Hypopharyngeal cancer
Hypopharyngeal cancer, a type of throat cancer, primarily affects the hypopharynx, the lower part of the pharynx. This cancer is most commonly diagnosed in men, especially between the ages of fifty and sixty, and is more prevalent among Black and White Americans. Key risk factors include tobacco use, moderate to heavy alcohol consumption, poor nutrition, and the presence of Plummer-Vinson syndrome. The majority of hypopharyngeal cancers are aggressive squamous cell carcinomas that can spread rapidly, often presenting symptoms such as a persistent sore throat, difficulty swallowing, and hoarseness, which can complicate early diagnosis.
Currently, there are no routine screenings for this cancer; diagnosis typically involves physical examination, imaging studies, and biopsies. Treatment often requires surgical removal of the tumor, followed by radiation therapy, and may include chemotherapy in more advanced cases. The prognosis is generally poor, with survival rates significantly decreasing by the time the cancer reaches advanced stages. Preventative measures include maintaining a healthy lifestyle, avoiding tobacco, and limiting alcohol intake.
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Subject Terms
Hypopharyngeal cancer
ALSO KNOWN AS: Throat cancer
RELATED CONDITIONS: Head and neck cancers
DEFINITION: Hypopharyngeal cancer is a cancer of the throat (pharynx).
Risk factors: Tobacco use (smoking or chewing), moderate to heavy alcohol use, and poor nutrition are all factors that increase the risk of developing hypopharyngeal cancer. Plummer-Vinson syndrome, a rare disease also called Paterson-Kelly syndrome, is associated with an increased risk of cancer of the upper alimentary tract, including the pharynx. Human papillomavirus (HPV) may increase the risk as well. Hypopharyngeal cancer is three times more common in men than women and is more prevalent among Black and White Americans than among Asian and Latino Americans.
Etiology and the disease process: Hypopharyngeal cancers are squamous cell carcinomas that develop in the epithelial cells lining the throat. Primary tumors may occur in more than one area. This aggressive cancer spreads quickly. Around 60 percent of cases begin in the glottis, which is the area containing the vocal cords. Around 35 percent develop in the vocal cords, called the superglottic area.
Incidence: This cancer is uncommon, with around 12,500 new cases diagnosed each year, mostly in men. It is usually diagnosed in people between the ages of fifty and sixty and rare in people under thirty. The incidence of hypopharyngeal cancer decreases as smoking becomes less common.
Symptoms: Symptoms are general, making early diagnosis difficult. The most common symptoms are a sore throat (usually on one side only) that does not respond to antibiotics, a lump on the neck (swollen lymph node), hoarseness, difficulty swallowing, and ear pain.
Screening and diagnosis: There is no routine screening for hypopharyngeal cancer. Diagnosis is made by a physical examination of the neck and throat, followed by imaging studies (X-rays, magnetic resonance imaging, computed tomography scanning, or positron emission tomography scanning). An endoscopy (lighted tube passed down the throat) and biopsy (tissue sample) confirm the diagnosis.
The same procedures used in diagnosis are used for staging the cancer:
- Stage 0: Cancer is only in the lining of the throat (carcinoma in situ).
- Stage I: Only one tumor is present or smaller than 2 centimeters (cm) in diameter.
- Stage II: The tumor is 2 to 4 cm in diameter and has not spread to the larynx (voice box) but may be in more than one area of the pharynx.
- Stage III: The tumor is larger than 4 cm or has spread to the larynx or esophagus, may have spread to one nearby lymph node, and the lymph node is 3 cm or smaller; or the cancer has spread to one nearby lymph node, which is 3 cm or smaller, and the tumor is either (1) in one area of the hypopharynx or 2 cm or smaller, (2) 2 to 4 cm and has not spread to the larynx, or (3) in two or more areas of the hypopharynx and has not spread to the larynx.
- Stage IVA: Cancer has spread to nearby cartilage, bone, thyroid, or soft tissue, and may have spread to one nearby lymph node, which is 3 cm or smaller; or cancer has spread to one nearby lymph node, which is 3 to 6 cm, or to more distant lymph nodes, which are less than 6 cm, and cancer is found either (1) in one area of the hypopharynx or is 2 cm or smaller, (2) in two or more areas of the hypopharynx or surrounding tissues, or is 2 to 4 cm and has not spread to the larynx, (3) in the larynx or esophagus and is more than 4 cm, or (4) in the surrounding cartilage, bone, thyroid, or soft tissue.
- Stage IVB: The cancer has spread to the muscles surrounding the upper spinal column, the carotid artery, or the chest cavity lining and may have spread to various lymph nodes; or the tumor is of any size and has spread to one or more lymph nodes, which are more than 6 cm.
- Stage IVC: The tumor has metastasized to other parts of the body.
Treatment and therapy: The tumor and surrounding tissue are surgically removed, potentially causing permanent voice loss. Radiation treatments usually follow surgery. Chemotherapy is used in very aggressive or inoperative cases or to shrink the tumor before surgery or radiation. Transoral robotic surgery (TORS) and transoral video laryngoscopic surgery (TOVS) are increasingly used to treat this cancer. Cetuximab (Erbitux), which blocks the epidermal growth factor protein, is commonly prescribed as part of treatment.
Prognosis, prevention, and outcomes: Most hypopharyngeal cancer is diagnosed in stage III or IV, and the overall survival rate is between 30 and 35 percent. The five-year survival rate for hypopharyngeal cancer is approximately 70 percent if diagnosed in stage I, 36 to 39 percent if diagnosed in stage II or III, and 24 percent if diagnosed in stage IV. The cancer may recur, usually within the first two years following surgery. Maintaining a healthy diet, avoiding tobacco products, and restricting alcohol use will help prevent this cancer.
Bibliography
Abeloff, Martin D. Abeloff’s Clinical Oncology. 6h ed., Elsevier, 2020.
Assal, Rami El, et al. Early Detection and Treatment of Head & Neck Cancers Theoretical Background and Newly Emerging Research. Springer, 2021.
Hamoir, Marc, et al. "Multidisciplinary Management of Hypopharyngeal Carcinoma." Head and Neck Cancer: Multimodality Management, edited by Jacques Bernier. Springer, 2011, pp. 431–55.
"Hypopharyngeal Cancer Treatment (PDQ)." National Cancer Institute, 22 July 2021, www.cancer.gov/types/head-and-neck/patient/adult/hypopharyngeal-treatment-pdq. Accessed 10 July 2024.
Kwon, Daniel I., et al. “Hypopharyngeal Carcinoma: Do You Know Your Guidelines?.” Head & Neck, vol. 41, no. 3, 2019, pp. 569-576. doi:10.1002/hed.24752.
"Laryngeal and Hypopharyngeal Cancers." American Cancer Society, www.cancer.org/cancer/types/laryngeal-and-hypopharyngeal-cancer.html. Accessed 10 July 2024.
Radosevich, James A., editor. Head & Neck Cancer: Current Perspectives, Advances, and Challenges. Springer, 2013.