Hypopharyngeal Cancer

Excerpt

Hypopharyngeal cancer is a rare and aggressive tumor that originates between the oropharynx and the esophageal inlet, inferior to the hyoid bone and superior to the lower margin of the cricoid cartilage. The hypopharynx comprises 3 subsites: the postcricoid space, the pyriform sinuses, and the posterior pharyngeal wall (see Image. The Larynx.). While these structures all lie close to the larynx, hypopharyngeal cancer is anatomically, pathologically, and therapeutically distinct from laryngeal cancer.

Squamous cell carcinoma accounts for 95% of hypopharyngeal cancers, while adenocarcinoma, sarcoma, and nonepidermoid carcinomas account for the majority of the remaining cases. Tumors of the hypopharynx have a propensity for local invasion into the aerodigestive tract and lymphatic spread; 70% of patients present with lymph node metastasis at diagnosis. Symptoms at presentation are determined by tumor size and location, with pain, bleeding, and dysphagia being the most common presenting complaints. Patients with more advanced disease may also present with malnutrition, which is a particularly poor prognostic factor. Advanced tumors often invade the larynx, leading to potential airway compromise and aspiration. For this reason, surgical management typically combines partial or total pharyngectomy and laryngectomy, depending on the tumor site and stage at presentation, and can result in significant functional morbidity.

Hypopharyngeal cancer has an annual incidence of approximately 3,000 cases per year in the United States, accounting for about 7% of upper aerodigestive tract cancers. While rarer than laryngeal cancer, hypopharyngeal cancer generally has worse outcomes due to the advanced stage commonly seen at presentation. Prognosis is dictated by stage, with a 60% 5-year survival for patients with early disease (T1-T2), compared to a <25% 5-year survival for those with more advanced tumors (T3-T4) or metastasis to cervical lymph nodes.