Hypopharyngeal Cancer

What is the hypopharynx?

The hypopharynx is the bottom part of the pharynx (throat), which is a hollow tube that is about five inches long. The pharynx starts behind the nose, goes down the neck (behind the voice box), and ends at the esophagus (the tube that goes from the throat to the stomach). The pharynx acts as the passageway for air and food that are on the way to the voice box or the esophagus. The hypopharynx is a combination of three anatomical subsites: The piriform sinus, the posterior hypopharyngeal wall, and the posterior cricoid.

What is hypopharyngeal cancer?

Hypopharyngeal cancer is a disease that occurs when cancerous (malignant) cells develop in the tissues of the hypopharynx.

What are the risk factors for hypopharyngeal cancer?

Risk factors include:

• Tobacco use (smoking or chewing)
• Excessive use of alcohol
• Lack of nutrients in the diet
• Presence of Plummer-Vinson syndrome (a disorder linked to severe, long-term iron deficiency anemia)

What are the symptoms of hypopharyngeal cancer?

The following signs and symptoms might be caused by hypopharyngeal cancer or by other conditions. See your doctor if you have:

• A lump in the neck
• Difficulty/pain associated with swallowing
• Voice changes
• Ear pain

How is hypopharyngeal cancer diagnosed?

Tests and procedures that are used to diagnose hypopharyngeal cancer include:

• Endoscopy — This procedure uses a thin, lighted tube that is inserted into the nose or mouth to check for anything unusual.
• Physical exam — Doctors check for swollen lymph nodes in the neck and look down the throat with a small mirror to check for anything unusual.
• CT scan (also called computed tomography or computerized tomography) — This scan takes a series of detailed pictures of areas inside the body. The images are created by a computer that is linked to an X-ray machine.
• MRI (also called magnetic resonance imaging) — This procedure uses radio waves and a powerful magnet, linked to a computer, to create detailed pictures of areas inside the body.
• Esophagoscopy — This procedure looks inside the esophagus to check for unusual areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth and down the throat into the esophagus. Tissue samples might be taken for biopsy. This is usually done under general anesthesia or heavy sedation.
• Bronchoscopy — This procedure looks for unusual areas inside the trachea and large airways of the lung. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples might be taken for biopsy. This is usually done under general anesthesia or heavy sedation.
• Biopsy — In this procedure, tissue samples are removal and viewed under a microscope to determine if cancer is present.

What are the stages of hypopharyngeal cancer?

The stages of hypopharyngeal cancer are numbered 0 through IV.

Stage 0
Cancer is confined only in the lining of the hypopharynx. There is no spread to lymph nodes.

Stage I
The tumor is in the hypopharynx and is 2 centimeters (about ½ inch) or smaller in size. There is no spread to lymph nodes.

Stage II
The tumor is either larger than 2 centimeters, but not larger than 4 centimeters (between about ½ and 1½ inches), and has not spread to the larynx (voice box), or it is found in more than one area of the hypopharynx or tissues nearby. There is no spread to lymph nodes.

Stage III
The tumor is in only one area of the hypopharynx, and is 2 centimeters or smaller in size. The cancer has also spread to a single lymph node on the same side of the neck, and the lymph node is 3 centimeters (just over 1 inch) or smaller. Stage III can also be defined by a tumor that is larger than 4 centimeters (about 1½ inches) or that has spread to the larynx, with or without lymph node spread.

Stage IV
This stage is divided into Stage IVA, IVB, and IVC.

Stages IVA and IVB
This is an advanced stage in which local disease and/or lymph node disease has spread. The spreading may involve movement from the pharynx into nearby soft tissues, such as the voice box, the thyroid gland, or the carotid artery. Neck disease may have spread to several lymph nodes or very large lymph nodes (over 6 centimeters; between 2 and 2½ inches).

Stage IVC
The cancer has spread beyond the hypopharynx to other parts of the body.

How is hypopharyngeal cancer treated at each stage?

Stage I
At Stage I, treatment might include pharyngectomy (removal of part of the pharynx) and surgery to remove lymph nodes or other tissues of the neck. Radiation therapy may follow the surgery in some patients – applied to the lymph nodes of the neck. Another option could be to use radiation therapy alone.

Stage II
Treatment of Stage II hypopharyngeal cancer might include partial or total laryngopharyngectomy (removal of the larynx and pharynx) and surgery to remove lymph nodes or other tissues of the neck. Radiation therapy may follow the surgery in some patients – applied to the lymph nodes of the neck. Chemotherapy might also be given during this radiation therapy. Another treatment option might be to use chemotherapy followed by radiation or surgery, depending on the response of the tumor to the chemotherapy.

Stage III and Stage IV
Treatment might include the following:

• Radiation therapy before or after surgery, with or without chemotherapy.
• Chemotherapy followed by surgery and/or radiation therapy
• Chemotherapy given at the same time as radiation therapy
• Surgery followed by chemotherapy given at the same time as radiation therapy
• Reconstructive surgery to help with eating, breathing, or talking if all or part of the hypopharynx is removed

What is the prognosis (chance for recovery) for people with hypopharyngeal cancer?

The 5-year survival rate for all stages of pharyngeal cancer is less than 50%. However, keep in mind that this estimate is based on data from thousands of cases of this type of cancer in the United States and might not apply to an individual person.

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