Laryngeal (larynx) cancer - Diagnosing laryngeal cancer

If you have symptoms of laryngeal cancer such as a hoarse voice and pain when swallowing, your GP will ask about your symptoms and recent medical history.

They may also examine the inside and outside of your throat for abnormalities, such as lumps and swellings.

If laryngeal cancer is suspected, you'll probably be referred to the ear, nose and throat (ENT) department of your local hospital for further testing.

The main tests that may be carried out in hospital are described below.

Nasendoscopy

A nasendoscopy is a procedure used to enable medical staff to get a clearer view of your larynx.

During the procedure, a small, flexible tube with a light and video camera at one end (endoscope) is inserted into one of your nostrils and passed into the back of your throat. The images from the endoscope are displayed on a monitor.

The procedure isn't painful but can sometimes feel uncomfortable, so an anaesthetic spray is often used to numb your nose and throat.

Laryngoscopy

If it wasn't possible to get a good view of your larynx during a nasendoscopy, or a possible problem is spotted, you may have a further test called a laryngoscopy.

Like a nasendoscopy, this procedure involves using an endoscope to examine your larynx. However, the endoscope used during a laryngoscopy is longer and inserted through the mouth. This allows medical staff to see the larynx in greater detail.

A laryngoscopy can be very uncomfortable, so is usually carried out under general anaesthetic (where you will be asleep). You should be able to leave hospital as soon as you've recovered from the effects of anaesthetic, which is usually the same day as the procedure or the day after.

Biopsy

During a biopsy, a small sample of tissue is removed and sent to a laboratory to be examined for cancerous cells. A biopsy can usually be done at the same time as a nasendoscopy or laryngoscopy. Small instruments are passed down the endoscope and used to remove a tissue sample.

Alternatively, if you have a lump in your neck, a needle and syringe can be used to remove a tissue sample. This is known as fine needle aspiration.

Further testing

If the results of the biopsy show you have cancer and there's a risk it may have spread, you'll probably be referred for further testing to assess how widespread the cancer is. The tests may include:

• a computerised tomography (CT) scan – a series of X-rays are taken to build up a more detailed three-dimensional picture of your larynx and the surrounding tissue
• a magnetic resonance imaging (MRI) scan – a strong magnetic field and radio waves are used to produce a more detailed image of your larynx and the surrounding tissue
• a PET-CT scan - a CT scan is used to take pictures of the inside of your body after you have been injected with a mildly radioactive substance that helps show cancerous areas more clearly
• an ultrasound scan - high frequency sound waves are used to produce an image of the larynx and surrounding tissue

Staging and grading

After these tests have been completed, the doctor in charge of your care should be able to tell you how far the cancer has spread and how fast it is likely to spread. These are known as the stage and grade of the cancer.

Healthcare professionals use a system called the TNM system to stage laryngeal cancer. T describes the size of the tumour, N describes whether cancer has spread to the lymph nodes and M gives an indication of whether the cancer has spread to other parts of the body.

The T stage of laryngeal cancer is given as a number from 1-4. Small tumours confined to one part of the larynx are described as T1 tumours and large tumours that have grown into tissues outside the larynx are described as T4.

The N stage of laryngeal cancer is given as a number from 0-3. N0 means the lymph nodes are not affected, whereas stages N2 to N3 mean that the lymph nodes are affected.

The M stage of laryngeal cancer is given as either M0 or M1. M0 means the cancer has not spread to other parts of the body and M1 means that it has.

There are three different grades used to describe the cancerous cells in the larynx, these are:

• grade 1 - the cancer cells look a lot like the normal cells in the larynx
• grade 2 - the cancer cells look a little like the normal cells in the larynx
• grade 3 - the cancer cells look very different to the normal cells in the larynx

Lower grade cancers, such as grade one, tend to grow more slowly and are less likely to spread, whereas higher grade cancers, such as grade three, grow quickly and are more likely to spread.