A variety of methods is used to diagnose pharyngeal cancers. They include:

• Physical exam and history
• Head, neck and chest X-rays
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear MRI, or NMRI.
• CT (computed tomography) scan: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an X-ray machine. Contrast medium (a dye injected into a vein or swallowed to help the organs or tissues show up more clearly) is generally not used when imaging the sinonasal area. This procedure is also called computerized tomography or computerized axial tomography.
• Positron emission tomography (PET) scan: A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose derivative fluorodeoxyglucose (FDG) is injected into a vein. The PET scanner rotates around the body and generates a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more FDG than normal cells do. PET scans may be used to find nasopharyngeal cancers that have spread to the bone. It has also been used to find distant metastases (primarily to the lungs) in hypopharyngeal cancers.
• Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
• Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through the patient’s nose or mouth to look at areas in the throat that cannot be seen during a physical exam of the throat. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples for biopsy.
• Biopsy: The removal of suspect tissue for analysis. A pathologist views the tissue under a microscope to look for cancer cells. This test is necessary to establish three things:  1) whether the tumor is benign or malignant, 2) what type of cell the tumor originated from and 3) what grade, or level of differentiation, the tumor cells display.
• Human papillomavirus (HPV) test: Testing the blood or a biopsy sample for HPV may help reveal information about the cancer involved and provide treatment guidance.

For nasopharyngeal cancer: 

• Nasoscopy: A procedure to look inside the nose for abnormal areas. A nasoscope is inserted into the nose. A nasoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples for biopsy.
• Neurological exam: A series of questions and tests to check the brain, spinal cord and nerve function. The exam checks a person’s mental status, coordination and ability to walk normally, and how well the muscles, senses and reflexes work.
• Epstein-Barr virus (EBV) test: Testing the blood or a biopsy sample for EBV may help reveal information about the specific type of nasopharyngeal cancer involved and provide treatment guidance.

For hypopharyngeal cancer: 

• Barium esophagogram: An X-ray of the esophagus. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and X-rays are taken.
• Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth or nose and down the throat into the esophagus. Tissue samples may be taken for biopsy.
• Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.