Diagnosis of laryngeal cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing laryngeal cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor will refer you to a specialist or order tests to check for laryngeal cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as laryngeal cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of laryngeal cancer.

The following tests are usually used to rule out or diagnose laryngeal cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest laryngeal cancer
• tobacco and alcohol use
• contact with asbestos or sulphuric acid at work

Your doctor may also ask about a family history of cancer.

A physical exam allows your doctor to look for any signs of laryngeal cancer. During a physical exam, your doctor may:

• look for any lumps, swelling or enlarged lymph nodes in the neck
• feel for lumps or swelling on the inside of the mouth, including the cheeks and lips
• feel the floor of the mouth and the base of the tongue
• examine the roof of the mouth and the back of the throat
• examine the nose and ears

Find out more about physical exams.

An endoscopy allows a doctor to look inside the body using a flexible or rigid tube with a light and lens on the end. This tool is called an endoscope.

A laryngoscopy is a type of endoscopy used to look at the larynx. The tool is called a laryngoscope. There are different types of laryngoscopy:

An indirect laryngoscopy can be done in the doctor’s office. The doctor uses a light source and a small hand mirror held at the back of the throat to look at the throat, larynx and vocal cords.

A flexible or fibre optic laryngoscopy is usually done by an ear, nose and throat (ENT) surgeon in the doctor’s office. The surgeon sprays an anesthetic on the back of the nose and throat just before the test. This helps open up the sinuses and prevents gagging. A flexible laryngoscope is inserted through the nose and down to the throat so the surgeon can look at the larynx.

A direct laryngoscopy is done by an ENT surgeon in the operating room using a general anesthetic (you will be unconscious). A direct laryngoscopy is usually done to collect a biopsy sample if a laryngeal tumour is seen during an indirect or flexible laryngoscopy. The surgeon inserts a rigid laryngoscope into the mouth to look at the larynx and remove a sample of tissue for biopsy.

Find out more about a laryngoscopy.

A laryngostroboscopy (or videostroboscopy) is used to examine the vocal cords during speech. A camera is attached to a laryngoscope, and flashing lights are used to slow down the image of the cords moving. The procedure is done by an ENT surgeon in a medical office or hospital. A laryngostroboscopy may be done to diagnosis laryngeal cancer. It may also be done to assess speech before, during and after treatment.

A panendoscopy is a procedure that combines a laryngoscopy, an esophagoscopy (endoscopy of the esophagus) and sometimes a bronchoscopy (endoscopy of the airways in the lungs). A panendoscopy lets the doctor look at the entire area around the larynx and hypopharynx, including the esophagus and windpipe (trachea). This procedure is done in an operating room with a general anesthetic.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will confirm whether or not cancer cells are found in the sample. The biopsies that could be used for laryngeal cancer are:

• endoscopic biopsy – tissue samples are removed from the larynx during a direct laryngoscopy
• fine needle aspiration (FNA) – to biopsy a lump in the neck or enlarged lymph node

Find out more about biopsies and a fine needle aspiration.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan of the head and neck may be done to help determine the size and location of a tumour and if cancer has spread to bone, cartilage or lymph nodes. A CT scan of the chest may be done to look for or rule out spread (metastasis) to the lungs. CT scans may not be needed for early stage laryngeal cancers.

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.

An MRI scan of the head and neck may be done to determine the size and location of a tumour and if the cancer has spread to bone, cartilage or lymph nodes. MRI may not be needed for early stage laryngeal cancers.

Find out more about MRIs.

An upper GI series may also be called a barium swallow. You will swallow a thick, chalky liquid and then have x-rays of the esophagus, stomach and upper small intestine (upper GI tract). The barium coats the inside of these organs and shows their outline on an x-ray. An upper GI series can show any abnormalities in the throat when swallowing, so it is often the first test done if you have trouble swallowing.

Find out more about an upper gastrointestinal series.

An x-ray uses small doses of radiation to make an image of parts of the body on film. If a CT scan of the chest is not done, a chest x-ray may be done to determine if cancer has spread to the lungs.

Find out more about x-rays.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-D colour images of the area being scanned.

A PET scan is used to find cancer that has spread, or metastasized, to the lymph nodes in the neck or other distant sites.

Find out more about PET scans.

If possible, a person diagnosed with laryngeal cancer will meet with a speech therapist (speech-language pathologist) before treatment. Tests may include recording your voice and speech and having a videofluoroscopy. A videofluoroscopy creates x-rays or images of the throat during swallowing. This procedure helps with rehabilitation of speech and swallowing after treatment.

A nutritional assessment may be done to ensure that a person with swallowing problems can maintain proper nutrition and is well enough to have treatment.

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. Blood tests are not used to diagnose or stage laryngeal cancer, but they may be used to check liver and kidney function and overall health before treatment.

Find out more about blood chemistry tests.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.