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{{Hypopharyngeal cancer}}
{{Hypopharyngeal cancer}}
{{CMG}} {{AE}}{{Faizan}}
{{CMG}}; {{AE}} {{G.D.}}, {{Faizan}}
==Overview==
==Overview==
Hypopharyngeal cancer is a [[disease]] in which [[malignant]] cells proliferate in the hypopharynx. Most hypopharyngeal cancers form in squamous cells, the thin, flat cells lining the inside of the hypopharynx. It first forms in the outer layer ([[epithelium]]) of the hypopharynx, which is split into three areas. Progression of the disease is defined by the spread of cancer into one or more areas and into deeper tissues. Genes involved in the pathogenesis of hypopharyngeal cancer include ''[[P16 (gene)|p16]]'', ''[[NOTCH1]]'', ''[[cyclin D1]]'', and ''[[TP53]]''. Hypopharyngeal cancer is associated with sideropaenic dysphagia and Paterson Brown Kelly syndrome.On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are characteristic findings of hypopharyngeal cancer. On microscopic histopathological analysis, [[spindle cell]]s, basaloid cells, and nuclear atypia are characteristic findings of hypopharyngeal cancer.There are no established direct causes for hypopharngeal cancer. The prevalence of hypopharyngeal cancer is estimated to be approximately 10% of all proximal aerodigestive tract malignancies.<ref name=aa>Epidemiology of Hypophrayngeal carcinoma.The incidence of hypopharyngeal cancer is estimated to be 0.78 cases per 100,000 individuals in the United States each year.Hypopharyngeal cancer commonly affects individuals older than 50 years of age. Males are more commonly affected with hypopharyngeal cancer than females. If left untreated, hypopharyngeal cancer produces few symptoms early in the course. Once the [[tumor]] has expanded from its site of origin, it may obstruct the aerodigestive tract. Common complications of hypopharyngeal cancer include [[airway obstruction]] and disfigurement of the neck or face. The prognosis varies with the type of hypopharyngeal cancer. Squamous cell carcinoma of hypopharynx has the most unfavorable prognosis. The optimal therapy for hypopharyngeal cancer depends on the stage at the time of diagnosis. The feasibility of surgery depends on the stage of hypopharyngeal cancer at the time of diagnosis.
Hypopharyngeal cancer was discovered in 1970 by Dr.Harrison in London, U.K. Hypopharyngeal cancer is a [[disease]] in which [[malignant]] cells proliferate in the [[hypopharynx]]. Most hypopharyngeal cancers form in the  [[Squamous|squamous cells]], which are thin, flat [[cells]] lining inside the [[hypopharynx]]. Hypopharyngeal cancer can be [[Classification|classified]] according to the [[anatomy]] regions and [[histopathological]] derivatives. The [[anatomic]] location of hypopharyngeal cancer is divided into 3 subtypes such as [[Pyriform fossa|pyriform]] [[sinus]] [[cancer]], [[Cricoid|postcricoid]] area [[cancer]] and [[posterior]] wall of the [[hypopharynx]]. There are no direct [[causes]] of hypopharyngeal cancer, however [[Tobacco|tobacco abuse]], [[Alcohol consumption|abuse of alcohol consumption]], [[HPV]] [[infection]], [[Plummer-Vinsom syndrome]], and [[asbestos]] have been associated with hypopharyngeal cancer. [[Genes]] involved in the [[pathogenesis]] of hypopharyngeal cancer include ''[[P16 (gene)|p16]]'', ''[[NOTCH1]]'', ''[[cyclin D1]]'', and ''[[TP53]]''. Hypopharyngeal cancer is associated with [[Dysphagia|sideropaenic dysphagia]] and [[Paterson-Brown-Kelly syndrome|Paterson Brown Kelly syndrome]]. On gross [[pathology]], flattened [[plaques]], [[mucosal]] [[ulceration]], and raised margins of the [[lesion]] are characteristic findings of hypopharyngeal cancer. On [[microscopic]] [[histopathological]] analysis, [[spindle cell]]s, basaloid cells, and [[nuclear]] [[atypia]] are characteristic findings of hypopharyngeal cancer. The [[prevalence]] of hypopharyngeal cancer is estimated to be 2,500 new cases annually in U.S and hypopharyngeal cancer is a very rare type of [[cancer]]. Hypopharyngeal cancer commonly affects [[patients]] in 55 to 65 years of age. Males are mostly affected with a hypopharyngeal cancer compare to women. Hypopharyngeal cancer comprises about 7% of all [[cancers]] of the [[head]] and [[neck]]. According to the National Cancer Institute and American Cancer Society, [[screening test]] for hypopharyngeal cancer is not recommended.The majority of patients with hypopharyngeal cancer are initially [[asymptomatic]]. Most [[patients]] with hypopharyngeal cancer clinically manisfest [[symptoms]] at a late stage (III and IV) because of the [[tumor]] aggression which [[Metastasize|metastasizes]] to [[lymph nodes]] and [[submucosa]]. Once the [[tumor]] has expanded from its original site, it may obstruct the [[Digestive|aerodigestive]] [[tract]]. Most common [[clinical]] presentations are [[Neck masses|neck mass]], [[Dysphagia|dysphagia with weight loss]], non healing [[sore throat]], [[odynophagia]], and [[hoarseness]]. Common complications of hypopharyngeal cancer include [[upper airway obstruction]] and disfigurement of the [[neck]] or [[face]]. The [[prognosis]] varies with the type of hypopharyngeal cancer. The [[Squamous cell carcinoma]] of the [[hypopharynx]] has a poor [[prognosis]] and small [[survival rate]].The [[medical]] [[therapy]] with the combination of the [[radiotherapy]] has been used compared to surgical [[therapy]] for the treatment of hypopharyngeal cancer. [[Swallowing]], [[speech]] and [[laryngeal]] preservation are important to consider during the treatment. The feasibility of [[surgery]] depends on the stage of hypopharyngeal cancer at the time of the [[diagnosis]].The main goal of the [[surgery]] is to clear any margin that contains the [[tumor]] [[cells]]. The available [[surgery]] options are transoral [[laser surgery]], total [[laryngectomy]] with partial [[Pharynx|pharyngectomy]] [[surgery]], total [[laryngectomy]] and circumferential [[Pharynx|pharyngectomy]].
 
