Hypopharyngeal Cancer

Schematic diagram of the upper airways. Source:NCI

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. Hypopharyngeal cancers have the worst prognosis among the head and neck cancers, since they are often at an advanced stage when they are diagnosed.^[1]

Stages of Hypopharyngeal Cancer

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 in a process called staging. The information gathered from the staging process determines the stage of the disease. Imaging studies (discussed below) have become increasingly important in determining the stage of the disease.^[2]

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the hypopharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed in one area of the hypopharynx only and the tumor is 2 centimeters or smaller.

Stage II

In stage II, the tumor 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 tumor 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 tumor 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 tumor:
  • can be any size and has spread to nearby soft tissue, connective tissue, the thyroid, or the esophagus; 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
  • 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
  • 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
  • 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 tumor either:
  • has spread to nearby soft tissue, connective tissue, blood vessels, the thyroid, or the esophagus, and may have spread to lymph nodes of any size; or
  • 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.

Signs and Symptoms

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.

Diagnosis

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

Exams and tests

• 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, computerized tomography, or computerized 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 esophagogram: An x-ray of the esophagus. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken.
• Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth or nose and down the throat into the esophagus. 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.

Treatment Option Overview

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.

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.

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.^[3] 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 tumor before surgery or radiation therapy. This is called neoadjuvant chemotherapy.

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.

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.

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.

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.

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.

Recurrent Hypopharyngeal Cancer

Treatment of recurrent hypopharyngeal cancer may include the following:

• Surgery.
• Radiation therapy.
• 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. When hypopharyngeal cancer recurs, it often takes the form of multiple tumor foci dispersed in different regions; the malignant cells may be especially difficult to detect if they are covered by otherwise normal-looking and intact tissue.^[4]

Clinical Trials

New types of treatment are being tested in clinical trials.

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

Stage I Hypopharyngeal Cancer

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I hypopharyngeal cancer.

Stage II Hypopharyngeal Cancer

• A clinical trial of chemotherapy followed by radiation therapy or surgery.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II hypopharyngeal cancer.

Stage III Hypopharyngeal Cancer

• 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.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III hypopharyngeal cancer.

Stage IV Hypopharyngeal Cancer

• 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.

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

• A clinical trial of radiation therapy with chemotherapy.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV hypopharyngeal cancer.

Recurrent Hypopharyngeal Cancer

• A clinical trial of chemotherapy.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent hypopharyngeal cancer.

Chances 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.

Related Problems

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.

Expected Outcome

The most important prognostic features are the size and extent of local spread of the primary tumor, and whether or not regional lymph nodes are involved.^[5] Additional factors include:

• 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.

References

1. ↑ Wycliffe ND, Grover RS, Kim PD, Simental A Jr. Hypopharyngeal cancer. Top Magn Reson Imaging. 2007 Aug;18(4):243-58. Abstract
2. ↑ Hermans R. Staging of laryngeal and hypopharyngeal cancer: value of imaging studies. Eur Radiol. 2006 Nov;16(11):2386-400. Abstract
3. ↑ Zackrisson B, Mercke C, Strander H, Wennerberg J, Cavallin-Ståhl E. A systematic overview of radiation therapy effects in head and neck cancer. Acta Oncol. 2003;42(5-6):443-61. Abstract
4. ↑ Zbären P, Weidner S, Thoeny HC. Laryngeal and hypopharyngeal carcinomas after (chemo)radiotherapy: a diagnostic dilemma. Curr Opin Otolaryngol Head Neck Surg. 2008 Apr;16(2):147-53. Abstract
5. ↑ Helliwell TR. ACP Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx. J Clin Pathol. 2003 Feb;56(2):81-5. Abstract | Full Text | PDF

Other Resources

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