What is Hypopharyngeal Cancer?
The hypopharynx is the part of the throat (pharynx) that lies beside and behind the larynx. The hypopharynx is the entrance into the esophagus. Food goes from the mouth and through the hypopharynx and esophagus, where it then passes into the stomach. The structure of the hypopharynx makes sure that food goes around the larynx and into the esophagus.
Squamous Cell Carcinomas
Almost all cancers in the hypopharynx develop from the thin, flat cells called squamous cells, which are in the epithelium, the inner layer lining the hypopharynx. Cancer beginning in this layer of cells is called squamous cell carcinoma or squamous cell cancer.
Most squamous cell cancers of the hypopharynx begin as pre-cancerous conditions called dysplasia. Most of the time, dysplasia doesn't turn into actual cancer. It often goes away without any treatment.
Some cases of dysplasia will progress into a condition called carcinoma in situ. In this stage, cancer cells are only seen in the epithelium lining. They have not grown into deeper layers or spread to other parts of the body. It is the earliest form of cancer.
Other rare types of cancer can also start in the hypopharynx.
- Minor Salivary Gland Cancers - Some areas of the hypopharynx have tiny glands known as minor salivary glands beneath the lining layer. These glands produce mucus and saliva to lubricate and moisten the area.
- Sarcomas - The shape of the hypopharynx depends on a framework of connective tissues and cartilage. Cancers like chondrosarcomas or synovial sarcomas can develop from connective tissues of the hypopharynx. This is extremely rare.
- Melanomas - Although, these cancers usually start in the skin, in rare cases they can start on inner (mucosal) surfaces of the body such as the hypopharynx.
Risk Factors & Diagnosis
Research is increasing regarding what we know about hypopharyngeal cancer. Scientists are learning more about its causes. Following are common risk factors for the disease:
- Smoking/Chewing tobacco
- Heavy alcohol use
- Eating a diet without enough nutrients
- Having Plummer-Vinson Syndrome
The symptoms below may be caused by hypopharyngeal cancer. Other conditions may cause the same symptoms, and so it is important to talk to your doctor if you experience of the following:
- A sore throat that does not go away
- Ear pain
- A lump in the neck
- Painful or difficult swallowing
- A change in voice
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.
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.
Different types of treatment are available for patients with hypopharngeal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. (A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer)
Your treatment options depend on the stage of cancer, your overall health and your preferences about treatment. In metastatic disease, the location and extent of the hypopharyngeal cancer is also an important consideration.
In all cases, treatment should be individualized for you. Although cancers are classified into particular stages, each person is unique. You do not have to rush to make a decision, so consider the options carefully. Research shows that cancer survivors of all educational levels and backgrounds can have a hard time communicating with their health care team. One of the best ways to improve communication with your health care team is to prepare your visits so that you can best make use of the time.
A treatment plan is a way to deal with both the short and long term goals of managing your hypopharyngeal cancer. There are several treatment options for hypopharyngeal cancer, depending on the cancer stage and the patient’s age and general health. Patients have time for second opinions and to talk through all of their options with their doctors and develop a treatment plan that best fits their needs.