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 recess, pyriform 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
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 (pain 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 professional examination.
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.
Hypopharyngeal Cancer Treatment
Hypopharyngeal 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 treatment.