Hypopharyngeal Cancer

Key Points for This Section

  • Hypopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the hypopharynx.
  • Use of tobacco products and heavy drinking can affect the risk of developing hypopharyngeal cancer.
  • Possible signs of hypopharyngeal cancer include a sore throat and ear pain.
  • Tests that examine the throat and neck are used to help detect (find) and diagnose hypopharyngeal cancer.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Hypopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the hypopharynx.

The hypopharynx is the bottom part of the pharynx (throat). The pharynx is a hollow tube about 5 inches long that starts behind the nose, goes down the neck, and ends at the top of the trachea (windpipe) and oesophagus (the tube that goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the oesophagus.

Most hypopharyngeal cancers form in squamous cells, the thin, flat cells lining the inside of the hypopharynx. The hypopharynx has 3 different areas. Cancer may be found in 1 or more of these areas.

Use of tobacco products and heavy drinking can affect the risk of developing hypopharyngeal cancer.

Risk factors include the following:

  • Smoking tobacco.
  • Chewing tobacco.
  • Heavy alcohol use.
  • Eating a diet without enough nutrients.
  • Having Plummer-Vinson syndrome.

Possible signs of hypopharyngeal cancer include a sore throat and ear pain.

These and other symptoms may be caused by hypopharyngeal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

  • A sore throat that does not go away.
  • Ear pain.
  • A lump in the neck.
  • Painful or difficult swallowing.
  • A change in voice.

Tests that examine the throat and neck are used to help detect (find) and diagnose hypopharyngeal cancer.

The following tests and procedures may be used:

  • Physical exam of the throat: An exam in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.
  • Endoscopy: A procedure used to look at areas in the throat that cannot be seen with a mirror during the physical exam of the throat. An endoscope (a thin, lighted tube) is inserted through the nose or mouth to check the throat for anything that seems unusual. Tissue samples may be taken for biopsy.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Head, neck, and chest x-rays: An x-ray of the head, neck, and organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Barium oesophagogram: An x-ray of the oesophagus. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the oesophagus and x-rays are taken.
  • Oesophagoscopy: A procedure to look inside the oesophagus to check for abnormal areas. An oesophagoscope (a thin, lighted tube) is inserted through the mouth or nose and down the throat into the oesophagus. Tissue samples may be taken for biopsy.
  • Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

Prognosis (chance of recovery) depends on the following:

  • The stage of the cancer (whether it affects part of the hypopharynx, involves the whole hypopharynx, or has spread to other places in the body). Hypopharyngeal cancer is usually detected in later stages because early symptoms rarely occur.
  • The patient's age, gender, and general health.
  • The location of the cancer.
  • Whether the patient smokes during radiation therapy.

Treatment options depend on the following:

  • The stage of the cancer.
  • Keeping the patient's ability to talk, eat, and breathe as normal as possible.
  • The patient's general health.

Patients who have had hypopharyngeal cancer are at an increased risk of developing a second cancer in the head or neck. Frequent and careful follow-up is important.

Stages of Hypopharyngeal Cancer

Key Points for This Section

  • After hypopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the hypopharynx or to other parts of the body.
  • The following stages are used for hypopharyngeal cancer:
    • o Stage 0 (Carcinoma in Situ)
    o Stage I
    o Stage II
    o Stage III
    o Stage IV

    After hypopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the hypopharynx or to other parts of the body.

    The process used to find out if cancer has spread within the hypopharynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnose hypopharyngeal cancer are often also used to stage the disease.

    The following stages are used for hypopharyngeal cancer:

    Stage 0 (Carcinoma in Situ)

    In stage 0, cancer is found only in the lining of the hypopharynx. Stage 0 cancer is also called carcinoma in situ.

    Stage I

    In stage I, the tumour is found in one area of the hypopharynx only and is 2 centimeters or smaller.

    Stage II

    In stage II, the tumour is either:

    • larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx (voice box); or
    • found in more than one area of the hypopharynx or in nearby tissues.

    Stage III

    In stage III, one of the following is found:

    • The tumour is in only one area of the hypopharynx and is 2 centimeters or smaller; cancer has also spread to a single lymph node on the same side of the neck and the lymph node is 3 centimeters or smaller.
    • Cancer is in more than one area of the hypopharynx, is in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and is not in the larynx; cancer has also spread to a single lymph node on the same side of the neck and the lymph node is 3 centimeters or smaller.
    • The tumour is larger than 4 centimeters or has spread to the larynx; cancer may have spread to a single lymph node on the same side of the neck and the lymph node is 3 centimeters or smaller.

