Diagnosis and staging

The following investigations should be undertaken:

• complete head and neck examination, including endoscopy
• scans (ultrasound, CT, MRI or PET) to evaluate the primary site, regional lymph nodes and sites of possible distant metastases (scans should ideally be performed prior to biopsy to avoid the effect of upstaging from the oedema)
• biopsy (arranged by a practitioner with appropriate training and current experience).

Genetic testing

There is no established role for genetic testing for most head and neck cancers. Nasopharyngeal carcinoma has a higher incidence in people of Chinese or Southern European background, but there is currently no genetic test to identify specific individuals at risk.

Treatment planning

The multidisciplinary team should discuss all newly diagnosed patients with head and neck cancer so that a treatment plan can be recommended. The first multidisciplinary team meeting (MDM) should be within 2 weeks of receiving the diagnosis and staging results.

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.

Communication

The lead clinician’s (1) responsibilities include:

• discussing a timeframe for diagnosis and treatment options with the patient and/or carer
• explaining the role of the multidisciplinary team in treatment planning and ongoing care
• encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
• providing appropriate information and referral to support services as required
• communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from MDMs.

Checklist

Timeframe

Diagnostic investigations should be completed within 2 weeks of the specialist appointment.