Diagnosis of laryngeal cancer

Anyone who has unexplained hoarseness, foreign body sensation in the throat, or persistent throat pain that is unresponsive to treatment, especially those over 40 years old, should undergo a careful and comprehensive examination to confirm the diagnosis.

1. Clinical examination

Observe whether there are any abnormalities in the appearance of the neck and larynx, whether there is any swelling of the soft tissue, and whether the thyroid cartilage is deformed. Neck palpation examination: ① Whether the larynx is enlarged, tender, and whether the laryngeal friction sound disappears (the friction between the thyroid cartilage and the cervical vertebrae when pushing left and right). ② Whether there are enlarged lymph nodes around the neck and trachea, as well as their size, number, texture, and mobility. Laryngeal cancer mainly metastasizes to the upper cervical pretracheal lymph nodes. ② Whether the subcutaneous tissue, muscles, thyroid gland, etc. of the neck are invaded.

2. Laryngoscopy

(1) Indirect laryngoscopy: This is a simple and easy-to-use, most commonly used examination method. It can understand the various parts of the larynx and the movement of the vocal cords, and observe the location, depth, and range of the tumor, as well as whether it has invaded the laryngeal pharynx, the hypopharynx, the tongue root, etc. Smaller lesions of epiglottic cancer, laryngeal ventricle cancer, and subglottic cancer are more hidden and easily overlooked, so they should be carefully examined. It is also possible to directly clamp the laryngeal tissue under indirect laryngoscopy and send it for pathological examination.

(2) Direct laryngoscopy: This method makes up for the shortcomings of indirect laryngoscopy, and is especially suitable for small, hidden or submucosal invasive lesions. It is more accurate to obtain biopsies, and larger and deeper living specimens can be obtained. The examination should be carried out in sequence, starting from the tongue root, the lingual surface of the epiglottis, and the laryngeal surface of the epiglottis, gradually going deeper, entering the larynx through the interglottic area and the glottic epiglottic fold, and if necessary, entering the subglottic area through the glottis, and observing the fainting area one by one.

(3) Fiberoptic laryngoscopy: It also makes up for the shortcomings of indirect laryngoscopy. Fiberoptic laryngoscopy causes less pain to patients and is superior to indirect laryngoscopy.

3. Imaging examination

(1) X-ray examination: ① Lateral laryngeal plain film, observe the tumor location, invasion range, airway patency, thyroid cartilage damage from the side; whether the prevertebral soft tissue shadow is thickened, etc. In particular, lesions in the hypopharynx, epiglottal laryngeal surface, subglottis, etc. can be displayed more satisfactorily. ② Anteroposterior laryngeal tomography, select layers 1cm, 1.5cm, 2cm and 2.5cm from the anterior neck skin, and take the film when breathing calmly, stopping breathing, making high and low sounds, etc. It can show structures such as the epiglottal folds, piriform sinus, laryngeal vestibule, false vocal cords, laryngeal ventricle, vocal cords and subglottis. Sometimes it can also show whether the thyroid cartilage is damaged.

(2) CT scan and MRI examination: They complement the deficiencies of X-ray examination and laryngoscopy. They can display the structure of various parts of the larynx and observe cartilage destruction and invasion of cancer tissue into the deep part of the larynx.