==Historical Prospective==
Hypopharyngeal Cancer is a rare type of [[malignant tumor]]. Hypopharyngeal cancer was discovered by Harrisson in 1970 with more than half in the [[Cricoid|postcricoid]] part.


==Classification==
==Classification==
Hypopharyngeal cancer may be classified based on the location into 4 subtypes: pyriform sinus cancer, postcricoid area cancer, posterior wall of hypopharynx cancer, and hypopharynx cancer unspecified.
Hypopharyngeal cancer may be classified according to the location into 4 subtypes: [[Pyriform fossa|pyriform]] [[sinus]] cancer, [[Cricoid|postcricoid]] area [[cancer]], and [[Posterior|posterior wall]] of [[hypopharynx]] [[cancer]]. A [[Pyriform fossa|pyriform]] [[sinus]] [[cancer]] subtype is found in 60 to 85 percent of patients who are diagnosed with hypopharyngeal cancer. Hypopharyngeal cancer may also be classified based on the histopathology.


==Pathophysiology==
==Pathophysiology==
Hypopharyngeal cancer arises from [[squamous cell]]s, which are cells that are normally involved in protection of aerodigestive tract. Genes involved in the pathogenesis of hypopharyngeal cancer include ''[[P16 (gene)|p16]]'', ''[[NOTCH1]]'', ''[[cyclin D1]]'', and ''[[TP53]]''. Hypopharyngeal cancer is associated with [[sideropenic dysphagia]] and [[Paterson-Brown-Kelly syndrome]]. On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are characteristic findings of hypopharyngeal cancer. On microscopic histopathological analysis, [[spindle cell]]s, basaloid cells, and nuclear atypia are characteristic findings of hypopharyngeal cancer.
Hypopharyngeal cancer arises from [[squamous cell]]s, which are [[cells]] that are normally involved in protection of [[Digestive|aerodigestive]] [[tract]]. Hypopharyngeal cancer is a rare type of [[malignant]] [[cancer]] which has a delayed onset of clinical manifestations. Hypopharyngeal cancer is usually diagnosed at an advanced stage and it spreads to other organs such as [[lungs]], [[mediastinum]], [[bones]], [[brain]], [[liver]], [[esophagus]], and [[thyroid gland]]. The [[Metastasis|metastatic]] invasion depends on the [[anatomic]] location of the hypopharyngeal cancer. Hypopharyngeal cancer is mostly differentiated as [[squamous]] [[cell]] [[carcinoma]], but the [[undifferentiated]] type can be found in the [[Pyriform fossa|pyriform]] [[sinus]] region. The exact [[pathogenesis]] of the hypopharyngeal cancer is not exactly understood, but the  ''[[P16 (gene)|p16]]'', ''[[cyclin D1]]'', ''[[NOTCH1]]'', and ''[[TP53]]'' gene [[mutations]] have been associated with the [[development]] of the hypopharyngeal cancer. Hypopharyngeal cancer is associated with [[sideropenic]] [[dysphagia]] and [[Paterson-Brown-Kelly syndrome|Paterson]] [[Brown]] [[Kelly-Paterson syndrome|Kelly]] [[syndrome]]. On gross [[pathology]], flattened [[plaques]], [[mucosal]] [[ulceration]], and raised margins of the [[lesion]] are the characteristic findings of hypopharyngeal cancer. On [[microscopic]] [[histopathological]] analysis, [[spindle cell]]s, basaloid cells, and [[nuclear]] [[atypia]] are the characteristic findings of hypopharyngeal cancer.


==Causes==
==Causes==
