Laryngeal and hypopharyngeal cancers are usually found when a person has signs or symptoms. If cancer is suspected, tests will be necessary to confirm the diagnosis. The diagnosis in people who do not have symptoms occurs rarely and is usually accidental (due to tests that are done since other health problems exist).
Studies and tests for laryngeal or hypopharyngeal cáncer
If you have signs or symptoms that may suggest that you have laryngeal or hypopharyngeal cancer, your doctor will recommend one or more studies or tests.
Medical history and physical examination
Your doctor will ask about your symptoms, possible risk factors, family history and other diseases. A thorough physical examination can help to discover any possible signs of cancer or other illness. In particular, your doctor will pay close attention to your head and neck, and will look for abnormal areas in your mouth or throat, as well as enlarged lymph nodes in your neck.
Exam by a specialist
If your doctor suspects laryngeal or hypopharyngeal cancer, he or she will be recommend to see a specialist in ear, nose, and throat diseases, known as an otolaryngologist, who will do a more thorough examination of the head and neck area. This will include an examination of the larynx and hypopharynx, known as laryngoscopy, which can be done in two ways:
Direct (Flexible) Laryngoscopy: For this study, the doctor inserts a fiber optic laryngoscope (a thin flexible tube that has a light source) through your mouth or nose to look at the larynx and adjacent areas.
Indirect Laryngoscopy: In this study, doctors use small, special mirrors to look at the larynx and adjacent areas.
Both types of studies can be done in the doctor’s office. For any type of study, the doctor may use an aerosol in order to numb the back of your throat to facilitate the study.
Patients with laryngeal or hypopharyngeal cancers may also be at increased risk for other cancers in the head and neck region. For this reason, the nasopharynx (part of the throat behind the nose), mouth, tongue and neck are also carefully checked for any signs of cancer.
Panendoscopy
Panendoscopy is a procedure that combines laryngoscopy, esophagoscopy, and (sometimes) bronchoscopy. This allows the physician to examine Completely the entire area around the larynx and the hypopharynx, including the esophagus and trachea.
This study is usually done in the surgery room while you are under general anesthesia (asleep). The doctor uses a rigid laryngoscope to look for tumors in the larynx and the hypopharynx. Other parts of the mouth, nose, and throat are also examined. The doctor may also use an endoscope to look at the esophagus or a bronchoscope to examine the trachea.
The doctor will look at these areas through the endoscope to find out if there is any tumor, and to determine how large it is, and know how far it has spread to the surrounding areas. It is also possible for the physician to take small tissue samples (biopsy) from any tumor or other abnormal areas using instruments that are operated through the endoscope.
Biopsies for diagnosing laryngeal and hypopharyngeal cancers
In a biopsy, the doctor removes a tissue sample for examination under a microscope. It is the only way to confirm the diagnosis of laryngeal or hypopharyngeal cancer. There are different types of biopsies.
Endoscopic biopsy
The larynx and hypopharynx are located deep in the neck. Therefore, extracting samples from the larynx or hypopharynx for biopsies can be complex. Biopsies of these areas are performed in the surgery room while you are under general anesthesia (deep asleep), and not in the doctor’s office. The surgeon manipulates special instruments through a rigid laryngoscope (or other type of endoscope) to extract small tissue samples.
Fine needle aspiration biopsy (FNA)
This type of biopsy is not used to extract samples into the larynx or hypopharynx, but can be performed to find the cause of an enlarged lymph node in the neck. To obtain cells for a biopsy, a thin, hollow needle is inserted into the mass (or tumor) through the skin. The samples are then observed with a microscope. If cancer is found through FNA, the pathologist (a doctor who examines the samples under a microscope) can often indicate the type of cancer. If it appears that the cancer cells may come from the larynx or hypopharynx, an endoscopic examination and a biopsy of these areas will also be necessary.
In case that the FNA does not find cancer, this only means that no cancer was found in that lymph node. Cancer can still be present in other places. If you have symptoms that could be caused by laryngeal or hypopharyngeal cancer, other procedures may still be needed to find the cause of the symptoms.
FNA biopsies may also be useful in some patients who are known to have laryngeal or hypopharyngeal cancer. If the person has a lump in the neck, an FNA can help determine if the mass is due to the spread of the cancer. Finally, FNA can be used in patients whose cancer has been treated with surgery and / or radiotherapy to help determine if a mass of the neck in the treated area is scar tissue or if it is a returning cancer (recurrence).
