Diagnosing Laryngeal Cancer

NYU Langone doctors are experienced in recognizing and diagnosing laryngeal cancer, which arises in the larynx. The larynx, also called the voice box, is located in the front of the throat above the trachea, or windpipe.

The larynx enables you to speak. It contains the vocal cords, also known as the vocal folds. These are two thin structures that stretch horizontally across the larynx. When you exhale, the vocal cords produce vibrations, creating the sounds needed for speaking.

The larynx also helps with breathing. When you inhale and exhale, the vocal cords open, allowing air to flow into and out of the trachea. The entire larynx closes tightly when you swallow, preventing food and liquid from entering the windpipe.

Most laryngeal cancers develop in squamous cells. These flat cells form the epithelium, which lines the larynx.

Laryngeal cancer is often associated with a history of smoking. Doctors at NYU Langone encourage smokers to quit. Our Tobacco Cessation Programs can give you the support you need.

Symptoms of laryngeal cancer include hoarseness, difficulty breathing, a cough, difficulty swallowing, a sore throat, neck pain, or a mass on the side of the neck, which is usually a swollen lymph node.

Lymph nodes are small, bean-shaped organs that store lymphocytes, which are white blood cells that help fight infection. Lymphocytes travel throughout the body via a network of organs and vessels, called the lymphatic system. Laryngeal cancer can spread to the lymph nodes through the lymphatic system, and swollen nodes in the neck may be the first noticeable sign of laryngeal cancer.

The earlier laryngeal cancer is detected, the better the chances of a full recovery. If your doctor suspects you have laryngeal cancer, he or she asks about your medical history—for example, whether you have smoked or currently smoke—and whether family members have been diagnosed with the condition. Your doctor also asks about your symptoms and their duration and performs a physical exam.

To diagnose the condition, NYU Langone doctors may perform several tests, including laryngoscopy and a biopsy.

Laryngoscopy

During a laryngoscopy, the doctor inserts a laryngoscope—a thin, flexible, lighted tube with a lens at the tip that transmits images to a monitor—through the nose and into the throat. This procedure allows the doctor to look for tumors in the larynx. The laryngoscopy equipment used at NYU Langone enables doctors to find even small lesions.

Doctors may combine laryngoscopy with stroboscopy, in which a strobe light is passed through the scope, to view how a tumor may be affecting vocal cord vibration. The flashes of light are timed to vocal cord vibrations at a slightly slower speed, which creates the illusion of the cords moving in slow motion.

These procedures require a local anesthetic and can be performed in the doctor’s office.

Biopsy

If a doctor identifies a suspicious growth during laryngoscopy, he or she can perform a biopsy, in which a piece of tissue is removed. A pathologist examines the tissue under a microscope to determine if it contains cancer cells.

Squamous cell laryngeal cancers can begin as a precancerous condition called dysplasia, in which the cells appear abnormal under a microscope but are not cancerous. Although dysplasia is not cancer, it can cause hoarseness.

At NYU Langone, a biopsy can sometimes be performed in the office on the same day as the laryngoscopy. Your doctor passes small instruments through the scope to remove a sample of tissue. Doctors use local anesthesia, and you can go home the day of the procedure. You may experience a sore throat, hoarseness, or mild bleeding for several days afterward.

Doctors can also perform a biopsy of a laryngeal growth in a hospital operating room, using general anesthesia, if access to the area is challenging or if they need a more thorough look at a mass. This type of biopsy is also an option if you cannot tolerate an awake procedure. You can usually go home the same day, after the anesthesia has worn off.

Fine Needle Aspiration

If your doctor notices a swollen lymph node in the neck, he or she may perform a fine needle aspiration. During this procedure, which is performed in the doctor’s office, your doctor uses a small needle to withdraw fluid and cells from the node. These are examined under a microscope for signs of cancer. The doctor may apply a local anesthetic before the procedure.

CT Scans

After a diagnosis of laryngeal cancer, your doctor may perform a CT scan, which uses X-rays and a computer to create two- or three-dimensional, cross-sectional images of the body. A special dye may be injected into a vein in the arm to enhance the CT image.

This imaging test can help determine how much of the larynx has been affected by the cancer and whether it has spread to nearby lymph nodes or other structures in the neck. Nearby structures include the trachea; various types of cartilage in the neck, including thyroid cartilage, which forms the outer wall of the voice box, or Adam’s apple; and the thyroid gland, which sits below the larynx and helps regulate metabolism.

PET/CT Scans

To see if the cancer has spread to distant parts of the body, such as the lungs, liver or bones, your doctor may recommend a whole body PET/CT scan. The PET portion of the scan requires an intravenous (IV) infusion of radioactive glucose, or sugar, into a vein.

This sugar is quickly processed by cancer cells, while the radioactive material causes them to light up on PET scan images. These images are fused with those from a CT scan, providing doctors with detailed information about the location and extent of the cancer.