Tests for Laryngeal and Hypopharyngeal Cancers

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. Getting a diagnosis of laryngeal or hyopharyngeal cancer when you haven't had symptoms is rare. When it does happen, the cancer is usually found because of tests done to check other medical problems.

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 need to do exams or tests to be sure.

Medical history and physical exam

Your doctor will ask you about your symptoms, possible risk factors, family history, and other medical problems. A physical exam can help find signs of possible cancer or other diseases. Your doctor will pay very close attention to your head and neck, looking for abnormal areas in your mouth or throat, as well as swollen lymph nodes in your neck.

Exam by a specialist

If your doctor suspects a cancer of the larynx or hypopharynx, you will be referred to an ear, nose, and throat (ENT) doctor, also called an otolaryngologist. This doctor will do a more complete exam of your head and neck. This will include an inside look at the larynx and hypopharynx, known as laryngoscopy, which can be done in 2 ways:

  • Direct (flexible) laryngoscopy: To do this, the doctor puts a fiber-optic laryngoscope (a thin, flexible, lighted tube) in through your mouth or nose to look at your larynx and nearby areas. Biopsies can be done throught the scope (covered below).
  • Indirect laryngoscopy: The doctor uses special small mirrors that are put into your mouth to look at your 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.

People 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 also carefully looked at and checked 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 (swallowing tube) and trachea (windpipe).

This exam is usually done in an operating room while you are under general anesthesia. (This means drugs are used to put you into a deep sleep.) 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. The doctor may also use an endoscope 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 have spread to nearby areas. The doctor might also take out (biopsy) small tissue samples from any tumors or other changed areas using special tools put in 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's the only way to be sure of a diagnosis of laryngeal or hypopharyngeal cancer. There are many different types of biopsies. See Testing Biopsy and Cytology Specimens for Cancer to learn more about different kinds of biopsies, what the doctor looks for, how the tissue is tested to diagnosis cancer, and what the results will tell you.

Endoscopic biopsy

The larynx and hypopharynx are deep inside the neck, so taking out samples for biopsy can be complex. Biopsies of these areas are done in the operating room while you are under general anesthesia (asleep). The surgeon uses special instruments through an endoscope to remove small pieces of tissue.

Fine needle aspiration (FNA) biopsy

This type of biopsy isn't used to remove samples in the larynx or hypopharynx, but it may be done to find the cause of an swollen lymph node in the neck. A thin, hollow needle is put through the skin into the mass (or tumor) to get cells for a biopsy. The cells are then looked at under a microscope. If the FNA finds cancer, the pathologist (the doctor examining the samples) can often tell what type of cancer it is. If the cancer cells look like they might have come from the larynx or hypopharynx, an endoscopic exam and biopsy of these areas will be needed.

If the FNA doesn't find cancer, it only means that cancer was not found in that lymph node. There could still be cancer in other places. If you're having symptoms that might be from a laryngeal or hypopharyngeal cancer, you could still need other tests 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 person has a lump in the neck, an FNA can show if the mass is due to spread of the cancer. FNA may also be used in patients whose cancer has been treated by surgery and/or radiation therapy, to help find out if a neck mass in the treated area is scar tissue or if it's a return (recurrence) of the cancer.

Imaging tests

Imaging tests use x-rays, magnetic fields, 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're done for a number of reasons after a cancer diagnosis, such as:

  • To help look for a tumor if one is suspected
  • To learn how far cancer may have spread
  • To help determine if treatment is working
  • To look for signs that the cancer has come back after treatment

Computed tomography (CT) scan

The CT scan (also known as a CAT scan) uses x-rays to make 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 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, see if it's growing into nearby tissues, and find out if it has spread to lymph nodes in your neck. It may also be done to look for the spread of cancer to your lungs.

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.

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 be very useful in looking at other areas of the body, too.

Barium swallow

This is often the first test done if someone is having a problem with swallowing. For this test, you drink a chalky liquid called barium to coat the walls of the throat and esophagus (swallowing tube). A series of x-rays of the throat and esophagus is taken as you swallow. The barium can help show problems in the throat.

Chest x-ray

A chest x-ray may be done to see if the cancer has spread to the lungs. If any suspicious spots are seen 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 grow quickly, so they absorb large amounts of the radioactive sugar. After about an hour, you will be moved onto a table in the PET scanner. A special camera creates a picture of areas of radioactivity in your body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body. Some machines can do 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 pictures of that area on the CT.

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 can also be used to help tell if a suspicious area seen on another imaging test is cancer or not.

Other tests

Other tests may be done as part of a workup in people 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 certain treatments, like surgery or chemotherapy.

Blood tests are often done to see how well your liver and kidneys are working, and to help evaluate your overall health before treatment. Blood tests are also needed if you are getting chemo because it can affect the levels of blood cells in your body.

If surgery is planned, you might also get 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).

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: November 27, 2017 Last Revised: November 27, 2017

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