Introduction:
Hypopharyngeal cancer is a rare form of head and neck cancer characterized by the growth of malignant cells in the lower part of the throat, called the hypopharynx. Hypopharynx is an anatomical structure located between the oropharynx and the esophagus. It is also known as the laryngopharynx. The main functions of the hypopharynx are delivering food and fluids to the esophagus and regulating air passage into the lungs. Cancer in the hypopharynx can affect its normal function and causes severe complications that affect people's overall quality of life.
Most hypopharyngeal cancers are squamous cell carcinomas, cancer that develops in the squamous cell lining of different body parts. It accounts for three to six percent of all head and neck cancer. People of any age can develop hypopharyngeal cancer, but it most commonly occurs in people older than 50. Men are more commonly affected than women. It is often difficult to diagnose since it exhibits obvious symptoms during the initial stages. Treatment depends on the grade and severity of the cancer. Early diagnosis and treating the disease at early stages can improve the prognosis.
What Are the Causes and Risk Factors of Hypopharyngeal Cancer?
There is no definitive cause for hypopharyngeal cancer, and it is mostly caused by a combination of genetic and environmental factors. Genetic mutation is generally considered one of the main causes of hypopharyngeal cancer. Besides genetic mutations, some risk factors contribute to hypopharyngeal cancer development. They include;
1. Tobacco: Chewing or smoking tobacco for a long time can increase the risk of developing hypopharyngeal cancer.
2. Alcohol: Excess alcohol consumption can also increase hypopharyngeal cancer risk.
3. Plummer-Vinson Syndrome: A rare clinical condition characterized by iron-deficiency anemia, difficulty swallowing, cheilosis (swelling and small cracks at the corners of the mouth), glossitis (inflammation of the tongue), and esophageal web.
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Previously diagnosed with any head and neck cancers.
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Received radiation therapy near the head and neck for treating cancer or other diseases.
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Exposure to substances like certain chemicals, wood dust, asbestos, and paint fumes.
What Are the Signs and Symptoms of Hypopharyngeal Cancer?
Hypopharyngeal cancer generally does not cause any obvious symptoms. People may experience no signs of throat cancer at all during the early stage of the disease. The symptoms of hypopharyngeal cancer are often non-specific. The common symptoms of hypopharyngeal cancer include:
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A painless lump on the neck.
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Sore throat.
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Hoarseness or rough voice.
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Difficulty swallowing (dysphagia).
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A feeling of fullness or ringing sensation inside the ears.
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Ear pain.
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Loss of appetite.
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Weight loss.
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Hemoptysis (coughing up blood).
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Halitosis (bad breath).
How Do Hypopharyngeal Cancers Metastasize?
Hypopharyngeal cancer can sometimes overgrow and spread to the nearby tissues around the trachea or thyroid gland, hyoid bone (bone under the tongue), larynx, esophagus, lymph nodes, and the lungs. Lymph node metastasis is more common in hypopharyngeal cancer since the hypopharynx has abundant lymphatic drainage. The incidence of lymph node metastasis in hypopharyngeal cancer is around 60 percent. Metastatic hypopharyngeal cancer has a poor prognosis and requires aggressive treatments.
How Are Hypopharyngeal Cancers Diagnosed?
Healthcare providers primarily perform an oral and physical examination to look for signs and symptoms of the disease. They may also enquire about the patient’s medical history and the habit of using tobacco and alcohol to delineate the condition's underlying cause. The healthcare providers may suggest further diagnostic tests to have a clear diagnosis. The additional tests include;
1. Endoscopy: Healthcare providers suggest endoscopy to examine deep inside the throat and detect tumors. An endoscopy is a noninvasive diagnostic test in which the healthcare provider inserts an endoscope (a long, flexible instrument equipped with a camera) into the nose or mouth and then down the throat to look for tumors.
2. Biopsy: Healthcare providers recommend a biopsy for a definitive diagnosis of hypopharyngeal cancer. In addition, it helps distinguish hypopharyngeal cancer from other noncancerous conditions that affect the throat. In a biopsy, a small tissue sample from the tumor is removed and sent to the laboratory for pathological examination.
