Overview of Hypopharyngeal Cancer

Hypopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the hypopharynx. It is a type of head and neck cancer.

The hypopharynx is the bottom part of the pharynx (throat). The pharynx is a hollow tube about five 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 three different areas. Cancer may be found in one or more of these areas.

Hypopharyngeal Cancer Risk Factors

Anything that increases your risk of getting a disease is called a risk factor. Risk factors for hypopharyngeal cancer may include:

• Smoking and/or chewing tobacco
• Moderate or heavy alcohol use (more than one drink a day)
• Poor nutrition
• Human papillomavirus (HPV) infection
• Genetic syndromes (inherited gene mutations)
• Workplace exposures to certain fumes and chemicals
• Gender (more common in men than women)
• Age (more common among patients age 65 and older)
• Race (more common among African Americans and Caucasians)
• Gastroesophageal reflux disease (GERD)

Keep in mind that having a risk factor, or even several of them, does not mean that you will get hypopharyngeal cancer. Likewise, many people who do get the disease may have few or no known risk factors at all.

Signs and Symptoms of Hypopharyngeal Cancer

There are several signs and symptoms that could be related to hypopharyngeal cancer; however, it is important to remember that they can also be symptoms of other diseases. See your doctor if you have:

• A lump in the neck
• Unexplained ear pain
• Pain or difficulty when swallowing
• A persistent sore throat
• Constant, persistent coughing
• Difficulty breathing

If any of these symptoms last for more than three weeks, it is a good idea to be checked by a doctor. If it is cancer, early detection can give you better treatment results.

Diagnosing Hypopharyngeal Cancer

There are a variety of tests that examine the throat and neck in order to detect and diagnose hypopharyngeal cancer. In many cases, you will start with an ear, nose, and throat specialist (ENT) who will perform the exams and request further testing if your doctor believes there may be a tumor in your hypopharynx.

If the doctor suspects there could be cancer, a biopsy may be performed.  A biopsy requires a tissue sample be collected from the area of the body where cancer is suspected so that the cells can be tested to see if cancer is present. Some of the following tests or procedures may be run to make a determination.

• 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 – The hypopharynx is deep inside the neck in areas in the throat that cannot be seen with a mirror during the physical exam of the throat. An endoscopic biopsy is when an endoscope (a thin, lighted tube) is inserted through the nose or mouth, and using a special instrument through the endoscope, tissue samples are taken for the biopsy.
• Laryngoscopy – A procedure to look at the larynx (voice box) for abnormal areas. A mirror or a laryngoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the mouth to see the larynx. A special tool on the laryngoscope may be used to remove samples of tissue.
• Panendoscopy – A procedure that combines laryngoscopy, esophagoscopy, and (at times) bronchoscopy. This lets the doctor thoroughly examine the entire area around the hypopharynx, including the esophagus (swallowing tube) and trachea (windpipe). While the patient is under general anesthesia, the doctor will thoroughly examine all of these areas to look for tumors and determine their size and if they’ve spread. A tissue sample can be collected for biopsy during this procedure as well.

If cancer has been found in the biopsy, it’s common to add other tests to see if the cancer has spread, and if so, how far. Your doctor may request one or more of the following imaging studies:

• 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.
• 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. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• 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 that is taken after the patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and makes it easier for the doctor to see problems in the throat.

Staging Hypopharyngeal Cancer

Many of the test results (as described in the Diagnosis section) are used to determine the extent, or stage, of the cancer. The stage of cancer describes how much cancer is in the body. It helps your doctor understand the seriousness of the cancer, how best to treat it, and what the chance of survival is.

For hypopharyngeal cancer, doctors mostly depend on the TNM system created by the American Joint Committee on Cancer (AJCC). The TNM system is based on three key pieces of information:

• How big the main tumor (T) is
• If the cancer has spread to nearby lymph nodes (N)
• The spread (metastasis) to distant parts of the body (M)

Numbers or letters after T, N, and M provide more details about each of these factors. Lower numbers mean that the cancer is in an early stage. Higher numbers mean the cancer is more advanced.

The standardized stages of hypopharyngeal cancer are:

• Stage 0 – abnormal cells in the top layer of cells lining of the hypopharynx that may become cancer.
• Stage 1 – cancer is only in one part of the hypopharynx and is no more than two centimeters.
• Stage 2 – the tumor is between two and four centimeters and has grown into more than one part of the hypopharynx or it has grown into a nearby area; it has not spread to nearby lymph nodes or to distant parts of the body.
• Stage 3 – the tumor is larger than four centimeters or it is affecting the movement of the vocal cords or it has grown to the esophagus; or it has spread to a single lymph node on the same side of the neck.
• Stage 4A – cancer has spread to the cartilage around the thyroid or trachea, bone under the tongue, the thyroid, or nearby soft tissue; spread to one lymph node on the same side of the neck (larger than three but smaller than six centimeters).
• Stage 4B – cancer spread to the muscles in the upper spinal column, carotid artery, chest cavity lining, and/or lymph nodes (any size).
• Stage 4C – any size tumor has spread to other parts of the body.

Treatment Options for Hypopharyngeal Cancer

People with early hypopharyngeal cancer may be treated with surgery and/or radiation therapy. If the cancer is more advanced, patients may have a combination of treatments. Even if surgery removes all of the tumor, there is a chance that some cancer cells remain and chemotherapy may be recommended.

Your oncologist will recommend a treatment plan based on your stage, your general health, and whether the cancer has recurred. The recommended treatments may also change based on where the cancer is located to give the patient the best chance at keeping their ability to talk, eat, and breathe as normal as possible.

• Surgery – removal of the tumor in the throat and/or lymph nodes or other tissue in the neck. The American Cancer Society lists several types of surgery options for treating hypopharyngeal cancer.
• Chemotherapy – the use of anticancer medicines or drugs to shrink or kill cancerous cells and/or to reduce the spread of cancer to other parts of the body. The specific combination of medicines will depend on the location and stage of the disease as well as what works well for the patient.
• Radiation therapy – the use of high-energy radiation to kill or shrink cancer cells. External beam radiation is the most common radiation therapy used to treat hypopharyngeal cancer.
• Targeted therapy – a special type of chemotherapy is under clinical research for hypopharyngeal cancer that takes advantage of differences between normal cells and cancer cells. The targeted therapy only attacks the cancerous cells, while leaving the healthy ones alone.

Other new types of hypopharyngeal cancer treatments are being tested in clinical trials. Patients who may want to participate in a hypopharyngeal cancer clinical trial should talk with their cancer specialist. You can also view Maryland Oncology Hematology’s currently available clinical trials online.

Sources:

https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer/causes-risks-prevention/risk-factors.html
https://www.cancer.gov/types/head-and-neck/patient/adult/hypopharyngeal-treatment-pdq
http://www.throatcancerfoundation.org/about_throat_cancer/types_of_cancer/95_hypopharyngeal_cancer
https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer/detection-diagnosis-staging/hypopharyngeal-staging.html
https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer/treating/surgery.html