Tests for Laryngeal and Hypopharyngeal Cancer

A CT scan uses x-rays to make detailed cross-sectional images of your body. Instead of taking 1 or 2 pictures like a regular x-ray, a CT scanner takes many pictures. A computer combines these pictures to show a slice of the part of your body being studied.

An MRI scan also shows detailed images of soft tissues in your body. MRI scans use radio waves and strong magnets instead of x-rays. To get clear pictures, a contrast material called gadolinium might be injected into one of your veins before the scan.

Doctors often use MRI to try to find out if a cancer has grown into nearby structures, especially the soft tissue and nerves. An MRI scan might be done if you have a lot of dental fillings that could distort the pictures in a CT scan.

For a PET scan, a slightly radioactive form of sugar known as fluorodeoxyglucose (FDG) is injected into your blood. It collects mainly in cancer cells because these cells tend to take up more sugar (glucose) than normal cells.

PET/CT scan

A PET scan is often combined with a CT scan using a special machine that can do both at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with a more detailed picture on the CT scan. A PET/CT scan can be used to look at most organs in the body, except for the brain and spinal cord.

This is the type of PET scan most often used for people with cancer. Doctors use PET/CT scans to see if and where a cancer has spread. This is known as staging.

A cine esophagogram is a specialized imaging test used to evaluate swallowing function in people diagnosed with head and neck cancers.

For this test, you drink a liquid containing barium, which coats the walls of your throat and esophagus. Your esophagus is the tube that connects your throat to your stomach.

A continuous series of rapid x-ray images captures the swallowing process in motion. This lets your doctor closely observe how well the muscles of your throat and esophagus are working together. The test is particularly useful for people with laryngeal or hypopharyngeal cancers, who may have trouble swallowing because of the cancer or its treatment.

An ultrasound uses sound waves and their echoes to create images of the inside of your body. A small microphone-like instrument called a transducer gives off sound waves and picks up the echoes as they bounce off organs. The echoes are converted by a computer into an image on a screen.

During a neck ultrasound, a transducer is moved along the skin over your neck. It can help find swollen or abnormal lymph nodes, which can be a sign of cancer. The ultrasound can help guide a needle into the abnormal lymph node for an FNA biopsy. It might also be used after treatment to look for signs of cancer coming back (recurrence).

Small mirrors on long, thin handles are used to look at your larynx (voice box). The doctor may spray numbing medicine on the back of your throat to help make the exam easier.

A flexible fiber-optic scope called an endoscope is put in through your mouth or nose. The doctor uses this to look at your larynx and nearby areas that cannot easily be seen with mirrors. It can also help them get a clearer look at areas of change that were seen with the mirrors during an indirect laryngoscopy.

The doctor applies numbing medicine to your nose to help make the exam easier. They might also use a special tool to get a small sample from your throat for testing. This is called a biopsy.

A rigid scope called a laryngoscope is put in through your mouth. The doctor uses this to look closely at your larynx, hypopharynx, and nearby areas of your throat.

This test is usually done in an operating room, while you are in a deep sleep under general anesthesia. The scope lets the doctor look for tumors and see how large they are. It also lets them check if any tumors have spread to nearby tissues.

During the procedure, the doctor might use special tools to remove small samples of tissue from tumors or other abnormal areas. This is called a biopsy. The samples are sent to the lab for testing.

You might get an FNA biopsy if you have a suspicious lump in or near your neck. To do this, the doctor puts a needle into the lump to remove fluid that has cells or tiny bits of tissue in it. The needle is thin and hollow. The cells are then looked at in the lab to see if they are cancer cells.

This type of biopsy can show if an enlarged lymph node in your neck is caused by the spread of cancer from somewhere else or by a cancer that started in your lymph nodes (lymphoma).

If you have already been diagnosed with laryngeal or hypopharyngeal cancer and you have enlarged neck lymph nodes, FNA can help doctors learn if the swelling is caused by the spread of the cancer.

The larynx and hypopharynx are deep inside the neck. Taking out samples for a biopsy can be complicated.

Biopsies of these areas are done in the operating room while you are in a deep sleep under general anesthesia. The surgeon uses special instruments through an endoscope to remove small pieces of tissue.

The cancer cells are commonly tested for specific gene and protein changes. These changes might help doctors tell if targeted therapy is an option for treatment.

The cells may be tested to see if they have high numbers of gene changes called microsatellite instability (MSI). Testing might also be done to check for changes in any of the mismatch repair (MMR) genes (MLH1, MSH2, MSH6, and PMS2) or the proteins they encode.

PD-L1 (programmed death ligand 1) is a protein on cancer cells. The presence of PD-L1 guides decisions about whether a person will benefit from certain immunotherapy drugs.

TMB is a measure of the number of gene changes (mutations) inside cancer cells. A high TMB means cancer cells have many gene changes. If laryngeal and hypopharyngeal cancer cells have a high TMB, it is more likely that the body’s immune system will recognize them as abnormal and attack them.

If your tissue is tested and found to have a high TMB (TMB-H), treatment with the immunotherapy drug pembrolizumab (Keytruda) might be an option.