Hypopharyngeal Cancers

Hypopharyngeal cancers are usually seen in the middle-aged group and elderly, with the incidence rising above the age of 40. Men are more commonly affected than women with a 3:1 ratio. It accounts for 7% of all cancers of the upper aerodigestive tract.

Where exactly is the hypopharynx?

The hypopharynx is the most inferior part of the pharynx that leads into the esophagus.

It consists of 3 parts:

1. Posterior pharyngeal wall
2. Pyriform sinus
3. Post-cricoid area

What are the symptoms of hypopharyngeal cancers?

Hypopharyngeal cancers are usually silent in the early stages. Larger tumours are responsible for majority of patient’s complaints. Patients may complain of:

1. Persistent sore throat
2. Difficulty swallowing
3. Persistent feeling of lump in throat
4. Persistent earache
5. Blood in saliva or sputum
6. Change in voice
7. Lump in the neck (which usually indicates a spread of the cancer to the lymph nodes)

What are the risk factors?

Risk factors include:

1. Smoking
2. Heavy alcohol consumption
3. Chewing tobacco
4. Poor nutrition especially low in dietary fibre
5. Plummer-Vinson syndrome (a disease marked by iron-deficiency anaemia, and formation of web-like membranes in the throat causing difficulty swallowing)

How do we work-up and diagnose hypopharyngeal cancers?

A thorough head and neck examination is performed which includes examination of the oral cavity, the neck and a nasoendoscopy. A panendoscopy and biopsy under general anaesthesia is done in the operating theatre for tissue diagnosis. A fine needle aspiration cytology is also performed of any neck node. Either a computed tomography scan or magnetic resonance imaging (CT or MRI) is done to evaluate the extent of the hypopharyngeal lesion and possible neck node involvement. If the biopsy confirmed the diagnosis of cancer, a CT scan of the thorax and liver is done as part of the staging work-up, looking for distant spread to the lungs or the liver.

How do we treat hypopharyngeal cancers?

All patients will be discussed at the multidisciplinary tumour board where the best recommended treatment options will be detailed. Treatment modality depends on:

1. Age and general health of the patient
2. Extent of the hypopharyngeal lesion infiltration
3. Stage of the cancer
4. Patient’s expectations and preferences

For early stage disease, single modality treatment is considered either with radiotherapy or surgery of the primary hypopharyngeal lesion and the associated nodes in the neck. Conservative surgery may be performed for small tumours, especially if robotics expertise is available. For more advanced stages, multi-modality treatment is needed, either a combination of chemoradiotherapy or surgery with postoperative radiotherapy, with or without chemotherapy.

Even after completion of treatment of cancer, patients often have to undergo months of rehabilitation due to altered speech and swallowing. Hence, intensive speech and swallowing therapy as well as a regular dietician review is to be expected by our patients.