Diagnosis - Laryngeal (larynx) 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 National Institute for Health and Care Excellence (NICE) recommends that anyone aged 45 or over with persistent unexplained hoarseness or an unexplained lump in their neck should have an appointment with a specialist within 2 weeks.

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

Nasendoscopy

A nasendoscopy is a procedure used to get a clear 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 down the back of your throat. The images from the endoscope are displayed on a monitor.

You'll usually be awake while this is carried out and it may feel uncomfortable. 

A local anaesthetic spray is sometimes used to numb your nose and throat beforehand, so you don't feel any pain.

Laryngoscopy

If it was not 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.

But the endoscope used during a laryngoscopy is longer and inserted through the mouth. This allows the larynx to be seen in greater detail.

A laryngoscopy can be very uncomfortable, so it's usually carried out under general anaesthetic (where you're 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 or the day after.

Biopsy

During a nasendoscopy or laryngoscopy, your doctor may use small instruments to remove a sample of cells from your larynx so it can be examined for signs of cancer. This is known as a biopsy.

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 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 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 to show cancerous areas more clearly
• an ultrasound scan – high-frequency sound waves are used to check for signs of cancer in the lymph nodes (glands found throughout the body) near the larynx

Staging and grading

After these tests have been completed, your doctor should be able to tell you the extent of the cancer. This is 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 is given as a number from 1 to 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 is given as a number from 0 to 3 – N0 means the lymph nodes are not affected, whereas stages N2 to N3 mean that 1 or more lymph nodes are affected.
• The M stage 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 also 3 different grades (1 to 3) used to describe laryngeal cancer.

Lower-grade cancers, such as grade 1, tend to grow more slowly and are less likely to spread. 

Higher-grade cancers, such as grade 3, grow quickly and are more likely to spread.

Cancer Research UK has more information about the stages and grades of laryngeal cancer