There are no established direct causes for hypopharngeal cancer. Common risk factors for hypopharyngeal cancer can be found [[Hypopharyngeal cancer risk factors|'''here''']].
There are no direct [[causes]] for hypopharngeal cancer however, there are some common risk factors that may lead to gene [[mutations]] and cause the hypopharyngeal cancer. Common risk factors for hypopharyngeal cancer can be found [[Hypopharyngeal cancer risk factors|'''here''']].


==Differentiating Hypopharyngeal Cancer from other Diseases==
==Differentiating Hypopharyngeal Cancer from other Diseases==
Line 18: Line 21:


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The prevalence of hypopharyngeal cancer is estimated to be approximately 10% of all proximal aerodigestive tract malignancies. The incidence of hypopharyngeal cancer is estimated to be 0.78 cases per 100,000 individuals in the United States. Hypopharyngeal cancer commonly affects individuals older than 50 years of age. Males are more commonly affected with hypopharyngeal cancer than females.
The [[prevalence]] of hypopharyngeal cancer is estimated to be 2,500 new cases annually in U.S and hypopharyngeal cancer is a very [[rare]] type of [[cancer]]. Hypopharyngeal cancer commonly affects patients in 55 to 65 years of age. Males are mostly affected with a hypopharyngeal cancer compare to women. Hypopharyngeal cancer comprises about 7% of all [[cancers]] of the [[head]] and [[neck]].


==Risk Factors==
==Risk Factors==
Common risk factors in the development of hypopharyngeal cancer are smoking tobacco, chewing tobacco, heavy alcohol intake, and [[Plummer-Vinson syndrome]].
Common risk factors in the development of hypopharyngeal cancer are [[tobacco]] use, and abuse of [[alcohol]] consumption.
 
==Screening==
According to the National Cancer Institute and American Cancer Society, [[Screening test|screening]] [[test]] for hypopharyngeal cancer is not recommended.


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
If left untreated, hypopharyngeal cancer produces few symptoms early in the course. Once the [[tumor]] has expanded from its site of origin, it may obstruct the aerodigestive tract. Common complications of hypopharyngeal cancer include [[airway obstruction]] and disfigurement of the neck or face. The prognosis varies with the type of hypopharyngeal cancer. Squamous cell carcinoma of hypopharynx has the most unfavorable prognosis.
The majority of patients with hypopharyngeal cancer are initially [[asymptomatic]]. Most patients with hypopharyngeal cancer clinically manisfest [[symptoms]] at late stage (III and IV) because of the [[tumor]] aggression which [[Metastasis|metastasizes]] to [[lymph nodes]] and [[submucosa]]. Once the [[tumor]] has expanded from its site of [[origin]], it may obstruct the [[Digestive|aerodigestive]] [[tract]]. Most common clinical presentations are [[neck]] [[mass]], [[dysphagia]] with [[weight loss]], non healing [[sore throat]], [[odynophagia]], and [[hoarseness]]. Common complications of hypopharyngeal cancer include upper [[airway obstruction]] and disfigurement of the [[neck]] or [[face]]. The [[prognosis]] varies with the type of hypopharyngeal cancer. [[Squamous]] [[cell]] [[carcinoma]] of [[hypopharynx]] has poor [[prognosis]] and small [[survival rate]].


