Diagnosing Laryngeal Cancer

There are a variety of tests that examine the throat and neck in order to detect and diagnose laryngeal cancer. In many cases, you will start with an ear, nose, and throat specialist (ENT) who will perform the exams and request further testing if your doctor believes there may be a tumor in the larynx.

If the doctor suspects there could be cancer, a biopsy may be performed.  A biopsy requires a tissue sample be collected from the area of the body where cancer is suspected so that the cells can be tested to see if cancer is present. Some of the following tests or procedures may be run to make a determination.

• Physical exam of the throat - An exam in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.
• Laryngoscopy - A procedure to look at the larynx (voice box) for abnormal areas. A mirror or a laryngoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the mouth to see the larynx. A special tool on the laryngoscope may be used to remove samples of tissue.
• 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 (at times) bronchoscopy. This lets the doctor thoroughly examine the entire area around the larynx and hypopharynx, including the esophagus (swallowing tube) and trachea (windpipe). While the patient is under general anesthesia, the doctor will thoroughly examine all of these areas to look for tumors and determine their size and if they’ve spread. A tissue sample can be collected for biopsy during this procedure as well.

If cancer has been found in the biopsy, it’s common to add other tests including imaging to see if the cancer has spread, and if so, how far. Your doctor may request one or more of the following imaging studies:

• CT scan (CAT scan) - A procedure that makes a series of detailed pictures of areas inside the body, 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. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• 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 makes 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. In some cases the PET scan and CT scan may be used together. This is called a PET-CT.
• MRI (magnetic resonance imaging) - A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Bone scan - A procedure to check if there are rapidly dividing cells, such as cancer cells, 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 that is taken after the patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and makes it easier for the doctor to see problems in the throat.