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 examination. 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.
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.
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:
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 Pharyngeal 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 Pharyngeal 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.
Staging is a system that describes the extent of cancer in the body. This process also reveals the type of pharyngeal cancer, which is a key part of developing a personalized treatment plan.
Pharyngeal cancer staging begins by evaluating three key components of cancer: size, location and spread. In the earliest stage of pharyngeal cancer (stage I), the cancer is localized to the pharynx. Later stages are characterized by the growth and spread of cancerous tissues throughout the body (stage IV).
Tumor (T) describes the size of the original tumor.
Node (N) indicates whether the cancer is present in the lymph nodes.
Metastasis (M) refers to whether cancer has spread to other parts of the body.
A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. For instance, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information could not be assessed. Once the T, N and M scores have been assigned, an overall pharyngeal cancer stage is assigned.
Stage I: The tumor is small (7 cm or less across) and limited to the pharynx (Example: T1, N0, M0).
Stage II: The tumor has grown larger but still remains within the pharynx. In this stage of pharyngeal cancer, there is no evidence of spread to lymph nodes or distant sites (Example: T2, N0, M0).
Stage III: The tumor has grown beyond the pharynx and may now extend into nearby tissues or organs. The cancer may or may not have spread to nearby lymph nodes (Example: T1, N1, M0).
Stage IV: The tumor may be any size and has grown beyond the pharynx. The cancer may have spread to lymph nodes or other parts of throat (Example: Any T, Any N, M1).