Tests for Laryngeal and Hypopharyngeal Cancers

Laryngeal and hypopharyngeal cancers are usually found because of signs or symptoms a person is having. If cancer is suspected, tests will be needed to confirm the diagnosis.

Medical history and physical exam

Your doctor will ask you about your symptoms, possible risk factors, your lifestyle and social habits, and other medical problems. A physical exam can help find signs of possible cancer or other diseases. Your doctor will pay very close attention to your head and neck, looking for abnormal areas in your mouth or throat, as well as any swollen lymph nodes in your neck.

Exams by a specialist

If your doctor suspects a cancer of the larynx or hypopharynx, you will be referred to an ear, nose, and throat (ENT) doctor, also called an otolaryngologist. This doctor will more completely examine your head and neck. This will include an inside look at the larynx and hypopharynx with an instrument, known as laryngoscopy, which can be done in 2 ways:

Indirect laryngoscopy

This is the simplest way to check your throat. The doctor uses a special small mirror and a light to look into your throat. The mirror is attached to a long handle, and it is placed against the roof of your mouth. The doctor shines the light into your mouth to see the image in the mirror. This exam can be done in 5 to 10 minutes in the doctor’s office. The doctor may spray numbing medicine to the back of your throat to help make the exam easier.

Direct flexible laryngoscopy

To do this, the doctor puts a fiber-optic laryngoscope (a thin, flexible, lighted tube) that goes up in your nose and down to your throat to look at your larynx and nearby areas. It usually takes about 10 minutes for the procedure which can also be done in the doctor's office. The doctor applies numbing medicine to your nose to help the exam. Sometimes, the doctor may use special tool to get a small sample (biopsy) from your throat for testing.

Direct rigid laryngoscopy

This is a complete exam of your throat. This exam is usually done in an operating room where you are given drugs through an intravenous (IV) line to put you in a deep sleep (under general anesthesia). The doctor uses a rigid laryngoscope  to look for tumors in the larynx and hypopharynx. Other parts of the mouth, nose, and throat are examined as well. Your doctor will look at these areas through the scope(s) to find any tumors, see how large they are, and see how far they have spread to nearby areas. The doctor might also take out (biopsy) small tissue samples from any tumors or other changed areas using special tools during the procedure.

People with laryngeal or hypopharyngeal cancer also have a higher risk for other cancers in the head and neck area, so the nasopharynx (part of the throat behind the nose), mouth, tongue, and the neck are also carefully looked at and checked for any signs of cancer.

Panendoscopy

Panendoscopy is a procedure that combines laryngoscopy, esophagoscopy, and bronchoscopy. This lets the doctor thoroughly examine the entire area around the larynx and hypopharynx, including the esophagus (swallowing tube) and trachea (windpipe). This exam is usually done in an operating room where you are given drugs through an intravenous (IV) line to put you in a deep sleep (under general anesthesia).

The doctor uses direct rigid laryngoscopy to look for tumors in the larynx and hypopharynx. The doctor may also use an endoscope to look into the esophagus or a bronchoscope to look into the trachea (windpipe). The doctor might also take out (biopsy) small tissue samples from any tumors or other changed areas using special tools during the procedure.

Types of biopsies

In a biopsy, the doctor removes a sample of tissue which is looked at closely in the lab. It's the only way to be sure that cancer is present. There are many different types of biopsies. See Testing Biopsy and Cytology Specimens for Cancer to learn more.

Endoscopic biopsy

The larynx and hypopharynx are deep inside the neck, so taking out samples for a biopsy can be complicated. Biopsies of these areas are done in the operating room while you are under general anesthesia (a deep sleep). The surgeon uses special instruments through an endoscope to remove small pieces of tissue.

Fine needle aspiration (FNA) biopsy

This type of biopsy isn't used to remove samples in the larynx or hypopharynx, but it may be done to find the cause of an swollen lymph node in the neck. A thin, hollow needle is put through the skin into the mass (or lymph node) to get cells for a biopsy. The cells are then looked at closely in the lab. If the FNA shows cancer, the pathologist (the doctor examining the samples) can often tell what type of cancer it is. If the cancer cells look like they might have come from the larynx or hypopharynx, an endoscopic exam and biopsy of these areas will be needed.

If the FNA doesn't show cancer, it only means that cancer was not found in that lymph node. There could still be cancer in other places. If you're having symptoms that might be from a laryngeal or hypopharyngeal cancer, you could still need other tests to find the cause of the symptoms.

FNA biopsies might also be useful in some patients already known to have laryngeal or hypopharyngeal cancer. If the person has a lump in the neck, an FNA can show if the mass is from cancer spread. FNA might also be used in patients whose cancer has been treated by surgery and/or radiation therapy, to help find out if a neck mass in the treated area is scar tissue or if it's a return (recurrence) of the cancer.