==Staging==
== Diagnostic Study of Choice and Staging==
According to the [[TNM staging system]], there are 5 stages of hypopharyngeal cancer based on the [[tumor]] size, [[lymph node]] involvement, and distant [[metastasis]].
The [[diagnostic]] study of choice for hypopharyngeal cancer is [[CT scan]] with [[contrast]] of [[head]] and [[neck]]. The definitive [[diagnosis]] of hypopharyngeal cancer is [[biopsy]] of the [[tumor]].
According to the American Joint Committee of Cancer (AJCC) [[TNM staging system]], there are 5 stages of hypopharyngeal cancer based on the [[ tumor ]]size, [[lymph node]] involvement, and distant [[metastasis]].


==History and Symptoms==
==History and Symptoms==
The hallmark of hypopharyngeal cancer is [[dysphagia]]. A positive history of [[odynophagia]] and [[hoarseness]] is suggestive of hypopharyngeal cancer. Common symptoms include lump in the neck, dysphasia, and hoarseness.
The hallmark of hypopharyngeal cancer is [[dysphagia]]. A positive history of [[odynophagia]] and [[hoarseness]] is suggestive of hypopharyngeal cancer. Common [[symptoms]] include a [[lump]] in the [[neck]], [[dysphagia]], [[chronic]] [[sore]] [[throat]] and [[hoarseness]].


==Physical Examination==
==Physical Examination==
Patients with hypopharyngeal carcinoma are usually well appearing. Physical examination of patients with hypopharyngeal carcinoma is usually remarkable for neck [[swelling]], [[hearing loss]], and partial airway obstruction.
Patients with hypopharyngeal carcinoma are usually well appearing. [[Physical]] [[examination]] of the patients with hypopharyngeal carcinoma is usually remarkable for the [[neck]] [[swelling]].


==Laboratory Findings==
==Laboratory Findings==
There are no diagnostic laboratory findings associated with hypopharyngeal cancer.
There are no [[diagnostic]] laboratory findings associated with hypopharyngeal cancer.
 
==Electrocardiogram==
There are no [[ECG ]]findings associated with hypopharyngeal cancer.


==Chest X Ray==
==Chest X Ray==
There are no chest x ray findings associated with hypopharyngeal cancer.
[[Chest X rays]] may be performed to detect [[metastasis]] of hypopharyngeal cancer to the [[lungs]].


==CT==
==CT==
Head and neck [[CT scan]] may be helpful in the diagnosis of hypopharyngeal cancer. Findings on CT scan suggestive of hypopharyngeal cancer include solid soft tissue nodule, region of superficial thickening with increased enhancement, and obliteration of [[fat]] planes.
[[Head]] and [[neck]] [[CT scan]] may be helpful in the [[diagnosis]] of hypopharyngeal cancer. Findings on [[CT scan]] suggestive of hypopharyngeal cancer include [[soft]] [[tissue]] [[mass]], irregular thickening of the [[mucosa]], and [[necrotic]] region which is a sign of [[metastasis]].


==MRI==
==MRI==
[[MRI]] may be helpful in the diagnosis of hypopharyngeal cancer. Findings on MRI suggestive of hypopharyneal cancer include intermediate to low signal mass and soft tissue enhancement.
[[MRI]] may be helpful in the diagnosis of hypopharyngeal cancer. Findings on the [[MRI]] suggestive of hypopharyneal cancer include [[tumors]] are hypointense on T1 and hyperintense on T2 for [[soft]] [[tissues]].


