Checking for mouth cancer and having a biopsy

To diagnose mouth or oropharyngeal cancer your specialist needs to take a sample of tissue from the affected area. This is called a biopsy.

A pathologist looks at the tissue under a microscope to see if there are any cancer cells. 

There are different ways of looking at the back of your mouth and throat and taking a biopsy. These include:

• nasendoscopy
• panendoscopy
• incisional biopsy

You might also have a biopsy to check for cancer in a swollen lymph node or neck lump.

Looking inside your mouth, throat, and airways

You usually have a test called a nasendoscopy to look at the inside of your nose, your mouth and the back of your throat.

You might also have a type of test called a panendoscopy. Your doctor can take samples (biopsies) of any abnormal areas at the back of your mouth and throat during a panendoscopy.

Your doctor might be able to take a biopsy without using a panendoscope if the abnormal area is easy to reach. For example, on your lip or the inside of your cheek. This is an incisional biopsy.

Nasendoscopy

A nasendoscopy is a test to look at the:

• inside of the mouth 
• throat (pharynx)
• voice box (larynx)

Before your biopsy

There are no special preparations for a nasendoscopy. 

You can eat and drink and take your medicines as normal unless your doctor or nurse tells you otherwise.

You can have a local anaesthetic spray into your nose. This numbs the area where the endoscope passes.

Having a nasendoscopy

You usually sit upright in a chair for this test. 

Your doctor passes a thin flexible tube called a nasendoscope into your nose and down the back of your throat to your voice box. The tube has a camera and a light at the end and allows the doctor to check for any abnormal-looking areas.

Your doctor can see the pictures from the camera on a TV screen. 

You should continue to breathe normally throughout the test. It’s also important to swallow when you need to swallow as this clears the phlegm in your throat. 

During the test, you may sneeze, and it may also make your eyes water. 

Your specialist will usually take a biopsy if they see an abnormal area. This might happen on the same day or as a separate appointment. You might have a local or general anaesthetic.

Your nurse or doctor will let you know more about your biopsy if you need to have one. 

After your naseendoscopy

You can usually go home straight after your test. 

If you had the anaesthetic spray, you can’t eat or drink until the anaesthetic wears off and your throat feels normal again. This is usually about an hour. Check with your nurse or doctor when you can start eating and drinking again. 

Panendoscopy

A panendoscopy is a test to look at your upper airway. This includes your mouth, nose, voice box and top of your food pipe. 

You might have panendoscopy if other tests have shown an abnormal area in your mouth or throat and your doctor needs to be able to see it more clearly. Or you might have it if your doctor needs to take a sample of tissue (a biopsy).

You have this under a general anaesthetic in the operating theatre. This means you are asleep for the test.

This test can take between 20 to 60 minutes. But you might be in the operating department for about 1 to 2 hours. This includes time in the recovery unit after the test.

Before your test

Before your panendoscopy you usually have a pre-assessment appointment. This prepares you for your operation. You meet members of your treatment team at this appointment.

The doctor or nurse will tell you what you need to do on the day. This includes instructions about when to stop eating and drinking, and whether to stop taking any of your medicines.

What happens?

While you are asleep your surgeon uses the panedoscope to look at your nose, throat, voice box, top of your food pipe, and top of your windpipe.

If there are any abnormal areas, they may take a biopsy. Biopsies are sent to the laboratory to be looked at under a microscope.

After the test, you go to the recovery area. A nurse will look after you until you wake up and are ready to return to the ward.

After your test

You usually go home after you have recovered from the anaesthetic. This is usually on the same day. 

As you’re having a general anaesthetic you’ll need someone with you so they can take you home and stay with you overnight. Also for 24 hours after you shouldn’t drive, drink alcohol, or operate heavy machinery.

Possible risks

Panendoscopy is a very safe procedure but your nurse will tell you who to contact if you have any problems afterwards. Your doctors will make sure the benefits of having a panendoscopy outweigh these possible risks.

Some of the possible risks may include:

Sore throat

This is common after having a panendoscopy and can last for a few days. Contact the hospital if you have severe pain in your throat.

Stiff neck

You may have a stiff neck after the test because of the position you were in on the theatre table. This should settle soon after.

Tear in your food pipe

Very rarely, there can be a small tear (perforation) of your food pipe. It’s likely you would need surgery to repair the tear.

Incisional (scalpel) biopsy  

An incision biopsy means cutting out a small piece of tissue from the affected area. It is sometimes called a scalpel biopsy. You have it under local anaesthetic.

You are most likely to have this type of biopsy if the affected area is easy to reach. For example, your lip, tongue or the inside of your cheek.

You might have this in the minor operation theatre in the outpatient department. 

Before the biopsy 

Your nurse or doctor will let you know of any preparation beforehand. Take your usual medicines as normal unless your doctor or nurse tells you otherwise.

If you take medicine to thin your blood, you might need to stop it before your biopsy. Your doctor or nurse will tell you when to stop.

Your doctor will explain what will happen and ask you to sign a consent form. This is a good time to ask any questions you may have.

The biopsy takes a few minutes, but you will be in the department for about 30 to 60 minutes. This is so:

• you understand why you are having the biopsy
• you are comfortable before they start the biopsy 
• the nurse can check you are well enough to go home afterwards 

During the biopsy 

To have a biopsy you usually lie on a couch. When you are ready your doctor injects some local anaesthetic into the area to numb it.

The doctor cuts around the affected area using a scalpel and gently lifts the piece of tissue using a pair of tweezers and cuts it off. This may be uncomfortable but only lasts a short time. For many people, the most uncomfortable part is the local anaesthetic injection.

The biopsy is sent to the laboratory. A pathologist looks at the sample under a microscope to see if there are any cancer cells.

After the biopsy

You can usually go home soon after you’ve had your biopsy. 

Looking after the biopsy area 

Your doctor will give you instructions about how to look after your mouth after your biopsy. You might have a few stitches.

Stitches are often dissolvable and will disappear on their own. Your doctor or nurse will tell you if you need the stitches removed. 

Possible risks

Possible risks include infection and bleeding.

Bleeding

It’s rare to have any bleeding after you’re a biopsy. You may notice a small amount of blood in your saliva for a few hours afterwards. But this should soon settle. Your doctor or nurse will give you advice on what to do if you have any bleeding.

Infection

Your doctor or nurse will let you know how to look after your biopsy site. Contact your healthcare team if the area becomes increasingly red or hot, or if you have increasing pain.

After your test

A nasendoscopy, panendoscopy, and a biopsy are usually safe procedures. But your nurse will tell you who to contact if you have any problems afterwards. 

Getting your results

You usually get the results of your biopsy within 2 weeks.

Waiting for test results can be a worrying time. Ask your doctor or nurse how long it will take to get them. Contact them if you haven’t heard anything after a couple of weeks.

You might have the contact details for a specialist nurse. You can contact them for information and support if you need to. You can contact your specialist nurse if you’re finding it hard to cope. It can also help to talk to a close friend or relative about how you feel.