Image Studies
Imaging studies use X-rays, magnetic fields, or radioactive substances to get pictures from inside the body. These studies are not used to diagnose laryngeal or hypopharyngeal cancers, but can be done for a number of reasons, both before and after the cancer diagnosis. These reasons include:
- Help find a tumor if one is suspected.
- Know how far the cancer has spread.
- Help determine if treatment has been effective.
- Detect possible signs of cancer that recur after treatment.
CT scan
Computed tomography (CT or CAT scan) uses x-rays to produce detailed cross-sectional images of your body. Instead of taking a photograph, as conventional radiography does it, a CT scan takes many photographs of the part of your body that is studied while rotating around it. Then, a computer combines these images into an image of a section of your body. Unlike regular X-rays, CTs create images with details of soft tissues and organs in the body.
This study may help your doctor determine the size of the tumor if it is spreading to nearby tissues or if it has spread to the lymph nodes of the neck. It can also be done to determine if there is cancer spread in the lungs.
The computerized tomograph that is used for this study consists of a ring similar to a large donut, with a stretcher narrow bed that is in the central opening. You will have to lie still on the bed while the test is being performed. CT scans take longer than conventional x-rays, and you may feel a bit confined by the ring while taking pictures.
Before the study, you may be asked to drink approximately 1 to 2 pints of an oral contrast. This helps to delineate the digestive tract, so that certain areas can not be confused with tumors. You may also be given an intravenous line by injecting a different class of contrast dye (IV contrast) to help you better delineate other structures in your body. Some people are allergic to dye and have hives, a flushing sensation or, rarely, more serious reactions such as difficulty breathing and low blood pressure. Be sure to tell your doctor if you are allergic to anything or if you have ever had a reaction to any X-ray contrast material.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) uses radio waves and powerful magnets instead of X-rays. The energy of the radio waves is absorbed and then released into a pattern formed by the type of tissue and certain diseases . A computer translates the pattern into a very detailed image of the parts of your body. Contrast material can be injected just like CT exams, but it is done less often.
Because it provides a detailed picture, an MRI may be done to determine if there is cancer spread in the neck. This study can be very useful for examining other areas of the body.
The procedure for MRI is a little more uncomfortable than the CT study. First, they take more time, often up to an hour. Second, you should remain lying inside a narrow tube, which could be confining and may bother people who suffer from claustrophobia (fear of enclosed places). Sometimes, newer and more open MRI machines can help people who face this fear, if necessary. However, in some cases the images may not be as sharp. MRI machines produce humming and clicking noises so that some centers provide hearing aids to help block these noises.
Study with barium
Often, this is the first study if a person has a swallowing problem. For this study, you drink a thick, limestone fluid called barium that covers the walls of the throat and esophagus. As you swallow the fluid, a series of x-rays photographs of the throat and esophagus are taken. Barium may help show abnormal areas in the throat.
Chest x-ray
An x-ray of the chest may be done to determine if the cancer has spread to the lungs. If any suspicious spot is seen on the chest x-ray, a chest CT scan may be needed to get a more detailed picture.
Positron emission tomography
For the positron emission tomography (PET), a form of radioactive sugar (known as fluordesoxyglucose or FDG) is injected into the blood. The amount of radioactivity used is very low. Cancer cells grow rapidly in the body, so they absorb large amounts of radioactive sugar. After about an hour, you will be placed on the PET machine bed. You will lie down for about 30 minutes while a special camera creates a photograph of areas where the radioactivity is in the body. The image is not very detailed, as in CT or MRI, but provides useful information about your entire body.
PET can be done to examine possible areas of cancer spread, especially if there is a good chance that the cancer will be more advanced. This study may also be used to help to determine if a suspicious area in another imaging study is cancer or not.
Some newer machines can make one PET and one CT at a time (PET / CT scan). This allows the physician to compare the areas of higher radioactivity in the PET with the more detailed appearance of that area in the CT.
Other tests
For people diagnosed with laryngeal or hypopharyngeal cancer, other types of tests may be performed as part of an evaluation. These tests are not used to diagnose cancer, but can be performed to determine if a person is healthy enough to receive other treatments, such as surgery or chemotherapy.
Blood tests are often performed to evaluate the function of the liver and kidneys, as well as to help to assess general health of the patient before receiving treatment. Blood tests are also needed if you are receiving chemo as it can affect the blood cell levels in your body.
If you plan to have surgery, you may also have an electrocardiogram to make sure your heart is working well. Some people who undergo surgery may also need tests to evaluate their lung function. These are known as lung function tests.