Laryngeal Cancer Diagnosis & Detection
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Although routine screening for laryngeal cancer is not typically recommended, several tests can be done if any of the symptoms of this disease are present and do not go away.
How Is Laryngeal Cancer Diagnosed?
The following diagnostic tests are common for all types of head and neck cancer:
Medical History and Physical Exam: The first step in diagnosing cancer is usually a general physical. Your doctor will ask you about your symptoms, whether you have any of the known risk factors and about any other medical conditions. During a physical exam, your doctor may find signs of cancer in the larynx, such as any abnormalities in the mouth or throat, or enlarged lymph nodes in the neck.
If your doctor is concerned that you may have cancer, he or she will refer you to a specialist for additional tests. This specialist will likely be either an otolaryngologist, typically referred to as an ear, nose and throat (ENT) doctor.
Specialist Consultation: The specialist will carefully examine the entire area of your head and neck, including the lymph nodes of the neck, to check for any signs of cancer.
This exam may include the use of mirrors so that your doctor can see areas inside the neck that are not easily viewed. Other procedures that may be done to closely examine the larynx include:
Indirect Laryngoscopy: Your doctor may place small mirrors at the back of your mouth in order to clearly examine your throat, the base of your tongue and part of your larynx (voice box).
Direct Laryngoscopy: Your doctor may use a fiber-optic laryngoscope, which is a thin, flexible, lighted tube that is inserted through the mouth or nose, to view the larynx and surrounding areas.
For both of these procedures, your doctor may spray the back of your throat with a numbing medicine to avoid pain. Because people diagnosed with laryngeal cancer are also at increased risk for other head and neck cancers, your doctor will also examine the nasopharynx (the top portion of the throat, behind the nose), mouth, tongue and neck.
Panendoscopy: If your doctor suspects the presence of cancer, a more thorough examination of the head and neck will likely be done. In this exam, an individual is given general anesthesia in an operating room so that the entire region of the body can be closely inspected for cancer. Endoscopes are used to look at the throat, larynx, esophagus and possibly the windpipe (trachea) and bronchi. If any tumors are found, your doctor will remove samples that can be looked at under a microscope.
Biopsy: Only a biopsy can give a definitive diagnosis of laryngeal cancer. A sample of tissue or cells is required for a biopsy, which must be conducted before treatment can begin. The types of biopsies typically used for diagnosing head and neck cancers are:
- Incisional Biopsy: A small piece of tissue is cut from an abnormal-looking area. Because the larynx is deep inside the neck, removing samples involves a complex procedure. Therefore, biopsies of this region are usually done in an operating room with general anesthesia administered to prevent any pain.
- Fine Needle Aspiration (FNA): Here, a very thin needle attached to a syringe is used to extract (aspirate) cells from a tumor or lump. This approach can be particularly useful for several situations that can occur with laryngeal cancer:
If a diagnosis of laryngeal cancer is made, various kinds of imaging tests can then help determine the extent of the disease. If questions remain after a biopsy, then an imaging test may also be used to help determine whether cancer is present. The types of imaging tests that are commonly used for laryngeal cancer include:
Chest X-ray: An x-ray of the chest may be taken to check if the cancer has spread to the lungs. Cancer will not be present in the lungs unless if it is in an advanced stage. An x-ray is usually an outpatient procedure, meaning that you do not have to be admitted to a hospital for the test. If the result is abnormal, further tests will be done.
Computed Tomography (CT) Scan: A CT scan can provide information about the size, shape and position of any tumors, and may also help identify enlarged lymph nodes that may contain cancer cells.
Magnetic Resonance Imaging (MRI): Less commonly, an MRI scan may be used to examine laryngeal cancer. MRIs provide a very detailed view, and can be particularly useful in determining whether or not the cancer has spread, either to other areas in the neck or other regions of the body.
Positron Emission Tomography (PET): For patients diagnosed with laryngeal cancer, a PET scan may be useful for seeing if cancer has spread to the lymph nodes, for determining the originating site of cancer when it is found in the lymph nodes first or for checking the entire body for any spreading of cancer cells.
Barium swallow: Also known as an “upper GI series,” a barium swallow involves drinking a chalky drink made of a barium-based solution, which allows cancer cells in the esophagus and upper part of the digestive system to be seen with an x-ray. This imaging technique can also show if cancer is interfering with swallowing.
Blood Test: Blood tests are not used to diagnose cancer, but can help evaluate your overall health and provide your doctor with useful information about your care before treatment begins.
Electrocardiogram: If surgery is planned as part of your care, your doctor may suggest having an electrocardiogram (EKG) to ensure that your heart is functioning well. Confirming that your lungs are healthy may also be important, which can be checked with a pulmonary function test.
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