Laryngeal and hypopharyngeal cancers are usually found because of signs or symptoms a person is having. If cancer is suspected, tests will be needed to confirm the diagnosis. Diagnosis in people without symptoms is rare and usually accidental (because of tests done to check other medical problems).
Signs and symptoms
In most cases, laryngeal and hypopharyngeal cancers are found because of the symptoms they cause. Diagnosis in people without symptoms is rare and usually accidental (because of tests done to check other medical problems).
Hoarseness or voice changes
Laryngeal cancers that form on the vocal cords (glottis) often cause hoarseness or a change in the voice. This can lead to them being found at a very early stage. People who have voice changes (like hoarseness) that do not improve within 2 weeks should see their health care provider right away. For a complete evaluation, they may be referred to an ear, nose, and throat (ENT) specialist. These doctors are also known as otolaryngologists or as head and neck surgeons.
For cancers that don't start on the vocal cords, hoarseness occurs only after these cancers reach a later stage or have spread to the vocal cords. These cancers are sometimes not found until they have spread to the lymph nodes and the patient notices a growing mass in the neck.
Other symptoms
Cancers that start in the area of the larynx above the vocal cords (supraglottis), the area below the vocal cords (subglottis), or the hypopharynx do not usually cause hoarseness or other such clear symptoms, and are therefore more often found at later stages.
Symptoms of these cancers may include:
- A sore throat that does not go away
- Constant coughing
- Pain when swallowing
- Trouble swallowing
- Ear pain
- Trouble breathing
- Weight loss
- A lump or mass in the neck (due to spread of the cancer to nearby lymph nodes)
Having one or more of these symptoms does not mean you have laryngeal or hypopharyngeal cancer. In fact, many of these symptoms are more likely to be caused by other conditions. Still, if you have any of these symptoms, it is very important to have them checked by a doctor so that the cause can be found and treated, if needed.
Exams and tests for laryngeal or hypopharyngeal cancer
If you have signs or symptoms that suggest you might have a cancer of the larynx or hypopharynx, your doctor will recommend one or more of the following exams or tests.
Medical history and physical exam
The first step in any medical evaluation is for your doctor to gather information about your symptoms, risk factors, family history, and other medical conditions. A thorough physical exam can help uncover any signs of possible cancer or other diseases. In particular, your doctor will pay close attention to your head and neck, looking for abnormal areas in your mouth or throat, as well as enlarged lymph nodes in your neck.
Consultation with a specialist
If your doctor suspects a cancer of the larynx or hypopharynx, you will be referred to an otolaryngologist (a doctor who specializes in diseases of the ear, nose, and throat), who will do a more thorough exam of the head and neck area. The specialist will also examine the larynx and hypopharynx (known as laryngoscopy). It can be done in 2 ways:
Direct (flexible) laryngoscopy: For this exam, the doctor inserts a fiber-optic laryngoscope — a thin, flexible, lighted tube — through the mouth or nose to look at the larynx and nearby areas.
Indirect laryngoscopy: In this exam, the doctor uses special small mirrors to view the larynx and nearby areas.
Both types of exams can be done in the doctor's office. For either type of exam, the doctor may spray the back of your throat with numbing medicine to help make the exam easier.
Patients with laryngeal or hypopharyngeal cancer also have a higher risk for other cancers in the head and neck region, so the nasopharynx (part of the throat behind the nose), mouth, tongue, and the neck are carefully looked at and felt for any signs of cancer.
Panendoscopy
Panendoscopy is a procedure that combines laryngoscopy, esophagoscopy, and (at times) bronchoscopy. This lets the doctor thoroughly examine the entire area around the larynx and hypopharynx, including the esophagus and trachea (windpipe).
This exam is usually done in an operating room while you are under general anesthesia (asleep) so that the doctor can thoroughly examine the throat, voice box, and nearby areas. The doctor uses a rigid laryngoscope to look for tumors in the larynx and hypopharynx. Other parts of the mouth, nose, and throat are examined as well. If a tumor is found that is large or seems likely to spread, the doctor may also need to use an esophagoscope to look into the esophagus or a bronchoscope to look into the trachea (windpipe).
Your doctor will look at these areas through the scope(s) to find any tumors, see how large they are, and see how far they may have spread to surrounding areas. A small piece of tissue from any tumors or other abnormal areas may be removed (biopsied) to be looked at under a microscope to see if they contain cancer. Biopsies can be done with special instruments operated through the scopes.
Biopsies to diagnose laryngeal and hypopharyngeal cancers
In a biopsy, the doctor removes a sample of tissue to be looked at under a microscope. It is the only way to confirm the diagnosis of laryngeal or hypopharyngeal cancer.
Endoscopic biopsy
The larynx and hypopharynx are deep inside the neck, so removing samples for biopsy can be complex. Because of this, these biopsies are done in the operating room while you are under general anesthesia (asleep), rather than in a doctor's office. The surgeon uses special instruments through a rigid laryngoscope (or other type of endoscope) to remove small tissue samples.
Fine needle aspiration (FNA) biopsy
For an FNA biopsy, a thin, hollow needle is placed through the skin into a mass (or tumor) to obtain cells for a biopsy. The cells are then looked at under a microscope. FNA is not used to biopsy samples in the larynx or hypopharynx, but it may be done to find the cause of an enlarged lymph node in the neck.