==Other Imaging Findings==
==Other Imaging Findings==
Other diagnostic studies for hypopharyngeal cancer include barium swallow, which demonstrates irregular filling defects. Small sessile or superficially spreading lesions can be difficult or impossible to diagnose. Larger lesions may be visualized as irregular filling defects. Fluoro-D-glucose positron emission tomography may be performed to detect metastases of hypopharyngeal cancer.
[[Ultrasound]] may be helpful to assess hypopharyngeal cancer along with [[endoscopy]]. [[Ultrasound]] may be use to detect, and localize primary [[tumors]] that invade neighboring organs such as [[esophagus]], [[thyroid gland]], and [[postcricoid]] area.


==Other Diagnostic Studies==
==Other Diagnostic Studies==
Biopsy may be diagnostic of hypopharyngeal cancer. Findings on biopsy diagnostic of hypopharyngeal cancer include spindle cells, basaloid cells, and nuclear atypia.
[[Biopsy]] may be [[diagnostic]] of hypopharyngeal cancer. Findings on [[biopsy]] [[diagnostic]] of hypopharyngeal cancer include [[spindle cell]]s, basaloid [[cells]], and [[nuclear]] [[atypia]].


==Medical Therapy==
==Medical Therapy==
The optimal therapy for hypopharyngeal cancer depends on the stage at the time of diagnosis.
The [[medical]] [[therapy]] with the combination of the [[radiotherapy]] has been used compared to [[Surgery|surgical]] [[therapy]] for the treatment of hypopharyngeal cancer.The optimal [[therapy]] for hypopharyngeal cancer depends on the stage at the time of the [[diagnosis]]. The combined treatment helps with [[Organ (anatomy)|organ]] preservation. [[Swallowing]], [[speech]] and [[laryngeal]] preservation are important to consider during the treatment.


==Surgery==
==Surgery==
The feasibility of surgery depends on the stage of hypopharyngeal cancer at the time of diagnosis.
The feasibility of [[surgery]] depends on the stage of hypopharyngeal cancer at the time of [[diagnosis]]. The main goal of the [[surgery]] is to clear any margin that contains  [[tumor]] [[cells]]. The available [[surgery]] options are transoral [[laser surgery]], total [[laryngectomy]] with partial [[Pharynx|pharyngectomy]] [[surgery]], total [[laryngectomy]] and circumferential [[Pharynx|pharyngectomy]].  


==Primary Prevention==
==Primary Prevention==
Effective measures for the primary prevention of hypopharyngeal cancer include [[smoking cessation]] and limiting or avoiding alcohol consumption.
Effective measures for the primary [[prevention]] of hypopharyngeal cancer include [[smoking cessation]], decrease [[alcohol consumption]], increase [[Vegetable|vegetables]] and fruits consumption, and [[vaccination]] for [[Human papillomavirus|HPV]].


==Secondary Prevention==
==Secondary Prevention==
Secondary prevention measures of hypopharyngeal cancer include routine physical examination and imaging at scheduled intervals after treatment. Dental screening and screening for [[thyroid cancer]]s are recommended among patients who had received [[radiation therapy]] to the [[oral cavity]] and cervical region, respectively.
Secondary [[prevention]] measures of hypopharyngeal cancer include routine [[physical]] [[examination]] of [[head]] and [[neck]] and [[thyroid]] [[Screening]] are recommended among the patients who had received [[radiation therapy]] to the [[head]] and [[neck]] regions.


==References==
==References==

Latest revision as of 15:34, 12 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Faizan Sheraz, M.D. [3]

