Clinical Investigations

The nasopharynx can be inspected using a post-nasal mirror placed behind the soft palate but biopsy specimens are usually obtained with either rigid or flexible endoscopes. The hypopharynx and larynx can be inspected by indirect visualisation using a laryngeal mirror held against the soft palate or a fibre optic endoscope passed through an anaesthetised nose. Biopsies can be readily obtained under general anaesthesia using a laryngoscope and operating microscope. Endoscopy of the upper aerodigestive tract is performed prior to surgery for malignant disease to identify occult second primary neoplasms.

Serological studies for Epstein-Barr virus antigens are useful in nasopharyngeal carcinoma both in assessing the effects of therapy and in detecting recurrence. Baseline function of the thyroid gland should be determined prior to radical surgery or radiotherapy to the neck.

Ultrasonography has proved useful in evaluation of lymphadenopathy and in guidance of needles for FNA and core needle biopsy.

Barium studies are performed in cases of dysphagia and to assess swallowing function prior to treatment for malignant disease. Chest radiographs may identify a concurrent bronchial or lung lesion. CT and MRI scanning are essential in planning surgery by indicating the depth of the tumour and detecting other changes in the neck. CT has less motion artefact and is good for bone detail while MRI gives superior soft tissue contrast without dental amalgam artefact or exposure to ionising radiation.

FNA is essential in assessing patients presenting with cervical lymphadenopathy, particularly when there is a high probability of malignant disease.

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