Nasofibrolaryngoscopy is a diagnostic technique in which the otolaryngologist inserts a thin, flexible endoscope equipped with a light and camera through the nose to examine the nasal cavities, pharynx and larynx (including the vocal cords) directly and in real time.

This procedure allows visualisation of structural or functional alterations of the upper airway (such as inflammation, tumours or changes in the mobility of the vocal cords) without the need for surgery. It facilitates both visualisation of the lesion and the performance of a guided biopsy.

Magnetic Resonance Imaging in the diagnosis of head and neck cancer allows for the clear visualisation of both the primary tumour and the extent of its local and lymphatic spread, thanks to its excellent contrast in soft tissues.

It is often used to diagnose tumours of the nasopharynx, oropharynx, base of tongue, salivary glands.

Contrast-enhanced MRI offers the following possibilities:

• Staging tumours of the head and neck.
• Detect perineural or skull base invasion.
• Differentiate between recurrence and post-radiotherapy changes.

PET-CT (Positron Emission Tomography fused to Computed Tomography) is the most advanced and recommended imaging test for the management of head and neck cancer in complex cases. It combines metabolic information (PET) with high-resolution anatomical information (CT) in a single session and is indicated when there is suspicion of disease spread.

It has consolidated as a fundamental tool for diagnosis, cancer staging, treatment planning and evolutionary control or patient follow-up.

PET-CT is the test of choice for:

• Locally advanced tumours
• Cases of carcinoma of unknown primary
• Radiotherapy planning
• Response and recurrence assessment