Hypopharyngeal Cancer Treatment

Hypopharyngeal cancer is a disease in which 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 esophagus (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 esophagus.

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 cancer forms in the tissues of the hypopharynx. It may spread to nearby tissues or to cartilage around the thyroid or trachea, the bone under the tongue (hyoid bone), the thyroid, the trachea, the larynx, or the esophagus. It may also spread to the lymph nodes in the neck, the carotid artery, the tissues around the upper part of the spinal column, the lining of the chest cavity, and to other parts of the body.

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

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors include the following:

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

Signs and symptoms of hypopharyngeal cancer include a sore throat and ear pain.

These and other signs and symptoms may be caused by hypopharyngeal cancer or by other conditions. Check with your doctor if you have any of the following:

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

Tests that examine the throat and neck are used to help diagnose hypopharyngeal cancer and find out whether the cancer has spread.

The following tests and procedures may be used:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• 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.
• Fiberoptic Laryngoscopy: 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, such as the head, neck, chest, and lymph nodes, 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.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
• 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, such as the head, neck, chest, and lymph nodes. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for cancer cells.
• Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
• 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 throat and 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.

Certain factors affect chance of recovery and treatment options.

The 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 signs and 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 stage of the cancer, keeping the patient’s ability to speak and swallow as normal as possible and 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

After cancer has been diagnosed, tests are done to find out if cancer cells have spread within the area 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.

There are three ways that cancer spreads in the body.

• Tissue. The cancer spreads from where it began by growing directly into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to lymph nodes.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body, such as the liver or bone.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

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 and is 2 cm or smaller and is found in only part of the hypopharynx.

Stage II

In stage II, the cancer is larger than 2 cm but not larger than 4 cm and has not spread to the voice box, or it has grown into more than one part of the hypopharynx.

Stage III

In stage III, the tumor:

• is 4 cm or smaller or has spread to the voice box or inner lining of the esophagus. Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 cm or smaller; or
• has spread to one lymph node on the same side of the neck as the tumor. The affected lymph node is 3 cm or smaller. Cancer is also found
• in only one area of the hypopharynx and/or the tumor is 2cm or smaller or is in more than one areas of the hypopharynx or in a nearby area, or
• the tumor is larger than 2cm but smaller than 4cm and has not spread to the larynx.

Stage IV*

Stage IV is the most advanced stage of cancer.

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

Surgery 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.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation with or without chemotherapy after surgery for aggressive features of cancer. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.

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. External radiation therapy is used to treat hypopharyngeal cancer.

Radiation therapy may work better 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. A blood test to check the thyroid hormone level in the body may be done before and after therapy to make sure the thyroid gland is working properly.

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 cerebrospinal fluid, 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.

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