Exams and tests for laryngeal or hypopharyngeal cancer

Exams and tests for laryngeal or hypopharyngeal cancer
Hypopharyngeal carcinoma is relatively uncommon representing only 10% of all proximal aerodigestive tract malignancies. Squamous cell carcinomas account for ~95% of all primary tumours of the hypopharynx.

Hypopharyngeal cancer is a disease in which malignant cells grow in the hypopharynx (the area where the larynx and esophagus meet). It first forms in the outer layer (epithelium) of the hypopharynx (last part of the pharynx), which is split into three areas. Progression of the disease is defined by the spread of cancer into one or more areas and into deeper tissues.
hypopharyngeal cancer diagnosis
Image 1 : Hypopharingeal Cancer
This type of cancer is rare. Only about 2,500 cases are seen in the US each year. Because of this, Hypopharyngeal Cancer is difficult to catch in its earliest stages and has one of the highest mortality rates of any head and neck cancer. 

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Factors that contribute to the development of hypopharyngeal cancer include:
  • Smoking
  • Chewing tobacco
  • Heavy alcohol use
  • Poor diet

Smoking, like lung cancer, can cause hypopharyngeal cancer because it contains carcinogens that alter the DNA or RNA in a dividing cell. These alterations may change a normal DNA sequence to an oncogene, a gene that causes cancer after exposure to a carcinogen.

Squamous cells, a type of cell that lines hollow organs like the throat, mouth, lungs, and outer layer of skin, are particularly vulnerable when exposed to cigarette smoke.

Chewing tobacco can have the same effects as smoking and is also linked to hypopharyngeal cancer. The chewing tobacco is placed into the mouth, leaving it exposed to enzymes, like amylase, which partly digests the carcinogenic material. Saliva is swallowed, along with the cancer-promoting material, which passes through the hypopharynx on its way to the esophagus.

Heavy alcohol use is linked to Hypopharyngeal Cancer as well. Alcohol damages the lining of the hypopharynx, increasing the amount of chemicals that are allowed to seep into the underlying membranes. Heavy alcohol use is also associated with nutritional deficiencies.

A disease called Plummer-Vinson syndrome, a genetic disorder that causes a long-term iron deficiency, may also lead to Hypopharyngeal Cancer. Other factors like a deficiency in certain vitamins also appear to contribute to this type of cancer.

Symptoms of Hypopharyngeal Cancer include:
  • Swollen lymph nodes in the neck (first sign of a problem in half of all patients) 
  • Sore throat in one location that persists after treatment 
  • Pain that radiates from the throat to the ears
  • Difficult or painful swallowing (often leads to malnutrition and weight loss because of a refusal to eat)
  • Voice changes (late stage cancer)

Laryngeal and hypopharyngeal cancers are usually found because of signs or symptoms a person is having. If cancer is suspected, tests will be needed to confirm the diagnosis. Diagnosis in people without symptoms is rare and usually accidental (because of tests done to check other medical problems).

Exams and tests for laryngeal or hypopharyngeal cancer

If you have signs or symptoms that suggest you might have a cancer of the larynx or hypopharynx, your doctor will recommend one or more exams or tests.

1. Medical history and physical exam
Your doctor will ask you about your symptoms, possible risk factors, family history, and other medical conditions. A thorough physical exam can help find signs of possible cancer or other diseases. In particular, your doctor will pay close attention to your head and neck, looking for abnormal areas in your mouth or throat, as well as enlarged lymph nodes in your neck.

2. Examination by a specialist
If your doctor suspects a cancer of the larynx or hypopharynx, you will be referred to an ear, nose, and throat (ENT) doctor, also known as an otolaryngologist, who will do a more thorough exam of the head and neck area. This will include an exam of the larynx and hypopharynx, known as laryngoscopy, which can be done in 2 ways:
  • Direct (flexible) laryngoscopy: For this exam, the doctor inserts a fiber-optic laryngoscope − a thin, flexible, lighted tube − through the mouth or nose to look at the larynx and nearby areas.
  • Indirect laryngoscopy: In this exam, the doctor uses special small mirrors to view the larynx and nearby areas.

Both types of exams can be done in the doctor’s office. For either type of exam, the doctor may spray the back of your throat with numbing medicine to help make the exam easier.

3. Panendoscopy
Panendoscopy is a procedure that combines laryngoscopy, esophagoscopy, and (at times) bronchoscopy. This lets the doctor thoroughly examine the entire area around the larynx and hypopharynx, including the esophagus and trachea (windpipe).

This exam is usually done in an operating room while you are under general anesthesia (asleep). The doctor uses a rigid laryngoscope to look for tumors in the larynx and hypopharynx. Other parts of the mouth, nose, and throat are examined as well. The doctor may also use an endoscope to look into the esophagus or a bronchoscope to look into the trachea (windpipe).

Your doctor will look at these areas through the scope(s) to find any tumors, see how large they are, and see how far they have spread to surrounding areas. The doctor might also remove (biopsy) small tissue samples from any tumors or other abnormal areas using special instruments operated through the scopes.

References :

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