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Tests for Nasopharyngeal Cancer
Most people with nasopharyngeal cancer (NPC) are diagnosed after visiting the doctor with symptoms such as a lump in the neck or stuffy nose. The actual diagnosis of NPC is made by looking at a sample of nasopharyngeal cells in the lab.
Medical history and physical exam
- Medical history: Your health care team will ask about your medical history to learn about your symptoms and any possible risk factors.
- Physical exam: They will also examine you, looking for signs of NPC or other health problems.
If the results of your history and physical exam suggest you might have NPC, more tests will be done. This could include imaging tests and/or biopsies.
Blood tests
Your health care team might order certain blood tests as part of their initial assessment. These tests can also help your care team monitor your disease if you’ve been diagnosed with cancer.
Before and after treatment, you might need tests to measure the level of EBV DNA in your blood. This could help your cancer care team choose certain chemo drugs for treatment and monitor how well treatment is working.
The level of EBV DNA in your blood before treatment can also help determine your prognosis (outlook).
Routine blood tests help doctors understand your overall health. These tests can help diagnose nutrition problems, anemia (low red blood counts), liver disease, and kidney disease. They might also suggest the possibility of cancer spread to the liver or bone, which could lead to more testing.
Doctors can also use routine blood tests to help determine how well your body might tolerate certain treatments, like chemo.
Imaging tests to look for NPC
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to make pictures of the inside of your body. Imaging tests might be done both before and after a diagnosis of NPC for a number of reasons, including to:
- Look at suspicious areas that might be cancer
- Learn how far cancer may have spread
- Help determine if treatment is working
- Look for signs of cancer coming back after treatment
If you have NPC, or if your health care team suspects you have it, you might get one or more of the following tests.
A CT scan uses x-rays to make detailed cross-sectional images of your body. Instead of taking 1 or 2 pictures like a regular x-ray, a CT scanner takes many pictures and a computer combines them to show a slice of the part of your body being studied.
A CT scan of your nasopharynx, base of skull, and neck can:
- Provide information about the size, shape, and position of a tumor
- Show if the tumor is growing into nearby tissues
- Find enlarged lymph nodes that might contain cancer
- Look for cancer that may have grown into the bones at the base of the skull
CT scans can also be used to look for tumors in other parts of the body.
Like a CT scan, an MRI scan shows detailed images of soft tissues in your body.
MRI scans use radio waves and strong magnets instead of x-rays. To get clear pictures, a contrast material called gadolinium might be injected into one of your veins before the scan. Doctors often use MRI to try to find out if the cancer has grown into structures near the nasopharynx, particularly the nerves.
MRI is the preferred imaging test used to help diagnose this type of cancer. In most cases, MRIs are better than CT scans at showing the soft tissues in the nose and throat.
For a PET scan, a slightly radioactive form of sugar known as fluorodeoxyglucose (FDG) is injected into your blood. It mainly collects in cancer cells because these cells tend to take up more sugar (or glucose) than normal cells.
PET/CT scan
A PET scan is often combined with a CT scan using a special machine that can do both at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with a more detailed picture on the CT scan.
This is the type of PET scan most often used in people with cancer. Doctors use PET/CT scans to see if and where a cancer has spread (known as staging). This type of scan can be used to look at most organs in the body, but it isn’t useful for looking at the brain or spinal cord.
For a bone scan, a small amount of low-level radioactive material is injected into your blood and collects mainly in abnormal areas of bone. It can help show if a cancer has spread to the bones.
Procedures to look for NPC
Your nasopharynx is deep inside your head and can’t easily be seen, so doctors must use special techniques to examine this area.
You will probably be referred to an ear, nose, and throat (ENT) doctor (also called an otolaryngologist). They have the specialized training and equipment to do a complete exam of this part of your body.
Nasopharyngoscopy
This is the main type of exam used to look inside the nasopharynx for abnormal growths, bleeding, or other signs of disease. It is usually done in the doctor's office in one of two ways:
- Direct nasopharyngoscopy: The doctor uses a fiberoptic scope, similar to the one used during a direct laryngoscopy, to look directly at the lining of your nasopharynx. This is the method most often used to carefully examine the nasopharynx.
- Indirect nasopharyngoscopy: The doctor uses special small mirrors and bright lights, just like during an indirect laryngoscopy, to look at your nasopharynx and nearby areas.
The doctor may not be able to see the tumor if it starts under the lining of your nasopharynx, in the tissue called the submucosa. Because of this, you may need imaging tests such as CT or MRI scans.
Other possible exams
Depending on your signs and symptoms, you might also be referred for a:
- Baseline hearing test by an audiologist
- Complete exam of your eyes and vision by an ophthalmologist (eye doctor)
- Full dental exam by a dentist
- Evaluation of your speech and swallowing ability by a speech therapist
Tests to diagnose NPC
A biopsy is the only way to know for sure that nasopharyngeal cancer is present.