Overview

Hypopharyngeal cancer was discovered in 1970 by Dr.Harrison in London, U.K. Hypopharyngeal cancer is a disease in which malignant cells proliferate in the hypopharynx. Most hypopharyngeal cancers form in the squamous cells, which are thin, flat cells lining inside the hypopharynx. Hypopharyngeal cancer can be classified according to the anatomy regions and histopathological derivatives. The anatomic location of hypopharyngeal cancer is divided into 3 subtypes such as pyriform sinus cancer, postcricoid area cancer and posterior wall of the hypopharynx. There are no direct causes of hypopharyngeal cancer, however tobacco abuse, abuse of alcohol consumption, HPV infection, Plummer-Vinsom syndrome, and asbestos have been associated with hypopharyngeal cancer. Genes involved in the pathogenesis of hypopharyngeal cancer include p16, NOTCH1, cyclin D1, and TP53. Hypopharyngeal cancer is associated with sideropaenic dysphagia and Paterson Brown Kelly syndrome. On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are characteristic findings of hypopharyngeal cancer. On microscopic histopathological analysis, spindle cells, basaloid cells, and nuclear atypia are characteristic findings of hypopharyngeal cancer. The prevalence of hypopharyngeal cancer is estimated to be 2,500 new cases annually in U.S and hypopharyngeal cancer is a very rare type of cancer. Hypopharyngeal cancer commonly affects patients in 55 to 65 years of age. Males are mostly affected with a hypopharyngeal cancer compare to women. Hypopharyngeal cancer comprises about 7% of all cancers of the head and neck. According to the National Cancer Institute and American Cancer Society, screening test for hypopharyngeal cancer is not recommended.The majority of patients with hypopharyngeal cancer are initially asymptomatic. Most patients with hypopharyngeal cancer clinically manisfest symptoms at a late stage (III and IV) because of the tumor aggression which metastasizes to lymph nodes and submucosa. Once the tumor has expanded from its original site, it may obstruct the aerodigestive tract. Most common clinical presentations are neck mass, dysphagia with weight loss, non healing sore throat, odynophagia, and hoarseness. Common complications of hypopharyngeal cancer include upper airway obstruction and disfigurement of the neck or face. The prognosis varies with the type of hypopharyngeal cancer. The Squamous cell carcinoma of the hypopharynx has a poor prognosis and small survival rate.The medical therapy with the combination of the radiotherapy has been used compared to surgical therapy for the treatment of hypopharyngeal cancer. Swallowing, speech and laryngeal preservation are important to consider during the treatment. The feasibility of surgery depends on the stage of hypopharyngeal cancer at the time of the diagnosis.The main goal of the surgery is to clear any margin that contains the tumor cells. The available surgery options are transoral laser surgery, total laryngectomy with partial pharyngectomy surgery, total laryngectomy and circumferential pharyngectomy.

Historical Prospective

Hypopharyngeal Cancer is a rare type of malignant tumor. Hypopharyngeal cancer was discovered by Harrisson in 1970 with more than half in the postcricoid part.

Classification

Hypopharyngeal cancer may be classified according to the location into 4 subtypes: pyriform sinus cancer, postcricoid area cancer, and posterior wall of hypopharynx cancer. A pyriform sinus cancer subtype is found in 60 to 85 percent of patients who are diagnosed with hypopharyngeal cancer. Hypopharyngeal cancer may also be classified based on the histopathology.

Pathophysiology

Hypopharyngeal cancer arises from squamous cells, which are cells that are normally involved in protection of aerodigestive tract. Hypopharyngeal cancer is a rare type of malignant cancer which has a delayed onset of clinical manifestations. Hypopharyngeal cancer is usually diagnosed at an advanced stage and it spreads to other organs such as lungs, mediastinum, bones, brain, liver, esophagus, and thyroid gland. The metastatic invasion depends on the anatomic location of the hypopharyngeal cancer. Hypopharyngeal cancer is mostly differentiated as squamous cell carcinoma, but the undifferentiated type can be found in the pyriform sinus region. The exact pathogenesis of the hypopharyngeal cancer is not exactly understood, but the p16, cyclin D1, NOTCH1, and TP53 gene mutations have been associated with the development of the hypopharyngeal cancer. Hypopharyngeal cancer is associated with sideropenic dysphagia and Paterson Brown Kelly syndrome. On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are the characteristic findings of hypopharyngeal cancer. On microscopic histopathological analysis, spindle cells, basaloid cells, and nuclear atypia are the characteristic findings of hypopharyngeal cancer.

Causes

There are no direct causes for hypopharngeal cancer however, there are some common risk factors that may lead to gene mutations and cause the hypopharyngeal cancer. Common risk factors for hypopharyngeal cancer can be found here.

Differentiating Hypopharyngeal Cancer from other Diseases

Hypopharyngeal carcinoma must be differentiated from accessory salivary gland tumor, lymphoma, and retropharyngeal abscess.

Epidemiology and Demographics

The prevalence of hypopharyngeal cancer is estimated to be 2,500 new cases annually in U.S and hypopharyngeal cancer is a very rare type of cancer. Hypopharyngeal cancer commonly affects patients in 55 to 65 years of age. Males are mostly affected with a hypopharyngeal cancer compare to women. Hypopharyngeal cancer comprises about 7% of all cancers of the head and neck.

