Would you describe the process of having a biopsy for head and neck cancer? What can I expect?

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BruceCampbellMD (Physician (Verified) ) - 08 / 29 / 2012

A “direct laryngoscopy and biopsy” involves a trip to the operating room and a general anesthetic. While the patient is asleep, the surgeon carefully palpates the mouth and throat, then directly looks at the area where the cancer is found, often using a microscope or telescopes. This allows for precisely localizing the cancer and determining which throat structures are both involved and not involved. The biopsies are generally taken with small cutting instruments to try and preserve as much of the normal tissues as possible.

Some biopsies can be obtained through a flexible endoscope in the office. A fiber optic scope can be advanced through the nose to the area where the cancer is located. A tiny cutting forcep can be placed through a channel in these special scopes and a biopsy obtained. For some patients, this approach is better because it avoids an anesthetic. The disadvantages include a less thorough examination and the tiny size of the biopsy.

Finally, some biopsies are obtained using a needle aspiration and examination of small clumps of cells that are retrieved through the needle (Fine Needle Aspiration Cytology). This is effective for neck masses but not particularly useful for the voice box itself.

On the horizon are various tests where specific genetic changes and products (“biomarkers”) will be examined in the spit. These are still experimental and, although useful for screening, will not tell the physician exactly where the problem lies.
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