Radiology

• Offer ultrasound guided FNA or core biopsy of neck node.
  
  
• Offer contrast enhanced CT of the neck and/or contrast enhanced MRI neck and contrast enhanced CT of the chest. 
  
  
• Consider MRI for suprahyoid primary lesions and for cases of carcinoma with an unknown primary.
  
  
• Consider CT abdomen at baseline if concern of advanced disease.

• Consider FDG PET for assessment of distant metastases in advanced nasopharyngeal and hypopharyngeal tumours.

Radiology protocols will vary depending on the CT or MRI equipment being used. Consider dual phase contrast enhanced CT neck from skull base to suprasternal notch for the CT neck as this would ensure good contrast enhancement of arteries and veins plus ensure the correct scan range. For MRI consider including T1 and T2 sequences +/- gadolinium and images in more than one plane.

• Sinonasal cancer – Consider dedicated bone reformats of the sinuses from CT neck and MR Sinuses/Skull Base with contrast to assess.

• Cervical nodal metastasis with cancer of unknown primary of the head and neck – Offer FDG PET as soon as cancer of unknown primary is suspected following initial investigation with neck node ultrasound and pathological confirmation and CT and/or MRI imaging assessment, prior to EUA assessment of all the upper aero-digestive tract and biopsies.

• Salivary gland malignancy (and any tumour where there is concern about perineural infiltration) – Consider contrast enhanced MRI.

For more information about follow up post radical chemoradiotherapy, refer to the follow up section of this pathway.