Hypopharyngeal cancer is a rare form throat cancer that forms in the hypopharynx in the bottom portion of the throat (pharynx). The hypopharynx functions as a guide for food into the oesophagus and not into the larynx and lungs.
Hypopharyngeal cancers develop as carcinomas, which are cancers arising from cells in the skin or tissues that line organs. Most commonly, this disease presents as a squamous cell carcinoma, which develop in the squamous cells lining the skin. However, they can also develop as basaloid squamous carcinomas, spindle cell carcinomas and minor salivary gland carcinomas.
Hypopharyngeal cancer is more common in men, and is generally diagnosed in people between the ages of 55-70. However, anyone can develop this disease.
Treatment
If hypopharyngeal cancer is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for patients with hypopharyngeal cancer may include:
- Surgery, potentially including:
- Partial larynpharyngectomy (removal of part of the larynx and part of the pharynx).
- Total larynpharyngectomy (complete removal of both the larynx and the pharynx).
- Neck dissection to remove affected lymph nodes and other affected neck tissues.
- Chemotherapy.
- Radiation therapy.
- Clinical trials.
- Palliative care.
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
Risk factors
The risk factors for hypopharyngeal cancer include:
- Smoking/tobacco use.
- Heavy alcohol use.
- A diet lacking in nutrients.
- Having Plummer Vinson syndrome (a triad of dysphagia, glossitis, and iron deficiency anaemia).
Other potential risk factors for this disease include:
- Vitamin C deficiencies.
- Gastric reflux.
- Exposure to substances, such as:
- Asbestos.
- Steel/coal dusts.
- Iron compound fumes.
- Indoor air pollution from solid fuels (e.g., wood, crop residue, coal etc.)
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Early symptoms
Symptoms of hypopharyngeal cancer include:
- Difficulties swallowing and/or breathing.
- Persistent sore throat.
- Pain when swallowing.
- Ear pain.
- Persistent cough.
- A lump in the neck.
- Neck pain.
- Coughing up bloody mucus.
- Voice changes (such as hoarseness).
- Unexplainable weight loss.
- Blood in your saliva.
- Unexplainable bad breath.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have hypopharyngeal cancer, they will order a range of diagnostic tests to confirm the diagnosis, and refer you to a specialist for treatment.
Physical examination
Your doctor will collect your overall medical history, as well as your lifestyle/health habits, and current symptoms. Following this, they may examine your body to check for any abnormalities. More specifically, they will feel your neck to see if there are any swollen lymph nodes, which are indicative of infection. They may also look down your throat with a small, long-handled mirror to examine any abnormalities.
Imaging & blood tests
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), x-ray, barium oesophagogram, bone scan and/or positron emission tomography (PET scan), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis. Additionally, a blood test may be taken to assess your overall health and help guide treatment decisions.
Exploratory surgeries & biopsy
Usually, the doctor will perform an exploratory surgery to retrieve a sample for biopsy and diagnose the condition.
Endoscopy
An endoscopy is a day procedure that is often performed to examine the tracts of the digestive system. To look for Hypopharyngeal cancer, the doctor will place a long, thin tube with a light and a camera attached (endoscope) into your mouth or nose to check for any abnormalities.
Oesophagoscopy
An Oesophagoscopy is a day procedure that examines the oesophagus. A long, thin tube with a light and camera attached (oesophagoscope) is inserted through your mouth or nose and into the oesophagus to check for any abnormalities.
Bronchoscopy
A bronchoscopy is a day procedure that examines the trachea and lungs. A long, thin tube with a light and camera attached (bronchoscope) is inserted through the mouth or nose and into trachea and lungs to check for any abnormalities.
Once the location(s) of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. The tissue sample will then be analysed for cancer cells.
Prognosis (Certain factors affect the prognosis and treatment options)
While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage hypopharyngeal cancers have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
References
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.