Hypopharyngeal Cancer (Cancer of the
The hypopharynx is a digestive duct
connecting the oropharynx to the esophagus. Schematically, it is located laterally and behind the larynx and in
front of the cervical spine. It extends from the epiglottis at the top (next to the hyoid bone) to the upper
esophageal sphincter at the bottom. It opens to the font toward the larynx. On each side of the larynx, the
hypopharynx mucosa invaginates by forming a gutter called pyriform sinus (also piriform
sinus, piriform fossa, or smuggler's fossa). Cancer occurs in the
hypopharynx when a group of cells of any of these tissues starts producing malignant cells.
The majority of cancers of the hypopharynx are more or less differentiated squamous cell carcinomas. Other
malignant tumors are exceptional: cancers of the salivary glands, malignant lymphomas, sarcomas, undifferentiated
carcinomas. Cancers of the hypopharynx and in particular the
piriform sinus cancers are very lymphophilic (having an abnormally low level of lymphocytes in the
blood). About 80 % of cases are associated with metastasis, which makes survival more difficult.
Signs and Symptoms of
Hypopharyngeal Cancer symptoms tend
to be banal at the beginning. First, any unilateral functional sign should be considered as a warning sign. Common
signs and early symptoms include Dysphagia (Difficulty swallowing); Odynophagia
with swallowing); dysphonia (neurological disorder affecting the voice
muscles in the larynx, or voice box); drooling (saliva flowing outside of the mouth
unintentionally); earache, affecting most Hypopharyngeal
Cancer patients. One or more of these functional signs requires an urgent and
Some patients may also experience Laryngeal dyspnea. But it usually occurs late in the cases of obstructive and
large tumors of the piriform sinus or cancer in retro - cricoid region. It represents an extension to the endo-
laryngeal structures. Dysphonia occurs also at an advanced stage of evolution.
Cervical lymphadenopathy seemingly isolated without other signs is also a warning sign of cancer of the
hypopharynx. In this case, the malignant tumor locates mainly at the jugular
digastric or in the middle of the carotid.
Individuals at risk for Hypopharyngeal
Cancer (age, alcohol addiction or using tobacco) should never undergo any isolated biopsy in the lymph
node to not increase the risk of cervical tumor. The health care provider can perform regular professional oral
examination, including panendoscopy (also known as Upper endoscopy, it is a visual examination
of the lining of the esophagus, stomach and upper duodenum) under general anesthesia and treat lymph
nodes simultaneously with the tumor.
Cancer treatment can include many therapeutic procedures. As with all head and neck cancers, various
alternatives and treatment strategy are discussed in multidisciplinary consultation meeting between the patient and
the health care provider to offer to the patient a personalized treatment program. The meeting may be conducted in
the presence of other practitioners involved in the care of the patient: surgeon, radiation oncologist, oncologist,
radiologist, psychologist, pathologist, dentist. The different modalities of the proposed treatment are then
explained to the patient to inform him on what to expect. Depending on the psychological condition of the patient,
the help of a psychologist can also be recommended.
At the end of the consultation, a personalized care program is given to the patient. The program summarizes the
plan and the chronology of the various treatment modalities involved the course of the therapy.
Principles of treatment
The current therapeutic problem of Hypopharyngeal cancer lies not in the treatment of the tumors of small volume
where preservation of the larynx is possible by conservative surgery or radiotherapy but in advanced cancers where
it is difficult to preserve the affected organ. Therefore, to prevent
major surgical removal, a combining neo-adjuvant chemotherapy and external radiotherapy can be used in the