Diagnosis
If you have any symptoms of laryngeal cancer, your doctor will conduct a physical examination and ask you questions about your general health, lifestyle, and family history. It is likely that it will be necessary to see a physician who specializes in diseases of the head and neck. These physicians are trained to do specialized examinations of the head and neck and to diagnose cancer. This specialist, called either an Otolaryngologist, Head and Neck Surgeon, or an Ear, Nose and Throat (ENT) physician, will thoroughly examine the mouth, tongue, throat, and lymph nodes, and may perform the following procedures if laryngeal cancer is suspected.
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Laryngoscopy
• Indirect Laryngoscopy: a doctor uses a small mirror inserted into the mouth and a powerful light from a head lamp to examine the back of the mouth and the top of the larynx. This is more of a historical examination and has been for the most part replaced by more accurate endoscopic examinations.
• Flexible Endoscopic Laryngoscopy: a doctor uses a thin flexible tube with a camera and light on the end, called a flexible endoscope. The endoscope is inserted into the nose to examine the larynx and surrounding structures. Sometimes video or images can be saved for future reference.
• Rigid Endoscopic Laryngoscopy: a doctor uses a thin rigid metal tube with an angled camera and light on the end, called a rigid endoscope. The endoscope is inserted into the mouth and while resting on the tongue can examine the larynx and surrounding structures. Sometimes video or images can be saved for future reference.
• Direct Laryngoscopy: a doctor uses rigid tubed instruments to directly (no endoscope required) examine the throat while the patient is asleep with general anesthesia, as demonstrated in the illustration below. Usually, a direct laryngoscopy is performed in an operating room.
Biopsy
If the diagnostic tests indicate the presence of a lesion or mass, a biopsy will generally be recommended to test the area of concern for the presence of cancer. A biopsy is a procedure in which the doctor removes a tissue sample and a pathologist examines it under a microscope to determine if it contains cancer cells. A biopsy is the only way to be certain of a cancer diagnosis. The doctor may recommend the following types of biopsy, depending on the location and extent of the tumor:
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Endoscopic Biopsy
If the doctor notices anything suspicious during indirect laryngoscopy or direct laryngoscopy endoscopy, a special tool may be attached to the endoscope and used to remove a tissue sample for a biopsy. This is often performed in the operating room under general anesthesia, but sometimes can be performed in the office without general anesthesia.
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Fine Needle Aspiration (FNA) Biopsy
Usually to evaluate a suspicious lump or growth in the neck, an FNA is performed by inserting a fine needle connected to a syringe into the area of concern to extract a tissue sample. After administering local anesthesia (numbing medication), the needle is passed through the skin and into the area of concern. The aspirated sample is then examined in a laboratory to determine if it contains cancer cells.
Imaging Tests
Imaging produces pictures of the internal structures of the body allowing the doctor to determine if an abnormality is present. Many times, imaging tests can also reveal the size, location, and extent of a tumor. Imaging tests may also be able to detect the spread of cancer into nearby structures. Your doctor may request the following types of Imaging Tests:
Barium Swallow
During a barium swallow study, the patient drinks a chalky liquid called barium and undergoes a series of X-rays. This is a common evaluation for patients with symptoms of difficulty swallowing.
X-Rays
A chest X-ray may be requested to determine if the cancer has spread to the lungs. This test can be useful adjunct to the tests needed to evaluate the tumors of laryngeal cancer. X-ray examinations are not used in the direct evaluation of laryngeal cancer.
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Computed Tomography (CT) Scan
A CT scanner rotates around your body using X-ray energy to take pictures. CT scan results produce detailed cross-sectional images of the body's internal structures. It allows doctors to pinpoint the exact location of the tumor and check for cancer spread. Sometimes, a CT scan with IV contrast will be requested. If so, the radiology technicians or nurses will use a small amount of iodine-related medication injected into the veins to make tumors and growths more visible.
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Magnetic Resonance Imaging (MRI)
MRI uses magnetic energy produced by a powerful electrical current to create images of the body's internal structures. The energy waves are translated by a computer to show cross-sectional images of the body. This examination is frequently requested with IV contrast where non-iodine medication is injected into the veins to make tumors more visible.
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Positron Emission Tomography (PET) Scan
A PET scan is a useful test to evaluate the activity of areas of the body. During a PET scan, radiology technicians or nurses will use a slightly radioactive substance, usually sugar, injected intravenously into the patient's bloodstream. As cancer uses more than the typical amount of sugar, this substance collects in cancer cells in the patient's body and can show as a "positive" finding on the PET scan. Many times, PET scans are performed in combination with a CT scan (see above) and are therefore called PET/CT scans.
