In some patients, the primary cancer may grow slowly and be too small to be seen on examination and scans; the primary site may appear later during follow-up. Sometimes, a biopsy of the primary site is needed to make sure there is no cancer within them, but examining these areas is often difficult when the patient is awake. The doctor may suggest examining the areas under general anaesthesia (with you asleep) if the primary site of cancer hasn’t been identified. Whilst under anaesthesia, the doctor can perform a thorough examination of the mouth, throat, voice box and the back of the nose (nasopharynx).
Based on the examination, the doctor may recommend:
- Needle biopsy (Fine Needle Aspiration or FNA biopsy): This is when a thin needle is inserted into the suspicious lymph node to remove a sample. Typically this is performed using ultrasound guidance with local anaesthetic to reduce your discomfort. The tissue is then examined under a microscope to look for cancer cells by a pathologist. This is the only sure way to know if you have cancer. o
- If a diagnosis cannot be made based on the FNA, it is either repeated or a core biopsy (a similar procedure with a larger needle) may be performed. If the diagnosis still remains uncertain, then a surgeon may perform an excisional lymph node biopsy to remove the suspicious lump under general anaesthesia and send the sample to the pathologist for review.