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{{Hypopharyngeal cancer}}
{{Hypopharyngeal cancer}}
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{{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 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.

Revision as of 14:22, 22 January 2019

Hypopharyngeal cancer Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hypopharyngeal Cancer from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

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History and Symptoms

Physical Examination

Laboratory Findings

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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 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, 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.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.

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.

Pathophysiology

Hypopharyngeal cancer arises from squamous cells, which are cells that are normally involved in protection of aerodigestive tract. Genes involved in the pathogenesis of hypopharyngeal cancer include 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 cells, basaloid cells, and nuclear atypia are characteristic findings of hypopharyngeal cancer.

Causes

There are no established direct causes for hypopharngeal 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 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.

Risk Factors

Common risk factors in the development of hypopharyngeal cancer are smoking tobacco, chewing tobacco, heavy alcohol intake, and Plummer-Vinson syndrome.

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.

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.

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.

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.

Laboratory Findings

There are no diagnostic laboratory findings associated with hypopharyngeal cancer.

Chest X Ray

There are no chest x ray findings associated with hypopharyngeal cancer.

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.

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.

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.

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 optimal therapy for hypopharyngeal cancer depends on the stage at the time of diagnosis.

Surgery

The feasibility of surgery depends on the stage of hypopharyngeal cancer at the time of diagnosis.

Primary Prevention

Effective measures for the primary prevention of hypopharyngeal cancer include smoking cessation and limiting or avoiding alcohol consumption.

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 cancers are recommended among patients who had received radiation therapy to the oral cavity and cervical region, respectively.

References

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