Diagnosis

Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
• The type of cancer suspected
• Severity of symptoms
• Previous test results

In addition to a physical examination, the following tests may be used to diagnose laryngeal and hypopharyngeal cancer:

Physical examination. The doctor will feel for any lumps in the neck, lip, gums, and cheek. The doctor will inspect the nose, mouth, throat, and tongue for abnormalities and often use a mirror for a clearer view of these structures. Though there is no specific blood test that detects laryngeal or hypopharyngeal cancer, several tests, including blood and urine tests, may be done to determine the diagnosis and establish the extent of the disease.

Laryngoscopy. This test can be performed in three ways. In an indirect laryngoscopy, the doctor sprays the throat with a local anesthetic to numb the area and prevent gagging and then uses a small, long handled mirror to see the vocal folds. In a fiberoptic laryngoscopy, the doctor inserts a lighted tube through the person’s nose or mouth and down the throat to view the larynx and hypopharynx. In a direct laryngoscopy, done in an operating room, the person receives a sedative or general anesthetic. The doctor then views the larynx and hypopharynx using an instrument called a laryngoscope. A sample of tissue for a biopsy (see below) is often taken during a direct laryngoscopy. Frequently, the doctor will recommend a triple endoscopy, a procedure done under general anesthesia to examine the ear, nose, and throat area, as well as the trachea and the bronchus located next to the lung and the esophagus.

Videostroboscopy. This fiberoptic video technique is used so the doctor can see the larynx. It is performed in the same way as the indirect laryngoscopy. It is used to view the vocal folds and can detect motion abnormalities and other changes, including changes in vibration. Videostroboscopy helps to determine the location and size of a tumor, as well as how the tumor has affected the function of the larynx and hypopharynx.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. In a fine needle aspiration biopsy, cells are withdrawn using a thin needle inserted directly into the tumor. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

The following imaging tests may be used to determine if the cancer has metastasized:

X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs. Sometimes, the patient will be asked to swallow barium, which coats the mouth and throat, to enhance the image on the x-ray (called a barium swallow). A barium swallow is used to identify abnormalities along the throat and esophagus. A special type of barium swallow, called a modified barium swallow, may be needed to evaluate difficulties with swallowing. A dentist may take extensive x-rays of the teeth, mandible (jawbone), and maxilla (upper jaw), including a panorex (panoramic view). Any signs of cancer may be followed with a computed tomography scan.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of soft tissue, such as the tonsils and the base of the tongue.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This test can detect the spread of cancer to the liver or the lymph nodes in the neck (cervical lymph nodes).

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is injected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. In head and neck cancer, bone scans are recommended if there are signs of bone metastasis.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.

To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed.