Diagnosis of hypopharyngeal cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing hypopharyngeal cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for hypopharyngeal cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as hypopharyngeal cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of hypopharyngeal cancer.

The following tests are usually used to rule out or diagnose hypopharyngeal cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest hypopharyngeal cancer
• tobacco use
• alcohol use

Your doctor may also ask about a family history of:

• head and neck cancers
• other cancers

A physical exam allows your doctor to look for any signs of hypopharyngeal cancer. During a physical exam, your doctor may:

• feel the neck area for lumps or swelling
• check for lumps or swelling on the inside of the mouth, including the cheeks and lips
• feel the floor of the mouth and the base of the tongue
• examine the roof of the mouth and the back of the throat
• check your ears and test your hearing

Find out more about physical exams.

An endoscopy is done when diagnosing and staging hypopharyngeal cancer. It allows a doctor to look inside the body using a flexible tube with a light and lens on the end. This tool is called an endoscope.

Different types of endoscopy may be used to look inside the pharynx (throat), collect tissue samples and find out how far the cancer has spread.

A panendoscopy looks at all the structures in the throat. It combines a laryngoscopy, an esophagoscopy and sometimes a bronchoscopy. A laryngoscopy uses an endoscope to examine the larynx (voice box). An esophagoscopy uses an endoscope to examine the esophagus. A bronchoscopy uses an endoscope to examine the airways (bronchi) in the lungs.

A panendoscopy is usually done in an operating room under a general anesthetic (you will be unconscious). After the procedure, you won’t be allowed to eat or drink for about 1 hour. You will also be told to rest your voice by not speaking. Your healthcare team may give you pain-relieving drugs if you have a sore throat.

Your doctor may do a panendoscopy to thoroughly check the mouth (oral cavity), pharynx, larynx, esophagus, trachea (windpipe) and bronchi.

Find out more about endoscopies.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will show whether or not cancer cells are found in the sample.

An endoscopic biopsy is done during an endoscopy. The doctor collects tissue samples from any abnormal areas in the hypopharynx or other parts of the throat.

A fine needle aspiration (FNA) uses a very thin needle and syringe to remove a small amount of fluid or cells from the abnormal area. FNA may be used to collect cell or tissue samples from lumps and lymph nodes in the neck.

Find out more about biopsies and fine needle aspiration.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan of the head and neck may be done to find out the size and location of a tumour and see if cancer has spread (metastasized) to bone, cartilage or lymph nodes.

A CT scan of the chest may be done to see if cancer has spread to the lungs.

CT scans may not be needed for early stage hypopharyngeal cancers.

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI scan of the head and neck may be done to check the size and location of a tumour and see if the cancer has spread to bone, cartilage or lymph nodes. MRI may not be needed for early stage hypopharyngeal cancers.

Find out more about MRIs.

An upper GI series may also be called a barium swallow. You will swallow a thick, chalky liquid (barium) and then have x-rays of the esophagus, stomach and upper small intestine (upper GI tract). The barium coats the inside of these organs and shows their outlines on an x-ray. An upper GI series can show any abnormalities in the throat when you swallow, so it is often the first test done if you have trouble swallowing.

Find out more about an upper gastrointestinal series.

An x-ray uses small doses of radiation to make an image of parts of the body on film. It is used to look for a tumour in the hypopharynx. You may also need a chest x-ray to see if cancer has spread to the lungs or lymph nodes in the chest.

Find out more about x-rays.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned.

A PET scan is used to see if the cancer has spread to the lymph nodes in the neck or other distant sites.

Find out more about PET scans.

A PET-CT scan combines a CT scan and a PET scan. It can give the healthcare team more information about the tumour, including its location and size and if it has spread.

If possible, a person diagnosed with hypopharyngeal cancer will meet with a speech therapist (speech-language pathologist) before treatment. Tests may include recording your voice and speech and having a videofluoroscopy. A videofluoroscopy creates x-rays or images of the throat during swallowing. This procedure helps with rehabilitation of speech and swallowing after treatment.

A nutritional assessment may be done to make sure that a person with swallowing problems can maintain good nutrition and is well enough to have treatment.

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. Blood chemistry tests are not used to diagnose or stage hypopharyngeal cancer, but they may be used to check your overall health before treatment.

Find out more about blood chemistry tests.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.