How Are Laryngeal and Hypopharyngeal Cancers Diagnosed?

If you have some of the symptoms of laryngeal or hypopharyngeal cancer, your doctor will begin your diagnosis with a medical history and physical exam.

• Medical history and physical examination - Your doctor will take a complete medical history by asking you about your risk factors, symptoms, and other health problems or concerns. During the physical exam, your doctor will check your neck, lip, gums, and cheeks for lumps. The doctor will also look closely at your nose, mouth, throat, and tongue, possibly using a mirror to see these structures more clearly.

To take a better look at certain areas in the neck, the doctor might use endoscopy or panendoscopy.

• Endoscopy - The doctor inserts a thin, flexible fiberoptic tube (endoscope) attached to a light and viewing lens through your mouth or nose. Depending on the part of the body examined and the techniques used, this procedure has different names:
  • Laryngoscopy - Examination of the larynx. When the doctor uses a laryngoscope (an endoscope used to examine the larynx), the procedure is known as direct laryngoscopy. Laryngoscopy can also be performed indirectly (without an endoscope) using a small, long-handled mirror .
    
  • Pharyngoscopy - Examination of the pharynx
    
  • Nasopharyngoscopy - Examination of the upper part of the pharynx behind the nose (nasopharynx)
    
  • Esophagoscopy - Examination of the esophagus (a tube that connects the throat to the stomach)
    
  • Bronchoscopy - Examination of the bronchi (air passages that connect the trachea to each lung)
    
  • Videostroboscopy - An endoscope with a tiny video camera and strobe light used to capture moving images of the vocal cords
    
  • Panendoscopy (upper endoscopy) - A combination of direct laryngoscopy, pharyngoscopy, esophagoscopy, and bronchoscopy. This procedure is done in the operating room, while you are under general anesthetic (so that you are asleep) to determine the extent of the cancer.
    

A biopsy is the only way to be sure whether you have laryngeal or hypopharyngeal cancer. This involves cutting out a small piece of tissue and sending it to a laboratory. A pathologist (doctor who specializes in examining changes in cells and tissues to find out if these changes are caused by a certain disease) in the laboratory will look at the tissue under a microscope to see whether it has cancerous cells. The tissue sample can be collected in different ways:

• Fine needle aspiration (FNA) biopsy - The doctor uses a thin needle to collect a tiny piece of tissue or a small sample of fluid. The doctor might use CT scans or ultrasound (see below) to guide the needle. FNA is often used to find out if the cancer has spread (metastasized) to lymph nodes in the neck. It is also used to find out whether a new lump in an area that has been treated for cancer is a scar or a tumor that has come back.
• Endoscopic biopsy - The doctor inserts special instruments through an endoscope (see above) and removes small samples of tissue. This procedure is done in the hospital, while you are under general anesthetic.
• Imaging procedures allow doctors to learn where the cancer is located and whether it has spread from the larynx or hypopharynx to other areas of the body.
• Barium swallow (upper gastrointestinal series, upper GI series) - Before having this series of x-rays, you will drink a liquid that contains barium. The barium coats the lining of the esophagus, stomach, and intestines and makes tumors and other abnormalities show up more clearly on the x-rays. You will then have several x-rays taken. These x-rays are helpful for finding out whether you have any cancer in your hypopharynx or esophagus.
• Computed tomography (CT or CAT) scan - Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer combines these pictures into an image of a slice of your body. CT scans can show how large the tumor is and whether it has spread to other organs or to the lymph nodes.
• Magnetic resonance imaging (MRI) - MRI uses powerful magnets and radio waves to take detailed cross-sectional images. MRI produces images of cross-sectional slices of your body like a CT scanner. It can also make images of slices that are parallel to the length of your body.
• Positron emission tomography (PET) scan - Cancer cells use glucose (sugar) more quickly than most other body organs. During a PET scan, the doctor injects a small amount of glucose that has a radioactive atom into your arm. A special camera in the PET machine can detect the radioactivity. PET scans are useful for finding out whether the cancer has metastasized to the lymph nodes or other parts of the body.
• Ultrasound - A probe (transponder) aims sound waves at your head and neck. A computer translates the echo pattern of these sound waves into an image (sonogram) on a monitor. The echoes of healthy tissues and tumors are different. This test is used to find out whether the cancer has metastasized to the liver or lymph nodes.
• X-rays - X-rays are pictures of areas inside your body. Your doctor might order x-rays of your head, neck, and chest. Panorex is a new x-ray procedure that can be useful in diagnosing cancers of the head and neck.
  
  • Panorex - A rotating, panoramic x-ray is taken of your mouth and jaws.

This content has been reviewed and approved by Myo Thant, MD.