How are laryngeal and hypopharyngeal cancers found?
Screening refers to testing for diseases like cancer in people without any symptoms. Screening tests may find some types of cancer early, when treatment is most likely to work best. But for now there is no simple screening test for laryngeal and hypopharyngeal cancers.
Still, many of these cancers can be found early — when they are small and have not spread. They often cause symptoms, such as voice changes, which are described below.
Signs and symptoms of laryngeal and hypopharyngeal cancer
Laryngeal and hypopharyngeal cancers are usually found because of signs or symptoms a person is having. Tests will be needed to confirm whether cancer is causing the symptoms.
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 the cancer being found at a very early stage. People who have voice changes (like hoarseness) that do not get better within 2 weeks should see their doctor right away.
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.
Cancers that start above or below the vocal cords are often found at later stages and may cause other problems.
Talk to your doctor if you have any of these symptoms:
- Sore throat that doesn’t go away
- Constant coughing
- Pain when swallowing
- Trouble swallowing
- Ear pain
- Trouble breathing
- Weight loss
- Lump or mass in the neck
Many of these symptoms are more likely to be caused by something other than laryngeal or hypopharyngeal cancer. Still, if you have any of these symptoms, it is very important to have them checked by a doctor.
Exams to look for laryngeal or hypopharyngeal cancer
History and physical exam
If there is any reason to suspect cancer, the first step is for the doctor to gather facts about your health, symptoms, risk factors, and family history. You will then have a physical exam. Your doctor will look closely for abnormal areas in your mouth or throat, as well as enlarged lymph nodes in your neck.
Head and neck exam
If you might have cancer of the larynx or hypopharynx, your doctor will refer you to an expert in diseases of the ear, nose, and throat (called an ENT doctor, an otolaryngologist, or a head and neck surgeon). You will need to have a careful exam of your mouth, head, and neck area by the ENT doctor. The larynx and hypopharynx are deep inside the neck and cannot be seen on a regular exam. The doctor will look at these areas with mirrors or a special fiber optic scope. This thin, flexible, lighted tube will be put through your mouth or nose and moved down to your throat. It helps the doctor to see these areas. The doctor may spray the back of your throat with numbing medicine to help make the exam easier.
If the doctor suspects you have cancer in the head and neck he or she will do a complete exam of this area. This exam is done in the operating room after you are given drugs to make you sleep (general anesthesia). The surgeon looks at the entire area through different scopes and may take samples of tissue (biopsies) to be looked at under a microscope. Biopsy is discussed below.
Biopsies for laryngeal and hypopharyngeal cancers
A biopsy is a test that involves taking a sample of tissue to see if it contains cancer cells. It is the only sure way to know that a growth is cancer. Some biopsies are done in the operating room with the patient asleep. Others can be done in the doctor’s office.
The larynx and hypopharynx are found deep inside the neck, so biopsies of these places are not done in the doctor’s office. They are done in the operating room while you are under general anesthesia (asleep). The surgeon uses special instruments through the scope to remove small tissue samples.
Fine needle aspiration (FNA) biopsy
FNA is not used to biopsy the larynx or hypopharynx. But it may be done to find the cause of an enlarged lymph node in the neck. For this type of biopsy, a thin (fine) needle is placed into the tumor to remove cells. The cells are looked at under a microscope to see whether the swelling is caused by something like an infection, or if it is cancer.
FNA may also be used in patients whose cancer has been treated by surgery or radiation, to help find out if a neck mass in the treated area is scar tissue or if it is a return (recurrence) of the cancer.
Imaging tests may be useful in finding a tumor or in figuring out how far a cancer has spread.
CT (computed tomography) scan
These scans (also call CAT scans) use x-rays to take a series of pictures of the body from many angles. A computer combines the pictures to form a detailed image. This test can help your doctor learn the size of the tumor and whether it has spread to the lymph nodes, to other nearby areas, or to the lungs.
A CT scanner has been described as a large donut, with a narrow table in the middle “hole.” You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.
You may also have an IV (intravenous) line through which a contrast “dye” is injected. You may be asked to drink 1 to 2 pints of a liquid called “oral contrast” before any pictures are taken. This helps outline your organs so that they are not mistaken for tumors.
MRI (magnetic resonance imaging)
Like a CT scan, an MRI displays a detailed cross-sectional picture of the body. But the MRI uses radio waves and strong magnets instead of x-rays. MRI scans take longer than CT scans — often up to an hour. Also, you are placed in a narrow tube which can upset some people. Newer, open MRI machines can help with this, if needed. A contrast dye might be injected just as with CT scans.
MRI scans are very useful to look for spread of cancer in the neck. They are sometimes more helpful than CT scans for other places in the body, too.
This is a series of x-rays taken while you swallow a liquid with barium in it. Barium coats the inside surface of the throat and helps create a good picture. This test helps to see how your throat looks as you swallow. This is often the first test done if someone is having a problem with swallowing.
A chest x-ray may be done to see if the cancer has spread to the lungs. If anything not normal is seen on the chest x-ray, a CT scan of the chest may be needed to get a more detailed picture.
PET (positron emission tomography) scan
PET scans use a slightly radioactive form of sugar. The sugar is injected into a vein and after a certain amount of time cancer cells in the body absorb large amounts of the sugar. A special camera can then find where the sugar has collected.
Your doctor can use this test to see whether the cancer has spread to lymph nodes or other places. It can also be used to help tell if abnormal area seen on another imaging test is cancer or not. Newer machines combine CT and PET scans to even better pinpoint the tumor.
Other types of tests may be done as part of a workup if a person has laryngeal or hypopharyngeal cancer. These tests are not used to find the cancer, but they may be done to see if a person is healthy enough for other treatments, such as surgery or chemotherapy (chemo).
Blood may be drawn to check liver and kidney function, as well as to help find out about your overall health before treatment. Blood tests are also needed if you are getting chemo 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 working well. Some people having surgery also may need tests of their lung function. These are known as pulmonary function tests (PFTs).
Last Medical Review: 01/22/2013
Last Revised: 01/22/2013