Signs and symptoms

Laryngeal cancers that form on the vocal cords (glottis) often cause hoarseness. This can lead to them being found at a very early stage. Anyone who has voice changes (like hoarseness) that does not improve within 2 weeks should see their health care provider right away. For a complete evaluation, they may need to be referred to an ear, nose, and throat (ENT) specialist These doctors are also known as otolaryngologists or as head and neck surgeons.

A complete head and neck exam that includes viewing of the vocal cords and larynx will need to be done. This can be done with mirrors, but is more often performed using a special tool (the laryngoscope) by an ENT doctor.

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 generally cause hoarseness or other such clear symptoms, and are more often discovered at later stages.

Symptoms of these cancers may include:

• a sore throat that won’t go away
• constant coughing
• pain when swallowing
• difficulty swallowing
• ear pain that won’t go away
• difficulty breathing
• weight loss
• hoarseness that lasts more than 2 weeks
• a lump or mass in the neck

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.

Exams and procedures for evaluating suspected laryngeal or hypopharyngeal cancer

If you have signs or symptoms that suggest a cancer of the larynx or hypopharynx might be present, your doctor will recommend 1 or more of the following tests or procedures.

Complete medical history and physical exam

The first step in any medical evaluation is for your doctor to gather information about symptoms, risk factors, and family history and medical conditions. A thorough physical exam will help uncover any signs of possible cancer or other diseases. In particular, your doctor will look for any signs that the cancer has spread, such as enlarged lymph nodes in your neck.

Blood tests

Blood tests do not help diagnose laryngeal or hypopharyngeal cancer. Still, blood may be drawn to check liver and kidney function, as well as look for blood diseases to help evaluate a patient's overall medical condition.

Consultation with a specialist

If your doctor suspects a cancer of the larynx or hypopharynx, you will be referred to an otolaryngologist (a specialist in diseases of the ear, nose, and throat).

Complete head and neck exam

Anyone suspected of having a laryngeal or hypopharyngeal cancer needs to have a thorough physical exam with special attention to the head and neck area. In order to examine the larynx and hypopharynx, special mirrors or a fiber-optic laryngoscope is needed. A fiberoptic laryngoscope is a thin, flexible, lighted tube that can be inserted through the mouth or nose to look at these areas. When the fiberoptic laryngoscope is used to look at the larynx it is called direct laryngoscopy. When mirrors are used, it is called indirect laryngoscopy. Both procedures can be done in the doctor's office to help find the cause of symptoms, such as hoarseness or throat pain.

Because patients with laryngeal or hypopharyngeal cancer have a higher risk for other cancers in the head and neck region, the nasopharynx (area behind the nose), mouth, tongue, and the neck are carefully looked at and felt for any evidence of cancer.

Panendoscopy

Panendoscopy is a procedure that combines laryngoscopy, esophagoscopy, and (at times) bronchoscopy. This allows the doctor to thoroughly examine the entire area containing the larynx and hypopharynx, including the esophagus and trachea (windpipe). This procedure is usually done in an operating room on an outpatient basis. The patient is given general anesthesia so that they are asleep for the procedure. The patient is examined for tumors in the larynx and hypopharynx, as well as other parts of the mouth, nose, and throat. If a tumor is found that is large or seems likely to spread, the doctor may also need to look into the esophagus or the trachea (windpipe).

Your doctor will look at these areas through the scope to find any tumor, see how large it is, and see how far it may have spread to surrounding areas. A small piece of tissue from the tumor or other abnormal area may be removed so that it can be looked at under the microscope to see if cancer is present. This is called a biopsy, and it can be performed with a special instrument operated through the scope. Most often, biopsies of the hypopharynx or larynx are performed in the operating room under general anesthesia.

Imaging tests

Once a tumor is detected by examination, imaging studies may be useful to determine the extent of spread.

