investigation and assessment of upper aerodigestive cancer

Last edited 12/2018 and last reviewed 01/2022

Assessment of neck lumps

  • ultrasound-guidance should be considered in addition to fine-needle aspiration cytology or core biopsy for people with a neck lump that is suspected of being cancer of the upper aerodigestive tract
  • onsider having a cytopathologist or biomedical scientist assess the cytology sample adequacy when the procedure is carried out

Identifying the occult primary

  • a fluorodeoxyglucose positron emission tomography (FDG PET)-CT scan should be considered for the first investigation to detect the primary site in people with metastatic nodal squamous cell carcinoma of unknown origin that is thought to arise from the upper aerodigestive tract

  • consider using narrow-band imaging endoscopy to identify a possible primary site when it has not been possible to do so using FDG PET-CT

  • a biopsy should be offered to confirm a possible primary site

  • surgical diagnostic assessment should be offered if FDG PET-CT does not identify a possible primary site. This may include:
    • guided biopsies
    • tonsillectomy
    • tongue base mucosectomy

  • MRI or CT scan - should be considered before diagnostic surgery to help with radiotherapy treatment planning.

Clinical staging -who and how?

  • systemic staging should be offered to all people with cancer of the upper aerodigestive tract except those with T1N0 or T2N0 disease
  • offer FDG PET-CT to people with
    • T4 cancer of the hypopharynx or nasopharynx
    • to people with N3 cancer of the upper aerodigestive tract
  • conventional imaging (for example, chest CT) should be offered to people with cancer of the upper aerodigestive tract who require systemic staging but FDG PET-CT is not indicated for them