    Stage IV

    Stage IV is divided into stage IVA, IVB, and IVC as follows:

    • In stage IVA, the tumour:
      • o can be any size and has spread to nearby soft tissue, connective tissue, the thyroid, or the oesophagus; cancer may be found either in one lymph node on the same side of the neck (the lymph node is 3 centimeters or smaller) or in one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller); or
      o is in only one area of the hypopharynx, is 2 centimeters or smaller, and has also spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller); or
      o is in more than one area of the hypopharynx, is in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx; cancer has spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller); or
      o is larger than 4 centimeters or has spread to the larynx; cancer has also spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller).
    • In stage IVB, the tumour either:
      • o has spread to nearby soft tissue, connective tissue, blood vessels, the thyroid, or the oesophagus, and may have spread to lymph nodes of any size; or
      o is any size and has spread to lymph nodes that are larger than 6 centimeters.
    • In stage IVC, cancer has spread beyond the hypopharynx to other parts of the body.

    Recurrent Hypopharyngeal Cancer

    Recurrent hypopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the hypopharynx or in other parts of the body.

    Treatment Option Overview

    Key Points for This Section

    • There are different types of treatment for patients with hypopharyngeal cancer.
    • Three types of standard treatment are used:
      • o Surgery
      o Radiation therapy
      o Chemotherapy
    • New types of treatment are being tested in clinical trials.

    There are different types of treatment for patients with hypopharyngeal cancer.

    Different types of treatment are available for patients with hypopharyngeal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

    Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

    Three types of standard treatment are used:

    Surgery

    Surgery (removing the cancer in an operation) is a common treatment for all stages of hypopharyngeal cancer. The following surgical procedures may be used:

    • Laryngopharyngectomy: Surgery to remove the larynx (voice box) and part of the pharynx (throat).
    • Partial laryngopharyngectomy: Surgery to remove part of the larynx and part of the pharynx. A partial laryngopharyngectomy prevents loss of the voice.
    • Neck dissection: Surgery to remove lymph nodes and other tissues in the neck.

    Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

    Radiation therapy

    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

    Radiation therapy may be more effective in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The thyroid gland may be tested before and after therapy to make sure it is working properly.

    Chemotherapy

    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

    Chemotherapy may be used to shrink the tumour before surgery or radiation therapy. This is called neoadjuvant chemotherapy.

    New types of treatment are being tested in clinical trials.

    Information about ongoing clinical trials is available from the NCI Web site.

    Treatment Options by Stage

    Stage I Hypopharyngeal Cancer

    Treatment of stage I hypopharyngeal cancer may include the following:

    • Laryngopharyngectomy and neck dissection with or without high-dose radiation therapy to the lymph nodes of the neck.
    • Partial laryngopharyngectomy with or without high-dose radiation therapy to the lymph nodes on both sides of the neck.

    Stage II Hypopharyngeal Cancer

    Treatment of stage II hypopharyngeal cancer may include the following:

    • Laryngopharyngectomy and neck dissection. High-dose radiation therapy to the lymph nodes of the neck may be given before or after surgery.
    • Partial laryngopharyngectomy. High-dose radiation therapy to the lymph nodes of the neck may be given before or after surgery.
    • Chemotherapy given during or after radiation therapy or after surgery.
    • A clinical trial of chemotherapy followed by radiation therapy or surgery.

    Stage III Hypopharyngeal Cancer

    Treatment of stage III hypopharyngeal cancer may include the following:

    • Radiation therapy before or after surgery.
    • Chemotherapy given during or after radiation therapy or after surgery.
    • A clinical trial of chemotherapy followed by surgery and/or radiation therapy.
    • A clinical trial of chemotherapy given at the same time as radiation therapy.
    • A clinical trial of surgery followed by chemotherapy given at the same time as radiation therapy.

    Treatment and follow-up of stage III hypopharyngeal cancer is complex and is ideally overseen by a team of specialists with experience and expertise in treating this type of cancer. If all or part of the hypopharynx is removed, the patient may need plastic surgery and other special help with breathing, eating, and talking.

    Stage IV Hypopharyngeal Cancer

    Treatment of stage IV hypopharyngeal cancer that can be treated with surgery may include the following:

    • Radiation therapy before or after surgery.
    • A clinical trial of chemotherapy followed by surgery and/or radiation therapy.
    • A clinical trial of surgery followed by chemotherapy given at the same time as radiation therapy.

    Surgical treatment and follow-up of stage IV hypopharyngeal cancer is complex and is ideally overseen by a team of specialists with experience and expertise in treating this type of cancer. If all or part of the hypopharynx is removed, the patient may need plastic surgery and other special help with breathing, eating, and talking.

    Treatment of stage IV hypopharyngeal cancer that cannot be treated with surgery may include the following:

    • Radiation therapy.
    • Chemotherapy given at the same time as radiation therapy.
    • A clinical trial of radiation therapy with chemotherapy.

    Follow-up to check for recurrence should include careful head and neck exams once a month in the first year after treatment ends, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.

    Treatment Options for Recurrent Hypopharyngeal Cancer

    Treatment of recurrent hypopharyngeal cancer may include the following:

    • Surgery.
    • Radiation therapy.
    • Chemotherapy.
    • A clinical trial of chemotherapy.

    Follow-up to check for recurrence should include careful head and neck exams once a month in the first year after treatment ends, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.


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