Hypopharyngeal cancers are usually seen in the middle-aged group and elderly, with the incidence rising above the age of 40. Men are more commonly affected than women with a 3:1 ratio. It accounts for 7% of all cancers of the upper aerodigestive tract.
The hypopharynx is the most inferior part of the pharynx that leads into the esophagus.
It consists of 3 parts:
Hypopharyngeal cancers are usually silent in the early stages. Larger tumours are responsible for majority of patient’s complaints. Patients may complain of:
Risk factors include:
A thorough head and neck examination is performed which includes examination of the oral cavity, the neck and a nasoendoscopy. A panendoscopy and biopsy under general anaesthesia is done in the operating theatre for tissue diagnosis. A fine needle aspiration cytology is also performed of any neck node. Either a computed tomography scan or magnetic resonance imaging (CT or MRI) is done to evaluate the extent of the hypopharyngeal lesion and possible neck node involvement. If the biopsy confirmed the diagnosis of cancer, a CT scan of the thorax and liver is done as part of the staging work-up, looking for distant spread to the lungs or the liver.
All patients will be discussed at the multidisciplinary tumour board where the best recommended treatment options will be detailed. Treatment modality depends on:
For early stage disease, single modality treatment is considered either with radiotherapy or surgery of the primary hypopharyngeal lesion and the associated nodes in the neck. Conservative surgery may be performed for small tumours, especially if robotics expertise is available. For more advanced stages, multi-modality treatment is needed, either a combination of chemoradiotherapy or surgery with postoperative radiotherapy, with or without chemotherapy.
Even after completion of treatment of cancer, patients often have to undergo months of rehabilitation due to altered speech and swallowing. Hence, intensive speech and swallowing therapy as well as a regular dietician review is to be expected by our patients.