If the FNA finds cancer, the pathologist (doctor examining the samples with a microscope) can often tell what type of cancer it is. If the type of cancer seen is consistent with cancers that begin in the larynx or hypopharynx, an endoscopic exam and biopsy of these areas will be needed as well.
If the FNA does not find cancer, it only means that cancer was not found in that lymph node. Cancer could still be present in other places. If you are having symptoms that may suggest a laryngeal or hypopharyngeal cancer, you may still need other procedures to find the cause of the symptoms.
FNA biopsies may also be useful in some patients already known to have laryngeal or hypopharyngeal cancer. If the patient has a lump in the neck, an FNA can help determine if the mass is due to spread of the cancer. FNA may also be used in patients whose laryngeal or hypopharyngeal cancer has been treated by surgery and/or radiation therapy, to help find out if a new neck mass in the treated area is scar tissue or if it is a return (recurrence) of the cancer.
Imaging tests
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests are not used to diagnose laryngeal or hypopharyngeal cancers, but they may be done for a number of reasons both before and after a cancer diagnosis, including:
- To help look for a tumor if one is suspected
- To learn how far cancer may have spread
- To help determine if treatment has been effective
- To look for possible signs of cancer recurrence after treatment
Computed tomography (CT) scan
The CT scan (also known as a CAT scan) uses x-rays to produce detailed cross-sectional images of your body. Instead of taking one picture like a standard x-ray, a CT scanner takes many pictures of the part of your body being studied as it rotates around you. A computer then combines these pictures into an image of a slice of your body. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues and organs in the body.
This test can help your doctor determine the size of the tumor, if it is growing into nearby tissues, and if it has spread to lymph nodes in the neck. It may also be done to look for spread of cancer to the lungs.
You may be asked to drink 1 to 2 pints of a liquid called "oral contrast" before any pictures are taken. This helps outline the digestive tract so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which a different kind of contrast dye (IV contrast) is injected. This helps better outline other structures in your body. Some people are allergic to the dye and get hives, a flushed feeling, or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell your doctor if you have any allergies or have ever had a reaction to any contrast material used for x-rays.
CT scans take longer than regular x-rays. You will need to lie still on a table while they are being done. During the test, the table slides in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring you have to lie in while the pictures are being taken. Spiral CT (also known as helical CT) is now used in many medical centers. This type of CT scan uses a faster machine that reduces the dose of radiation and yields more detailed pictures.
Magnetic resonance imaging (MRI) scan
MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of your body. A contrast material may be injected just as with CT scans, but it is used less often.
Because it provides a very detailed picture, an MRI scan may be done to look for spread of the cancer in the neck. These scans can also be very useful in looking at other areas of the body as well.
MRI scans are a little more uncomfortable than CT scans. First, they take longer – often up to an hour. Second, you have to lie inside a narrow tube, which is confining and can upset people with claustrophobia (a fear of enclosed spaces). Newer, more open MRI machines can sometimes help with this if needed, although the images may not be as sharp in some cases. MRI machines make buzzing and clicking noises that you may find disturbing. Some centers provide earplugs to help block this noise out.
Barium swallow
In this test, the patient drinks a chalky liquid called barium to coat the walls of the throat and esophagus. A series of x-rays of the throat and esophagus is taken as the patient swallows, which the barium outlines clearly. This test can show abnormalities in the throat as a person swallows. This is often the first test done if someone is having a problem with swallowing.
Chest x-ray
A chest x-ray may be done to see if laryngeal or hypopharyngeal cancer has spread to the lungs. If any suspicious spots are noted on the chest x-ray, a CT scan of the chest may be needed to get a more detailed picture.
Positron emission tomography (PET) scan
For a PET scan, a form of radioactive sugar (known as fluorodeoxyglucose or FDG) is injected into the blood. The amount of radioactivity used is very low. Cancer cells in the body are growing rapidly, so they absorb large amounts of the radioactive sugar. After about an hour, you will be moved onto a table in the PET scanner. You lie on the table for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body.
A PET scan may be used to look for possible areas of cancer spread, especially if there is a good chance that the cancer is more advanced. This test also be used to help tell if a suspicious area seen on another imaging test is cancer or not.
Some newer machines are able to perform both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET with the more detailed appearance of that area on the CT.
For more information on these tests, see our document, Imaging (Radiology) Tests.
Other tests
Other types of tests may be done as part of a workup if a patient has been diagnosed with laryngeal or hypopharyngeal cancer. These tests are not used to diagnose the cancer, but they may be done to see if a person is healthy enough for other treatments, such as surgery or chemotherapy.
Blood tests do not help diagnose laryngeal or hypopharyngeal cancer. Still, blood may be drawn to check liver and kidney function, as well as to help evaluate your overall medical condition before getting treatment. Blood tests are also needed if you are getting chemotherapy because chemo can affect the levels of blood cells in the body.
If surgery is planned, you might also have an electrocardiogram (EKG) to make sure your heart is functioning well. Some people having surgery also may need tests of their lung function. These are known as pulmonary function tests (PFTs).
Feedback