3. Imaging Tests: If a biopsy confirms hypopharyngeal cancer, the healthcare providers suggest additional imaging tests to learn more about cancer. The imaging tests used in hypopharyngeal cancer diagnosis include;
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CT (Computed Tomography) Scan: A CT scan for hypopharyngeal cancer provides cross-sectional images of internal structures of the throat that helps determine the size, location, and extent of the tumor. It can also be used to determine hypopharyngeal cancer metastasis to nearby lymph nodes and other body parts.
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MRI (Magnetic Resonance Imaging): An MRI uses a magnetic field and radio waves to provide detailed tumor images. It is superior to a CT scan in determining hypopharyngeal cancer spread to different body parts. It also helps determine the stage and severity of hypopharyngeal cancer.
What Are the Stages of Hypopharyngeal Cancer?
The different stages of hypopharyngeal cancer include;
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Stage 0: Abnormal cells are found in the internal lining of the hypopharynx. These abnormal cells may become malignant (cancerous) and invade the nearby tissues.
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Stage 1: Tumor size is not more than 2 centimeters in size, and cancer has not spread to other body parts.
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Stage 2: Tumor size is between 2 to 4 centimeters, and cancer has not spread to other body parts.
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Stage 3: Tumor size is greater than 4 centimeters, and cancer has spread to a single lymph node on the same side of the neck.
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Stage 4A: Tumor growth has spread to nearby structures such as the cartilage around the trachea or thyroid, hyoid bone, esophagus, and lymph nodes.
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Stage 4B: Cancer has spread to the carotid artery, muscles in the upper spinal cord, chest cavity, and lymph nodes.
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Stage 4C: The tumor may be of any size and has spread to other body parts.
How Are Hypopharyngeal Cancers Treated?
Treatments for hypopharyngeal cancer depend on the stage and severity of the tumor. The treatment options for hypopharyngeal cancer include;
1. Surgery: Healthcare providers generally recommend surgery for hypopharyngeal cancer depending on the tumor's size, location, and extent. The main aim of surgery is to remove the tumor as much as possible without causing harm to the healthy tissues. The surgery options for hypopharyngeal cancer include the following;
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Pharyngectomy: In pharyngectomy, the surgeon removes all or a part of the diseased or damaged part of the pharynx.
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Laryngopharyngectomy: Laryngopharyngectomy is another surgical option for hypopharyngeal cancer where the surgeon removes all or a part of the diseased or damaged pharynx and the larynx.
2. Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It can be used as a standalone or with radiation therapy to treat hypopharyngeal cancer. Chemotherapy given after surgery removes the remaining tumor after surgery.
3. Radiation Therapy: Radiation therapy uses high-energy X-rays to kill cancer cells. Healthcare providers recommend intensity-modulated radiation therapy to treat hypopharyngeal cancer. Intensity-modulated radiation therapy is high-precision radiotherapy that delivers precise radiation to a tumor without causing much damage to the surrounding healthy tissues.
4. Immunotherapy: Immunotherapy is another possible treatment option for hypopharyngeal cancer that utilizes and stimulates one’s immune system to fight against cancer.
How Can Hypopharyngeal Cancers Be Prevented?
There are no sure ways to prevent pharyngeal cancer. However, undertaking certain preventive measures can reduce the risk of developing it.
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Quit tobacco smoking.
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Avoid excess alcohol consumption.
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Eating plenty of fruits and vegetables.
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Maintaining healthy body weight.
Conclusion:
The prognosis of hypopharyngeal cancer varies with the severity and stage of the tumor. Earlier stages of the disease often respond better to treatment and have a good prognosis. But most hypopharyngeal cancers are diagnosed at advanced stages with a poor prognosis. A multimodal treatment approach is effective in treating advanced stages of the disease. The overall survival rate of localized hypopharyngeal cancer is 61 percent, whereas for metastatic hypopharyngeal cancer is 31 percent.
