Diagnosis
To begin with, your GP will ask you questions about your symptoms and your lifestyle (for example, whether you smoke and drink). She or he will check your medical history to see what illnesses you have had in the past, and will look at your mouth and throat.

She or he may then send you to see an ear, nose and throat (ENT) specialist doctor at a nearby hospital. There are NHS cancer referral guidelines to help GPs decide who needs to see a specialist, and how quickly.

You will then have diagnostic tests, to find out the cause of your symptoms.

If cancer is suspected, you will have further tests, to find out if you have cancer, and if you have, how large the cancer is, and whether it has spread. The results of these tests will guide your treatment.

Here are some of the tests you may have at a hospital:

Indirect laryngoscopy
The doctor will ask you to open your mouth wide. She or he will hold a small mirror at the back of your throat, and angle it to see your larynx reflected. The mirror is like the one a dentist uses when checking your teeth.

Flexible (direct) laryngoscopy using an endoscope
First your doctor may spray some local anaesthetic into your nose to ease discomfort and stop you from gagging. Then he or she will gently pass a very fine, flexible instrument with a light on the end of it (an endoscope) through your nostril and down the back of your throat. The doctor can look at your larynx through the endoscope. It is often linked to a TV monitor so you can see your larynx too.

Examination under general anaesthetic
If your specialist notices something unusual, or has not been able to see your larynx clearly, she or he will arrange for you to be admitted to hospital for examination of your larynx under general anaesthetic.

While you are asleep the doctor can look more closely at your larynx with the use of an endoscope. Small samples of tissue (biopsies) may be taken, to be examined under a microscope. This may mean you have an overnight stay in hospital. Some people can go home a few hours later – the consultant anaesthetist will be able to discuss this with you at the time.

Biopsy
If there are any suspicious lumps in your neck, a tissue sample from the suspected tumour may be taken for examination under a microscope (biopsy). The sample may be taken through a syringe (fine needle aspiration), with the use of an endoscope, as described above. You will need a general anaesthetic.

Results
If cancer is diagnosed you may want emotional and practical support and advice for yourself and your family. Your team's cancer nurse specialist will be able to answer many of your questions and signpost you to further sources of support.

Further tests
If cancer is found in the larynx or neck glands, you will have further tests:

Computerised tomography (CT, or CAT) scan

This is a type of X-ray that creates a picture of a cross-section, or slice, of the inside of your body. You lie on a special couch which moves through a large hollow ring. X-rays pass through your body, and a picture is displayed on a TV screen. Many pictures may need to be taken, but each one takes only a few seconds. Half way through the scan (which takes between 10-30 minutes) you may receive an injection in the arm of a special dye that is picked up on X-ray, to give a better picture of your throat.

The dose of radiation is more than for an ordinary X-ray, but still within levels considered a low risk, so a CT scan is regarded as safe.

Doctors will use the scan to see where the cancer is and how big it is. Depending on the area scanned, it may also show whether it has spread. This is called 'staging' of the cancer.

X-rays

X-rays of your chest may be taken, to check your general health.

Blood test

A sample of your blood will give the doctor information about your general state of health, for example how well your liver and kidneys are working.

Magnetic resonance imaging (MRI) scan

This test uses powerful magnetic waves to make a picture of the soft tissue, organs and bones of your body. It does not use X-rays.

The machine is a large, tubular ring. You will be asked to lie on your back on a hard couch that passes through the ring. With the help of a computer, pictures of slices through your body are taken. Depending on how many pictures are being taken, you may have to lie still for up to an hour in an enclosed space. If this worries you, tell the radiographer. When it is switched on the machine is very noisy, so you will be given earplugs or headphones to wear. You may also be offered the opportunity to listen to a CD of your choice.

Most district general hospitals that treat cancer will carry out this test.

Preparing for an anaesthetic

If an operation is planned, your fitness for an anaesthetic will be tested, usually by a nurse at a pre-assessment clinic. An appointment will be arranged with you before the planned date for your surgery. You will be asked about your general health, about any breathing or chest problems you have, about any medicines or supplements you are taking, and allergies. A blood sample may be taken. Your pulse and heart-rate may be monitored. You will not be asked to do exercises.