Stages

If hypophyaryngeal cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The Spreading of Cancer

There are three ways that cancer spreads in the body:

Through tissue. Cancer invades the surrounding normal tissue.

Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary tumor and travel through the lymph or blood to other places in the body, another, or secondary tumor, may form. This process is called metastasis. The secondary, or metastatic, tumor is the same type of cancer as the primary tumor. For example, if hypopharyngeal cancer spreads to the bones, the cancer cells in the bones are actually hypopharyngeal cancer cells. The disease is metastatic hypopharyngeal cancer, not bone cancer.

Stages of Hypopharyngeal Cancer

These are the main features of each stage of the disease:

Stage 0 (Carcinoma in Situ) - In stage 0, abnormal cells are found in the lining of the hypopharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I - In stage I, cancer has formed in one area of the hypopharynx only and/or the tumor is two centimeters or smaller.

Stage II - In stage II, the tumor is either larger than two centimeters but not larger than four centimeters and has not spread to the larynx (voice box) or found in more than one area of the hypopharynx or in nearby tissues.

Stage III - In stage III, the tumor is larger than four centimeters or has spread to the larynx (voice box) or esophagus. Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is three centimeters or smaller. In addition, cancer is found in one area of the hypopharynx and/or is two centimeters or smaller or in more than one area of the hypopharynx or in nearby tissues, or is larger than two centimeters but not larger than four centimeters and has not spread to the larynx.

Stage IV - Stage IV is divided into stage IVA, IVB, and IVC.

Stage IVA - The cancer has spread to cartilage around the thyroid or trachea, the bone under the tongue, the thyroid, or nearby soft tissue. Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is three centimeters or smaller or it has spread to one lymph node on the same side of the neck as the tumor (the lymph node is larger than three centimeters but not larger than six centimeters) or to lymph nodes anywhere in the neck (affected lymph nodes are six centimeters or smaller). In addition, and one of the following is true:

Cancer is found in one area of the hypopharynx and/or is two centimeters or smaller

Cancer is found in more than one area of the hypopharynx or in nearby tissues, or is larger than two centimeters but not larger than four centimeters and has not spread to the larynx (voice box)

Cancer has spread to the larynx or esophagus and is more than four centimeters

Cancer has spread to cartilage around the thyroid or trachea, the bone under the tongue, the thyroid, or nearby soft tissue.

Stage IVB - The tumor has spread to muscles around the upper part of the spinal column, the carotid artery, or the lining of the chest cavity and may have spread to lymph nodes which can be any size or
may be any size and has spread to one or more lymph nodes that are larger than six centimeters.

Stage IVC - The tumor may be any size and has spread beyond the hypopharynx to other parts of the body.

Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required. Generally, treatment for the different stages are as follows:

Stage I - Treatment of stage I hypopharyngeal cancer may include a Laryngopharyngectomy and neck dissection with or without high-dose radiation therapy to the lymph nodes of the neck. Or, a Partial Laryngopharyngectomy with or without high-dose radiation therapy to the lymph nodes on both sides of the neck.

Stage II - Treatment of stage II hypopharyngeal cancer may include a Laryngopharyngectomy and neck dissection. High-dose radiation therapy to the lymph nodes of the neck may be given before or after surgery. Or, a Partial Laryngopharyngectomy. Or, Chemotherapy given during or after radiation therapy or after surgery. Or, a clinical trial of chemotherapy followed by radiation therapy or surgery.

Stage III - Treatment of stage III hypopharyngeal cancer may include radiation therapy before or after surgery. Or, Chemotherapy given during or after radiation therapy or after surgery. Or, a clinical trial of chemotherapy followed by surgery and/or radiation therapy. Or, a clinical trial of chemotherapy given at the same time as radiation therapy. Or, a clinical trial of surgery followed by chemotherapy given at the same time as radiation therapy.

Stage IV - Treatment of stage IV hypopharyngeal cancer that can be treated with surgery may include radiation therapy before or after surgery. Or, a clinical trial of chemotherapy followed by surgery and/or radiation therapy.

Treatment of stage IV hypopharyngeal cancer that cannot be treated with surgery may include radiation therapy, chemotherapy given at the same time as radiation therapy or a clinical trial of radiation therapy with chemotherapy.

Following treatment, it is important to have careful head and neck examinations to look for recurrence. Check-ups will be done monthly in the first year, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.

In all cases, treatment should be individualized for you. Although cancers are classified into particular stages, each person is unique.




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