Diagnosing Laryngeal Cancer

• Overview
• Risk Factors
• Signs and Symptoms
• Diagnosis
• Staging
• Treatment Options

Tests that examine the throat and neck are used to help detect laryngeal cancer and find out if the cancer has spread. The following tests and procedures may be used:

• Physical examination: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The doctor may feel for swollen lymph nodes in the neck and look down the throat to check for abnormal areas. A history of the patient’s health habits and past illnesses and treatments will also be considered.
  
  

• Laryngoscopy: A procedure that looks at the larynx and hypopharynx for abnormal areas using an instrument called a laryngoscope (a thin, tube-like instrument with a light and a lens for viewing). A special tool on the laryngoscope may be used to remove samples of tissue.

• Videostroboscopy. This procedure uses fiber-optic video technology that allows the doctor to better see the larynx. It is performed in a similar manner as a laryngoscopy.
  
  

• Endoscopy: A procedure used to look at areas in the throat that cannot be seen with a mirror during the physical exam of the throat. An endoscope (a thin, lighted tube) is inserted through the nose or mouth to check the throat for anything that seems unusual. Tissue samples may be taken for biopsy.
  
  

• Panendoscopy: A procedure that combines laryngoscopy, esophagoscopy, and bronchoscopy. This lets the doctor thoroughly examine the entire area around the larynx and hypopharynx, including the esophagus and trachea. The doctor will use a laryngoscope to look for tumors in the mouth, nose, throat, and voice box. They may also use an endoscope to look into the esophagus or a bronchoscope to look into the trachea. This exam is usually done in an operating room under general anesthesia.
  
  

• Biopsy: If cancer is suspected, a biopsy is performed to remove cells from the larynx so they can be viewed under a microscope. Laryngeal biopsies are usually performed under general anesthesia.
  
  

• Biomarker testing of the tumor: For patients with advanced laryngeal cancer, the oncologist may recommend running lab tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests can help determine the treatment pathway that might be best for you.

Laryngeal Cancer Tumor Grade

If cancer is found while evaluating the biopsied tissue, the pathologist will also determine a “grade” for the cancer. The grade describes how much the cancer cells look like healthy cells when viewed under a microscope. The grade is correlated to how fast the tumor is likely to grow. Tumors with higher grades (called poorly differentiated) tend to grow faster than those with lower grades (well differentiated). Tumors with higher grades are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.

GX: The grade cannot be evaluated

G1: The cells look more like normal tissue (well differentiated)

G2: The cells are moderately differentiated

G3: The cells don’t resemble healthy tissue (poorly differentiated)

Tests to Determine if the Cancer Has Spread Outside of the Larynx

The following imaging tests may be used to determine if and how much laryngeal cancer has spread:

• CT scan (CAT scan): CT or CTA stands for computed tomography, computerized tomography, or computerized axial tomography. This is a procedure that makes a series of detailed pictures of areas inside the body, such as the head, neck, chest, and lymph nodes, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
  
  

• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
  
  

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make detailed pictures of areas inside the body, such as the head, neck, chest, and lymph nodes. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  
  

• Bone scan: A procedure to check if rapidly dividing cells, such as cancer cells, are in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
  
  

• Barium esophagogram: An x-ray of the esophagus. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus, and x-rays are taken.