A thorough head and neck examination is performed which includes examination of the oral cavity, the neck and a nasoendoscopy.
A biopsy of the oropharyngeal lesion may be attempted in the clinic under local anaesthesia if it is visible and accessible via the oral cavity. Otherwise, a panendoscopy and biopsy under general anaesthesia are done in the operating theatre. For tonsillar cancers, a tonsillectomy may be performed during the panendoscopy for diagnosis.
A fine needle aspiration cytology is also performed of any neck node. Either a computed tomography scan or magnetic resonance imaging (CT or MRI) is done to evaluate the extent of the oropharyngeal lesion and possible neck node involvement. If the biopsy confirmed the diagnosis of cancer, a CT scan of the thorax and liver is done as part of the staging work-up, looking for distant spread to the lungs or the liver.
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