In a biopsy, the doctor removes a small piece of tissue or a sample of cells, so it can be tested in the lab. Several types of biopsies might be used, depending on the circumstances.
If a growth is seen in your nasopharynx, the doctor might remove a tiny piece of it with small instruments and the aid of a fiber-optic scope.
Biopsies of the nasopharynx are often done in the operating room while you are under general anesthesia (a deep sleep). This is usually an outpatient procedure, meaning you don’t have to stay in the hospital.
The tissue sample is sent to a lab, where a pathologist looks at it closely to see if there are cancer cells. A pathologist is a doctor who specializes in diagnosing and classifying diseases in the lab.
NPC can’t always be seen during an exam. If you have symptoms suggesting NPC but nothing looks abnormal on exam, the doctor might biopsy normal-looking tissue. The pathologist will examine and test the tissue to look for cancer cells.
An FNA biopsy may be used if you have a suspicious lump in or near your neck. To do this, the doctor puts a thin, hollow needle into the lump to remove fluid containing cells or tiny bits of tissue. The cells are then looked at in the lab to see if they are cancer cells.
This type of biopsy can show if an enlarged lymph node in your neck is caused by the spread of cancer from somewhere else, such as your nasopharynx, or by a cancer that started in your lymph nodes (lymphoma). Lymphomas can start in the nasopharynx, but this only happens about 5% of the time.
If you have already been diagnosed with NPC and you have enlarged neck lymph nodes, FNA can help find out if the swelling is caused by the spread of the cancer.
Lab tests of biopsy and other samples
Your biopsy samples will be sent to the lab where they are looked at closely. If cancer is found, other lab tests may also be done on the biopsy samples to help doctors better classify the cancer and guide your treatment options.
These biomarker tests look for genes, proteins, and other substances that can reveal important details about your cancer.
If the cancer is advanced, the cancer cells will probably be tested for specific gene and protein changes that might help tell if targeted therapy drugs could be a treatment option.
NPC cells may be tested to see if they have high numbers of gene changes called microsatellite instability (MSI). Testing might also be done to check for changes in any of the mismatch repair (MMR) genes (MLH1, MSH2, MSH6, and PMS2) or the proteins they encode.
PD-L1 (programmed death ligand 1) is a protein on cancer cells. The presence of PD-L1 guides decisions about whether a person will benefit from certain immunotherapy drugs.
TMB is a measure of the number of gene mutations (changes) inside the cancer cells. NPC cells that have many gene mutations (a high TMB) might be more likely to be recognized as abnormal and attacked by the body’s immune system. If your NPC tissue is tested and found to have a high TMB (TMB-H), treatment with pembrolizumab (Keytruda) might be an option.
Tests done before treatment for NPC
If you are diagnosed with nasopharyngeal cancer, your health care team might do other tests to see if you are healthy enough for certain treatments, like radiation or chemotherapy.
Pre-surgery tests
- Electrocardiogram (EKG): If surgery is planned as part of your treatment, you might get an EKG to make sure your heart is working well.
- Pulmonary function tests (PFTs): Some people having surgery may also need tests of their lung function.
Dental exam
Your cancer care team will also have you see your dentist before you get any radiation because it can damage the saliva (spit) glands and cause dry mouth. This can increase the chance of cavities, infection, and breakdown of the jawbone.
Hearing test
Cisplatin is a chemotherapy drug commonly used in treating nasopharyngeal cancer. This drug can affect your hearing, with side effects ranging from ringing in the ears to hearing loss.
Your care team will most likely have your hearing checked with an audiogram before you start treatment. If you already have hearing problems, your doctor might recommend a different chemotherapy drug.
Nutrition and speech tests
Often, a nutritionist will evaluate your nutrition status before, during, and after treatment with the goal of keeping your body weight and protein stores as normal as possible.
You might also visit a speech therapist who will test your ability to swallow and speak. They might give you exercises to do during treatment to help strengthen the muscles in your head and neck area so you can eat and talk as usual after you finish cancer treatment.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Leeman JE, Katabi N, Wong RJ, Lee NY and Romesser PB. Ch. 65 - Cancer of the Head and Neck. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa. Elsevier; 2020.
Lee VH, Kwong DL, Leung TW, Choi CW, O'Sullivan B, Lam KO, Lai V, Khong PL, Chan SK, Ng CY, Tong CC, Ho PP, Chan WL, Wong LS, Leung DK, Chan SY, So TH, Luk MY, Lee AW. The addition of pretreatment plasma Epstein-Barr virus DNA into the eighth edition of nasopharyngeal cancer TNM stage classification. Int J Cancer. 2019 Apr 1;144(7):1713-1722. doi: 10.1002/ijc.31856. Epub 2018 Dec 24.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Head and Neck Cancers, Version 1.2026. Accessed at www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf on Jan 28, 2026.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Smoking Cessation. V.2.2025 – December 3, 2025. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/smoking.pdf on Jan 28, 2026.
Last Revised: March 3, 2026
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