The diagnosis of supraglottic laryngeal cancer can be difficult and overwhelming. Further testing will be necessary to obtain a diagnosis and determine the best course of treatment.
Endoscopy, imaging, and biopsy are generally standard diagnostic approaches. Patients can expect their doctor to have a discussion with them about the risks, benefits, and alternatives to each of the following.
Endoscopy
An endoscope is a device that allows doctors to examine inside the body. It is made up of a thin flexible or rigid tube with a camera and light attached on the end. The lenses inside the endoscope provide magnification, allowing doctors to detect even small changes in the lining of the throat.
“Endoscopy” is simply the process of using an endoscope to visualize a particular part of the body. Doctors have specific types of endoscopic tools such as laryngoscopes, hypopharyngoscopes, bronchoscopes, and esophagoscopes – each designed to evaluate a different portion of the upper aerodigestive tract or throat. A flexible endoscope will be used in the clinic to visualize a supraglottic mass, as this area is not easy to see otherwise. Vocal cord mobility will also be assessed with the flexible scope, which is an important component of the physical exam and will help determine tumor stage.
Sometimes direct laryngoscopy in the operating room is necessary to fully assess the size and position of the tumor. Laryngoscopy is a way to look far inside and around the throat and larynx, or voice box and is usually performed while the patient is asleep. Learn more about endoscopy procedures.
Biopsy
A biopsy is the removal of a small piece of tissue to examine under a microscope to see if it is cancerous. A biopsy of a suspicious growth in the larynx is usually needed prior to treatment. Most laryngeal tumors will require a direct laryngoscopy with biopsy, which is performed under general anesthesia in the operating room. However, for supraglottic tumors, it is sometimes possible to take a biopsy in the office under local anesthesia using a flexible scope with topical anesthesia sprayed into the airway. In some cases, a fine needle aspiration (FNA) biopsy of any suspicious lymph nodes in the neck may also be helpful. Learn more about these and other kinds of biopsies.
Imaging
Imaging scans, also known as radiologic studies, provide the doctor with an inside view of the body. Imaging of the head and neck will be required to determine the extent as well as the behavior of a growth, and is a vital step prior to treatment of any tumor in the larynx. The most common imaging tests used are CT and/or MRI scans. A more advanced imaging study called a PET/CT may also be performed to evaluate if the cancer has spread to other sites in the body, as well as to determine if lymph nodes in the neck are likely to harbor cancer cells. The combination of PET and CT is a powerful tool to get both anatomic information as well as metabolic information that provides insight into the nature of the tissue identified on the scan. Learn more about imaging.
