopy

You have a panendoscopy under general anaesthetic. This means that you are asleep and won’t feel anything.

You usually have a panendoscopy if the abnormal area is difficult to reach. This includes the:

  • back of your mouth

  • throat

Checking your neck lymph nodes or neck lump

You might have an ultrasound scan to check the lymph nodes in your neck. Ultrasound scans use high frequency sound waves to create a picture of a part of the body. The ultrasound scanner has a microphone that gives off sound waves. The sound waves bounce off the organs inside your body and are picked up by the microphone. The microphone links to a computer that turns the sound waves into a picture.

If your doctor sees any abnormal areas, you might have a fine needle aspiration (FNA) at the same time.

A fine needle aspiration is a way of taking a sample of cells from an abnormal lymph node or lump in your neck. Your doctor uses a fine needle and syringe to take the cells. A pathologist then looks at the cells under a microscope.

Your doctor numbs the area with a local anaesthetic before taking the sample of cells.

CT scan

A CT (or CAT) scan stands for computer (axial) tomography. It is a test that uses x-rays and a computer to create detailed pictures of the inside of your body. The computer puts them together to make a 3 dimensional (3D) image.

You usually have a CT scan of your:

  • head and neck

  • chest

  • abdomen

The CT scan can show where the cancer is and whether it has spread to other parts of your body. 

MRI scan

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to take pictures of the inside of your body.

You might have an MRI scan of your head and neck if your doctor thinks the cancer has spread to the nearby lymph nodes.

Orthopantomogram (OPG)

An OPG is a type of x-ray. An x-ray is a test that uses small amounts of radiation to take pictures of the inside of your body.

An OPG takes pictures of the area around the upper jawbone (maxilla) and lower jawbone (mandible). You might have an OPG to see if you need any dental work before treatment starts.

PET-CT scan

A PET-CT scan combines a CT scan and a PET scan. It gives detailed information about your cancer.

You usually have a PET-CT scan in the radiology department. It usually takes between 30 and 60 minutes. You might have a PET-CT scan if your doctor finds cancer cells in the lymph nodes in your neck, but they don’t know where the cancer started. The PET-CT scan can help to show a cancer that other scans have not been able to find.

Barium swallow

A barium swallow is a test that looks at the food pipe (oesophagus) and stomach. This is not a very common test. You might have it if you are having difficulty swallowing food.

You have a barium swallow test in the radiology department. You stand next to the x-ray machine and drink the liquid barium. The radiographer Open a glossary item then takes a number of x-rays while the barium passes down your throat and into your stomach.

The liquid barium passes through your digestive system Open a glossary item. The liquid does not cause you any harm.

Treatment

The tests you have help your doctor find out if you have mouth or oropharyngeal cancer and how far it has grown. This is the stage of the cancer.

This is important because doctors recommend your treatment according to the stage of the cancer.

Coping

Coping with a diagnosis of mouth and oropharyngeal cancer can be difficult. There is help and support for you and your family.

  • Suspected cancer: recognition and referral
    National Institute of Health and Care Excellence (NICE), 2015 (last updated 2023)

  • Scottish Referral Guidelines for Suspected Cancer
    NHS Scotland, 2022

  • Implementing a timed head and neck cancer diagnostic pathway. Guidance for local health and care systems
    NHS England, 2023

  • Head and neck cancer explained: an overview of management pathways
    D Owens and others
    British Dental Journal, 2022. Vol 233. Pages 721-725

  • Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up
    J P Machiels and others
    Annals of Oncology, 2020. Vol 31, Issue 11. Pages 1462-1475

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
14 Feb 2024
Next review due: 
14 Feb 2027

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