Computed tomography scan

The computed tomography (CT) scan (also known as a CAT scan) is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image that represents a "slice" of your body. The machine takes pictures of multiple slices of the part of your body being studied. This test can help your doctor determine the size of the tumor, whether it is growing into nearby tissues, and if it has spread to lymph nodes in the neck.

Depending on the areas being scanned, 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 intestine 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 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 ever had a reaction to any contrast material used for x-rays.

CT scans take longer than regular x-rays, and you need to lie still on a table while they are being done. But the newest machines only take a few minutes, so your scan might be pleasantly short.

Magnetic resonance imaging

Magnetic resonance imaging (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. Not only does this produce cross-sectional slices of the body like a CT scanner, it also produces slices that are parallel with the length of your body.

A contrast material may be injected just as with CT scans. This is not the same contrast that is used for CT scans, so being allergic to one does not mean that you are allergic to the other type. MRI scans are very useful in providing pictures of the brain and spinal cord. They are sometimes more helpful than CT scans for other areas of the body as well.

MRI scans take longer than CT scans -- often up to an hour. Also, you are placed inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces (claustrophobia). Newer, "open" MRI machines can help with this if needed. The machine makes a thumping noise, and some places will provide headphones with music to block out the noise.

Barium swallow

This is a series of x-rays taken while the patient swallows a liquid containing barium. Barium can be seen on the x-rays as it coats the throat. It is useful to see how your throat looks as you swallow. It also shows what your hypopharynx looks like and how it functions.

Chest x-ray

A chest x-ray may be done to see if cancer is present in the lungs. Since smoking causes lung cancer as well as laryngeal and hypopharyngeal cancers, people with these latter 2 cancers have a high risk of lung cancer. Also, laryngeal and hypopharyngeal cancers can spread to the lungs. If any suspicious spots are noted on the chest x-ray, a CT scan of the chest may be needed.

Positron emission tomography

In a positron emission tomography (PET) scan, radioactive glucose (sugar) is injected into the patient's vein to look for cancer cells. Cancers use glucose (sugar) at a higher rate than normal tissues, so the radioactivity will tend to concentrate in the cancer. A scanner can spot the radioactive deposits. This test can be helpful for spotting small collections of cancer cells. It may also help tell if a tumor is benign or malignant. Your doctor may use this test to see if the cancer has spread to lymph nodes or elsewhere. PET scans can be used instead of several different x-rays because they can scan your whole body. Some machines combine a CT scan with a PET scan to even better pinpoint the tumor.

For more information on these tests, see our document, Imaging (Radiology) Tests.

Types of biopsies used to diagnose laryngeal and hypopharyngeal cancers

A biopsy is a procedure that removes a sample of tissue for examination under the microscope. It is the only way to confirm the diagnosis of cancer.

Endoscopic biopsy

The larynx and hypopharynx are located deep inside the neck, so biopsies of these areas are not done in the doctor's office. These are performed in the operating room while you are under general anesthesia (asleep). The surgeon uses special instruments through the endoscope to remove small tissue samples.

Fine needle aspiration biopsy

For a fine needle aspiration (FNA) biopsy, a thin needle is placed into the mass (or tumor) to obtain cells for a biopsy. The cells are looked at under a microscope to see if the swelling is caused by something benign (like an infection), or if it is cancer. This is often done to find the cause of an enlarged lymph node. FNA is not used to biopsy the larynx or hypopharynx.

If the FNA finds cancer, the pathologist (a doctor specializing in diagnosing disease by examining tissues with a microscope) examining the specimen 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, these areas are examined also.

FNA biopsies may be useful in other situations as well. If a patient with laryngeal or hypopharyngeal cancer has a neck mass that can be felt, an FNA can help determine if the mass is due to the 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 find out if a new neck mass in the treated area is scar tissue, or to find out if your cancer has come back (recurred).

If FNA is used to look at a lymph node and the results are benign, 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 suggesting a laryngeal or hypopharyngeal cancer, you will need other procedures to find the cause of the symptoms.

Last Medical Review: 05/07/2009
Last Revised: 05/07/2009