Hypopharyngeal Cancer

Hypopharyngeal cancer is a rare kind of throat cancer. Medical experts also use the term “head and neck cancer.”

The hypopharynx helps direct food past the larynx and into the esophagus. Cancer occurs in the tissues of the hypopharynx, which include the piriform sinus, the posterior hypopharyngeal wall, and the posterior cricoid region.

Cancer that starts in the hypopharynx can migrate to neighboring tissues or cartilage surrounding the hyoid bone, thyroid, trachea, larynx, or esophagus, among other organs. Additionally, it might extend to the tissues around the upper spinal column, the carotid artery, the lymph nodes in the neck, the lining of the chest cavity, and other body areas.

The vast majority of hypopharyngeal cancers are squamous cell carcinomas, which are generally caused by smoking.

Hypopharyngeal carcinoma accounts for a negligible portion of cases of head and neck cancer. There are about 65,000 Americans affected by head and neck cancer each year. Only 3,000 of the instances are linked to hypopharyngeal cancer.

In recent years, there has been a general decline in hypopharyngeal cancer incidence. Hypopharyngeal cancer can affect anyone. However, it often affects more men than women, primarily aged older than 50 years.

Hypopharyngeal malignancies frequently grow to significant sizes before people's symptoms begin.

• Difficulty swallowing: The most common symptom. The tumor interferes with swallowing and makes it difficult for food to pass. It frequently begins with trouble swallowing solid foods. When the tumor spreads into the esophagus, it will get challenging to swallow liquids as well.
• Throat pain: Pain during swallowing could be a symptom. In rare circumstances, throat pain could be felt even while swallowing is not taking place.
• Lump in the neck: Occurs when hypopharyngeal carcinoma has migrated to the lymph nodes in the neck. This can be the primary reason that prompts a person to visit the doctor.
• Ear pain: Also called otalgia and can arise, especially on one side and in the absence of other ear problems. Because one of the ear's nerves shares a pathway with the throat's nerve that reaches the brain. Referred pain, which is throat pain, is interpreted by the brain as ear pain. If you experience persistent, unexplained ear pain, see a doctor. It is important to comprehend the most typical causes of ear pain, which include temporomandibular joint and eustachian tube dysfunctions and middle ear infections.

Additional symptoms

• A breathy or hoarse voice
• Loss of weight
• Having the impression that something is in your throat
• A throat wound that is bleeding
• Coughing whenever you drink
• Challenging or noisy breathing

The actual cause of hypopharyngeal carcinoma is uncertain. However, a few risk factors can make this malignancy more likely to develop.

• Tobacco use, including chewing tobacco
• Alcohol abuse
• Poor nutrition
• Male gender
• Aged older than 65 years
• More prevalent in African Americans
• People exposed to wood dust, paint fumes, asbestos, and some other chemicals
• Gastroesophageal reflux disease

Like other head and neck cancers, hypopharyngeal carcinoma is staged using the American Joint Committee on Cancer TNM approach.

• T or tumor size: Based on imaging tests, the size, and the depth of the cancerous tumor within the hypopharynx are determined.
• N or lymph node involvement: Identifies whether and how the malignancy has progressed to the neck lymph nodes.
• M or metastases: Clarifies whether and where cancer has migrated outside of the neck (including into organs in the chest, liver, or bones).

In general, the stages are described as:

1. Stage 0: The cells that line the hypopharynx are abnormal. The cells have not multiplied and may not have developed into a tumor (Tis). No other bodily parts (M0) or lymph nodes are impacted (N0).
2. Stage I: The hypopharynx only has one spot where cancer has developed. Tumor size is 2 cm or less (T1). Other bodily components (M0), including the lymph nodes, are unaffected (N0).
3. Stage II: The hypopharynx has more than one area with abnormal cells, or the tumor is between 2 to 4 cm (T2). It has only affected a small portion of the hypopharynx. The larynx and other body components (M0) have not been impacted, and there are no afflicted lymph nodes (N0).
4. Stage III: The tumor is more than 4 cm, or it has progressed to the esophagus (T3) or larynx but not to the lymph nodes (N0, M0). The tumor might not be that large, but the cancer may have progressed to a lymph node that is no more than 3 cm (N1). The body's other organs are unaffected (M0).
5. Stage IV: Stage IV is further divided into three substages.
   • Stage IVA: The malignancy has spread to the thyroid, cricoid cartilage, larynx, bone under the tongue, or nearby soft tissue (T4a). Cancer may not have spread to any nearby lymph nodes (N0) or one lymph node on the same side of the neck as the tumor. The size is less than 3 cm (N1), or the tumor has spread to the lymph nodes (N2) while being tiny (T1 to T4a). The body is unaffected (M0).
   • Stage IVB: The tumor has invaded the carotid artery, the lining of the space between the lungs or the muscles of the upper spinal column (T4b). Any lymph node can be affected (any N). No other body parts are impacted (M0).
   • Stage IVC: The tumor could be of any size, and it could affect the larynx (any T). Lymph nodes could be impacted (any N). In addition to the hypopharynx, cancer has progressed to organs, such as the lung, liver, or bone (M1).

Based on your circumstances, your healthcare team will develop a treatment strategy. Your recommended course of treatment will be determined by several variables and may include more than one type of therapy.

• Chemotherapy: Strong drugs are used to kill cancer cells all over the body. Chemotherapy could be used to reduce a tumor’s size. Alternatively, it might help eliminate any cancer cells that surgery could not remove. Doctors typically advise chemotherapy along with radiation therapy.
• Radiation therapy: Targeted radiation beams are delivered by sophisticated devices to kill cancer cells while sparing healthy tissues. Based on your unique situation, your doctor will advise you on the best type of radiation therapy and decide the treatment period.
• Immunotherapy: More recent medications are used to increase the body's natural defenses. The immune system detects and eliminates cancer cells.
• Surgery: The doctor will consider the tumor's size and location along with other factors. Some people require multiple procedures. Your doctor will first try to remove as much of the tumor as possible. If cancer has progressed to other tissues, they could additionally remove lymph nodes or neck structures. There are a few surgical options, which include:
  • Pharyngectomy: Removes a part or all of the pharynx.
  • Laryngopharyngectomy: Removes part or all of the pharynx and larynx.