Pharyngeal Cancer Diagnosis & Detection

Although routine screening for pharyngeal 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 Pharyngeal 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 or 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 may include:

Indirect Pharyngoscopy: 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: A fiber optic source that uses a flexible, lighted, narrow tube may be inserted into the mouth or nose so that your doctor can examine hard-to-see areas such as the larynx and behind the nose.

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.

For tumors that begin under the lining of the pharynx, in a layer called the submucosa, these physical exams may not be enough for diagnosis. In this case, imagine tests that provide an internal view of the body may be needed.

Biopsy: Only a biopsy can give a definitive diagnosis of pharyngeal 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:

Imaging Tests

If a diagnosis of pharyngeal 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 pharyngeal cancer include:

Chest X-ray: An x-ray of the chest may be taken to check if the cancer has spread to the lungs.

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 so 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.

Other Tests 

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.

Epstein-Barr Virus (EBV) DNA Levels: For some patients, checking the blood for the amount of EBV DNA before and after treatment may give an indication of how effective the treatment has been. The exact link between EBV and pharyngeal cancer is not well understood, but it may be that eradicating an EBV infection provides a clue about whether the cancer cells have also been eradicated from the body.

Next Topic: Pharyngeal Cancer Staging