Lab tests of biopsy samples

Biopsy samples (from endoscopy or surgery) are sent to the lab where they are looked at closely. If cancer is found, other lab tests may also be done on the biopsy samples to help better classify the cancer.

Tests for certain proteins on tumor cells: If the cancer has spread (metastasized) or come back, doctors will probably look for certain proteins on the cancer cells. For example, cancer cells might be tested for the PD-L1 protein, which, if found, might predict if the cancer is more likely to respond to treatment with certain immunotherapy drugs.

Imaging tests

Imaging tests use x-rays, magnetic fields, or radioactive substances to create pictures of the inside of your body. Imaging tests are not used to diagnose laryngeal or hypopharyngeal cancers, but they're done for a number of reasons after a cancer diagnosis, such as:

• To look at suspicious areas that might be cancer
• To learn how far cancer may have spread
• To help determine if treatment is working
• To look for signs that the cancer has come back after treatment

Computed tomography (CT) scan

The CT scan (CAT scan) uses x-rays to make detailed cross-sectional images of your body. This test can help your doctor determine the size of the tumor, see if it's growing into nearby tissues, and find out if it has spread to lymph nodes in your neck. It might also be done to look for the spread of cancer to your lungs or other organs.

Magnetic resonance imaging (MRI) scan

Like CT scans, MRI scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. A contrast material called gadolinium may be injected into your vein before the scan to get clear pictures. 

An MRI scan can be done to look for spread of the cancer in the neck and other areas of the body, too.

Chest x-ray

A chest x-ray might be done to see if the cancer has spread to the lungs, but more often a CT scan of the lungs is done since it tends to give more detailed pictures.

Positron emission tomography (PET) scan

For a PET scan, a slightly radioactive form of sugar (known as fluorodeoxyglucose or FDG) is injected into the blood and collects mainly in cancer cells.

A PET scan may be used to look for possible areas of cancer spread, especially if the main cancer is more advanced. This test can also be used to help tell if a suspicious area seen on another imaging test is cancer or not.

PET/CT scan: Often a PET scan is combined with a CT scan using a special machine that can do both at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with a more detailed picture on the CT scan.

Bone scan

For a bone scan, a small amount of low-level radioactive material is injected into the blood and collects mainly in abnormal areas of bone. A bone scan can help show if a cancer has spread to the bones. But this test isn’t needed very often because PET scans can usually show if cancer has spread to the bones.

Barium swallow

This test might be done if someone is having a problem with swallowing. For this test, you drink a chalky liquid called barium to coat the walls of the throat and esophagus (swallowing tube). A series of x-rays of the throat and esophagus is taken as you swallow to help show problems.

Other pre-treatment tests

Other tests may be done as part of a workup in people diagnosed with laryngeal or hypopharyngeal cancer. These tests are not used to diagnose the cancer, but they may be done to see if a person is healthy enough for certain treatments, like surgery or chemotherapy.

Quit smoking: It is very important to quit smoking before any treatment for laryngeal and hypopharyngeal cancer. If you used to smoke cigarettes before being diagnosed, it is important to not start during treatment. Smoking during treatment can cause a poor response to radiation treatment, poor wound healing, poor tolerance to chemotherapy, and a higher chance of dying. 

Blood tests: A complete blood count (CBC) measures the numbers of different types of blood cells. For example, it can show if you are anemic (have a low number of red blood cells), if you could have trouble with bleeding (due to a low number of blood platelets), or if you are at increased risk for infections (because of a low number of white blood cells). This test is often done regularly during treatment, because many cancer drugs can decrease the blood cells made by the bone marrow.

Blood chemistry tests can help determine how well your liver or kidneys are working.

Pre-surgery (before surgery): If surgery is planned, you might also get an electrocardiogram (EKG) to make sure your heart is working well. Some people having surgery also may need tests of their lung function known as pulmonary function tests (PFTs).

Dental exam: Your cancer care team will also have you see your dentist before any radiation is given since it can damage the saliva (spit) glands and cause dry mouth. This can increase the chance of cavities, infection, and breakdown of the jawbone.

Hearing test: The most commonly used chemotherapy drug used in treating laryngeal and hypopharyngeal cancer, cisplatin, can affect your hearing. Side effects can range from ringing in the ears to hearing loss. Your care team will most likely have your hearing checked (with an audiogram) before starting treatment. Your doctor might also adjust your chemotherapy if your hearing is poor to start with.   

Nutrition and speech tests: Often, you will have a nutritionist who will evaluate your nutrition status before, during, and after your treatment to try and keep your body weight and protein stores as normal as possible. You might also visit with a speech therapist who will test your ability to swallow and speak. They might give you exercises to do during treatment to help strengthen the muscles in the head and neck area so you can eat and talk normally after finishing all of your cancer treatment.