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 may 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 an Ear, Nose, & Throat doctor (ENT), will thoroughly examine the mouth, tongue, throat, and lymph nodes, and may perform the following procedures if laryngeal cancer is suspected.
In a fiberoptic laryngoscopy, the doctor uses a laryngoscope (a thin tube with a camera and light on the end) inserted into the mouth or throat to examine the larynx and nearby structures. In a direct rigid laryngoscopy, the doctor uses a metal tube to examine the throat while a patient is asleep in the operating room. In an ‘indirect’ laryngoscopy, the doctor uses small mirrors 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 illustration represents a direct laryngoscopy in the operating room.
The doctor uses an endoscope (a thin tube with a camera and light on the end) to examine the larynx, wind pipe, and esophagus. This procedure allows the doctor to examine the entire area around the larynx, and determine if the tumor has invaded any nearby tissue or structures.
If any of these diagnostic tests indicate the presence of cancer, the doctor will conduct a biopsy to be certain. 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:
If the doctor notices anything suspicious during a laryngoscopy or upper 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.
Fine Needle Aspiration (FNA) Biopsy
The doctor uses a fine needle connected to a syringe to extract a tissue sample from a tumor or suspicious area. The needle is passed through the skin and into the tumor. The tissue sample is then examined in a laboratory to determine if it contains cancer cells. The doctor may also perform this type of biopsy to determine if swollen lymph nodes are related to the spread of cancer or another cause.
Imaging tests produce pictures of the body and allow the doctor to determine if a tumor is present, as well as the size, location, and extent of the tumor. Imaging tests can also detect the spread of cancer into nearby structures.
The doctor may recommend this procedure if the patient has trouble swallowing. For this test, the patient drinks a chalky liquid called barium and undergoes a series of X-rays. The barium coats the lining of the throat and esophagus and clearly outlines it on X-rays, making it easy for the doctor to identify any abnormalities.
The doctor may recommend a chest X-ray to determine if the cancer has spread to the lungs or other organs in the chest.
Computed Tomography (CT) Scan
If symptoms or examination raise concerns for the presence of cancer, your doctor may order a CT scan. A CT scanner rotates around your body taking pictures, and produces detailed cross-sectional images of your body. It allows doctors to pinpoint the exact location of the tumor and check for cancer spread.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (MRI) uses radio waves and a powerful magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show “slices” of the body. This test is very useful for examining specific areas of the body, especially the soft tissues in the head and neck region.
Positron Emission Tomography (PET) Scan
For a PET scan, the doctor injects a radioactive substance into the patient’s bloodstream. This substance collects in malignant (cancerous) cells in the patient’s body. The doctor then uses a PET scanner to detect these areas of radioactivity and to find the exact location of cancer in the patient’s body.