Risk Factors

Common risk factors in the development of hypopharyngeal cancer are tobacco use, and abuse of alcohol consumption.

Screening

According to the National Cancer Institute and American Cancer Society, screening test for hypopharyngeal cancer is not recommended.

Natural History, Complications and Prognosis

The majority of patients with hypopharyngeal cancer are initially asymptomatic. Most patients with hypopharyngeal cancer clinically manisfest symptoms at late stage (III and IV) because of the tumor aggression which metastasizes to lymph nodes and submucosa. Once the tumor has expanded from its site of origin, it may obstruct the aerodigestive tract. Most common clinical presentations are neck mass, dysphagia with weight loss, non healing sore throat, odynophagia, and hoarseness. Common complications of hypopharyngeal cancer include upper airway obstruction and disfigurement of the neck or face. The prognosis varies with the type of hypopharyngeal cancer. Squamous cell carcinoma of hypopharynx has poor prognosis and small survival rate.

Diagnostic Study of Choice and Staging

The diagnostic study of choice for hypopharyngeal cancer is CT scan with contrast of head and neck. The definitive diagnosis of hypopharyngeal cancer is biopsy of the tumor. According to the American Joint Committee of Cancer (AJCC) TNM staging system, there are 5 stages of hypopharyngeal cancer based on the tumor size, lymph node involvement, and distant metastasis.

History and Symptoms

The hallmark of hypopharyngeal cancer is dysphagia. A positive history of odynophagia and hoarseness is suggestive of hypopharyngeal cancer. Common symptoms include a lump in the neck, dysphagia, chronic sore throat and hoarseness.

Physical Examination

Patients with hypopharyngeal carcinoma are usually well appearing. Physical examination of the patients with hypopharyngeal carcinoma is usually remarkable for the neck swelling.

Laboratory Findings

There are no diagnostic laboratory findings associated with hypopharyngeal cancer.

Electrocardiogram

There are no ECG findings associated with hypopharyngeal cancer.

Chest X Ray

Chest X rays may be performed to detect metastasis of hypopharyngeal cancer to the lungs.

CT

Head and neck CT scan may be helpful in the diagnosis of hypopharyngeal cancer. Findings on CT scan suggestive of hypopharyngeal cancer include soft tissue mass, irregular thickening of the mucosa, and necrotic region which is a sign of metastasis.

MRI

MRI may be helpful in the diagnosis of hypopharyngeal cancer. Findings on the MRI suggestive of hypopharyneal cancer include tumors are hypointense on T1 and hyperintense on T2 for soft tissues.

Other Imaging Findings

Ultrasound may be helpful to assess hypopharyngeal cancer along with endoscopy. Ultrasound may be use to detect, and localize primary tumors that invade neighboring organs such as esophagus, thyroid gland, and postcricoid area.

Other Diagnostic Studies

Biopsy may be diagnostic of hypopharyngeal cancer. Findings on biopsy diagnostic of hypopharyngeal cancer include spindle cells, basaloid cells, and nuclear atypia.

Medical Therapy

The medical therapy with the combination of the radiotherapy has been used compared to surgical therapy for the treatment of hypopharyngeal cancer.The optimal therapy for hypopharyngeal cancer depends on the stage at the time of the diagnosis. The combined treatment helps with organ preservation. Swallowing, speech and laryngeal preservation are important to consider during the treatment.

Surgery

The feasibility of surgery depends on the stage of hypopharyngeal cancer at the time of diagnosis. The main goal of the surgery is to clear any margin that contains tumor cells. The available surgery options are transoral laser surgery, total laryngectomy with partial pharyngectomy surgery, total laryngectomy and circumferential pharyngectomy.

Primary Prevention

Effective measures for the primary prevention of hypopharyngeal cancer include smoking cessation, decrease alcohol consumption, increase vegetables and fruits consumption, and vaccination for HPV.

Secondary Prevention

Secondary prevention measures of hypopharyngeal cancer include routine physical examination of head and neck and thyroid Screening are recommended among the patients who had received radiation therapy to the head and neck regions.

References

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