Diagnosis of laryngeal cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer often means first ruling out other health conditions that share similar symptoms with cancer. It can be a very worrying time for you and your loved ones. Sometimes this process is quick. Sometimes it can feel long and frustrating. But it’s important for doctors to get all the information they need before making a diagnosis of cancer.

The following tests are usually used to rule out or diagnose laryngeal cancer. Many of the tests that are used to diagnose cancer are used to find out the stage (how far the cancer has spread). 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
• smoking tobacco or exposure to second-hand smoke
• alcohol consumption
• contact with asbestos or sulphuric acid at work

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 using a mirror and light
• examine the nose and ears

Find out more about physical exams.

During an endoscopy, a doctor looks inside the body using a flexible or rigid tube with a light and lens on the end. This tool is called an endoscope.

There are different types of endoscopies that may be done for laryngeal cancer:

• laryngoscopy
• laryngostroboscopy
• panendoscopy

A laryngoscopy is used to look at the larynx. There are different types of laryngoscopies.

A flexible laryngoscopy is usually done by an ear, nose and throat (ENT) doctor in the doctor’s office. The doctor 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 doctor can look at the larynx. This is the most common type of laryngoscopy.

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

A direct laryngoscopy is done by an ENT surgeon in the operating room using a general anesthetic (you will be asleep). A direct laryngoscopy is usually done to get a biopsy sample if a 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 tissue sample.

Find out more about laryngoscopies.

A laryngostroboscopy (also called a videostroboscopy) is used to examine how well the vocal cords move. A camera is attached to a laryngoscope and flashing lights are used to slow down the image of the vocal cords moving. The procedure is done by an ENT doctor in an office or the hospital.

A laryngostroboscopy may be done to diagnose 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, esophagus and windpipe (trachea). A gastroenterologist (GI doctor) will do this procedure 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 show 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 or panendoscopy
• fine needle aspiration (FNA) – to check 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 3D 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 the cancer has spread (metastasized) to bone, cartilage or lymph nodes. A CT scan of the chest may be done to look for or rule out that it has spread 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 3D pictures.

An MRI of the head and neck may be done to help 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 gastrointestinal (GI) series is an imaging test. It may also be called a barium swallow. During an upper GI series, you will swallow a thick, chalky liquid (called barium) and then have x-rays of the esophagus, stomach and upper small intestine (called the upper GI tract). The barium coats the insides of these organs and shows their outline on an x-ray. An upper GI series can show abnormalities in the throat when swallowing, so itʼs often the first test done if you have trouble swallowing.

Find out more about an upper GI series.

An x-ray uses small amounts 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 3D colour images of the area being scanned.

A PET scan is used to find cancer that has spread to the lymph nodes in the neck or other areas of the body.

A PET scan is often combined with a computed tomography (CT) scan (called a PET-CT scan) to help diagnose laryngeal cancer using a machine that can do both at the same time. A PET-CT scan may be able to show cancer that canʼt be seen using a PET scan alone.

Find out more about PET scans.

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.