Diagnosis
In cases of laryngeal cancer, the primary physician will most likely refer the person to an ear, nose and throat surgeon (otolaryngologist), for further analysis. The first step involves taking a medical and family history that will help the specialist look for signs of cancer. In addition, other tests may be performed, including:
- Endoscopy will allow the specialist access to the inside of the larynx to identify possible lesions and perform a biopsy.
- Panendoscopy is a combination of endoscopy of the larynx, esophagus and trachea that allows the specialist to have a more complete view of the entire region affected by the tumour to establish size, spread and possible invasion of surrounding tissues.
- Biopsy is a small sample of the tumour taken for pathological diagnosis that will determine if it is cancerous and what type it is.
- Imaging will be comprised of:
- Computer Tomography (CT) scans. This diagnostic technique presents a 3D cross-sectional image of the throat to determine if there is tumour invasion of the surrounding tissues and the size of that lesion.
- Magnetic Resonance Imaging (MRI) presents a clear picture of the tissues and in some cases can be used to distinguish benign from malignant tumours.
- Upper gastrointestinal (GI) x ray series or Barium swallow involve the use of a contrasting agent to reveal any growth that could be obstructing the gastrointestinal system.
- X rays of the lungs to rule out metastases.
- PET scans involve radioactive materials that react chemically with substances inside the organs. This is helpful in differentiating tumours from normal tissue.
- Speech and swallowing tests to assess these functions before treatment and to establish a baseline.
- Blood chemistry tests (or serology) to show organ function and detect certain abnormalities associated to cancer or other non-cancerous conditions. (Canadian Cancer Society)
Staging
Staging refers to a cancer classification system that tells the physician how far along the disease is. The TNM system of the American Joint Committee on Cancer is widely accepted and used across the world. T stands for size of the tumour; N refers to the spread to the lymph nodes; and M means metastasis or spread to distant organs.
T : Size of the tumour |
| T0: No evidence of primary |
| Tis: Carcinoma in situ: the cancer has affected the epithelial cells lining the oral cavity but the tumour is not deep. |
| T1: Tumour is 2 cm (1 cm equals 0.39 inches) or smaller. |
| T2: Tumour is larger than 2 cm but smaller than 4 cm. |
| T3: Tumour is larger than 4 cm. |
| T4: The tumour is any size and has invaded adjacent structures, such as the larynx, bone, connective tissues, or muscles. |
N: Lymph node involvement |
| N0: No metastasis in the regional lymph nodes. |
| N1: Metastasis in one lymph node on the same side of the primary tumour and smaller than 3 cm. |
| N2: Divided into 3 subgroups. N2a is metastasis in one lymph node larger than 3 cm and smaller than 6 cm. N2b is metastasis in multiple lymph nodes on the same side of the tumour, none larger than 6 cm. N2c denotes one or more lymph nodes, which may or may not be on the side of the primary tumour, none larger than 6 cm. |
| N3: Metastasis in lymph node larger than 6 cm |
M : Distant metastasis |
| M0: No distant metastasis. |
| M1: Distant metastasis present. |
Santhanam, Kausalya, and Rebecca J. Frey. “Oral Cancers.” The Gale Encyclopedia of Cancer: A Guide to Cancer and Its Treatments, edited by Kristin Fust, 4th ed., vol. 2, Gale, 2015, pp. 1295-1303. Gale Virtual Reference Library.