Hypopharyngeal Cancer Treatment (PDQ�)

General Information About Hypopharyngeal Cancer

Hypopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the hypopharynx.

The hypopharynx is the bottom part of the pharynx (throat). The pharynx is a hollow tube about 5 inches long that starts behind the nose, goes down the neck, and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the esophagus.

Most hypopharyngeal cancers form in squamous cells, the thin, flat cells lining the inside of the hypopharynx. The hypopharynx has 3 different areas. Cancer may be found in 1 or more of these areas.

Hypopharyngeal cancer is a type of head and neck cancer.

Use of tobacco products and heavy drinking can affect the risk of developing hypopharyngeal cancer.

Risk factors include the following:

• Smoking tobacco.

• Chewing tobacco.

• Heavy alcohol use.

• Eating a diet without enough nutrients.

• Having Plummer-Vinson syndrome.

Possible signs of hypopharyngeal cancer include a sore throat and ear pain.

These and other symptoms may be caused by hypopharyngeal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• A sore throat that does not go away.

• Ear pain.

• A lump in the neck.

• Painful or difficult swallowing.

• A change in voice.

Tests that examine the throat and neck are used to help detect (find) and diagnose hypopharyngeal cancer.

The following tests and procedures may be used:

• Physical exam of the throat: An exam in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.

• Endoscopy: A procedure used to look at areas in the throat that cannot be seen with a mirror during the physical exam of the throat. An endoscope (a thin, lighted tube) is inserted through the nose or mouth to check the throat for anything that seems unusual. Tissue samples may be taken for biopsy.

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

• Head, neck, and chest x-rays: An x-ray of the head, neck, and organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

• Barium esophagogram: An x-ray of the esophagus. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken.

• Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth or nose and down the throat into the esophagus. Tissue samples may be taken for biopsy.

• Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.

• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

Prognosis (chance of recovery) depends on the following:

• The stage of the cancer (whether it affects part of the hypopharynx, involves the whole hypopharynx, or has spread to other places in the body). Hypopharyngeal cancer is usually detected in later stages because early symptoms rarely occur.

• The patient's age, gender, and general health.

• The location of the cancer.

• Whether the patient smokes during radiation therapy.

Treatment options depend on the following:

• The stage of the cancer.

• Keeping the patient's ability to talk, eat, and breathe as normal as possible.

• The patient's general health.

Patients who have had hypopharyngeal cancer are at an increased risk of developing a second cancer in the head or neck. Frequent and careful follow-up is important.

Stages of Hypopharyngeal Cancer

After hypopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the hypopharynx or to other parts of the body.

The process used to find out if cancer has spread within the hypopharynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnosehypopharyngeal cancer are often also used to stage the disease.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.

• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for hypopharyngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormalcells 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 2 centimeters or smaller.

Stage II

In stage II, the tumor is either:

• larger than 2 centimeters but not larger than 4 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 4 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 3 centimeters or smaller; or

• has spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller and cancer is found:

  • in one area of the hypopharynx and/or is 2 centimeters or smaller; or

  • in more than one area of the hypopharynx or in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx.

Stage IV

Stage IV is divided into stage IVA, IVB, and IVC as follows:

• In stage IVA, 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 3 centimeters or smaller; or

  • has spread to one lymph node on the same side of the neck as the tumor (the lymph node is larger than 3 centimeters but not larger than 6 centimeters) or to lymph nodes anywhere in the neck (affected lymph nodes are 6 centimeters or smaller), and one of the following is true:

    • cancer is found in one area of the hypopharynx and/or is 2 centimeters or smaller; or

    • cancer is found in more than one area of the hypopharynx or in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx (voice box); or

    • cancer has spread to the larynx or esophagus and is more than 4 centimeters; or

    • cancer has spread to cartilage around the thyroid or trachea, the bone under the tongue, the thyroid, or nearby soft tissue.

• In 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 6 centimeters.

• In stage IVC, the tumor may be any size and has spread beyond the hypopharynx to other parts of the body.

Recurrent Hypopharyngeal Cancer

Recurrenthypopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the hypopharynx or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with hypopharyngeal cancer.

Different types of treatment are available for patients with hypopharyngeal 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. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is a common treatment for all stages of hypopharyngeal cancer. The following surgical procedures may be used:

• Laryngopharyngectomy: Surgery to remove the larynx (voice box) and part of the pharynx (throat).

• Partial laryngopharyngectomy: Surgery to remove part of the larynx and part of the pharynx. A partial laryngopharyngectomy prevents loss of the voice.

• Neck dissection: Surgery to remove lymph nodes and other tissues in the neck.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Radiation therapy may be more effective in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The thyroid gland may be tested before and after therapy to make sure it is working properly.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Chemotherapy may be used to shrink the tumor before surgery or radiation therapy. This is called neoadjuvant chemotherapy.

See Drugs Approved for Head and Neck Cancer for more information. (Hypopharyngeal cancer is a type of head and neck cancer.)

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI Web site.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

For hypopharyngeal cancer, follow-up to check for recurrence should include careful head and neck exams once a month in the first year after treatment ends, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.

Treatment Options by Stage

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Stage I Hypopharyngeal Cancer

Treatment of stage I hypopharyngeal cancer may include the following:

• Laryngopharyngectomy and neck dissection with or without high-dose radiationtherapy to the lymph nodes of the neck.

• Partial laryngopharyngectomy with or without high-dose radiation therapy to the lymph nodes on both sides of the neck.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I hypopharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage II Hypopharyngeal Cancer

Treatment of stage II hypopharyngeal cancer may include the following:

• Laryngopharyngectomy and neck dissection. High-dose radiationtherapy to the lymph nodes of the neck may be given before or after surgery.

• Partial laryngopharyngectomy. High-dose radiation therapy to the lymph nodes of the neck may be given before or after surgery.

• Chemotherapy given during or after radiation therapy or after surgery.

• A clinical trial of chemotherapy followed by radiation therapy or surgery.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II hypopharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage III Hypopharyngeal Cancer

Treatment of stage III hypopharyngeal cancer may include the following:

• Radiation therapy before or after surgery.

• Chemotherapy given during or after radiation therapy or after surgery.

• A clinical trial of chemotherapy followed by surgery and/or radiation therapy.

• A clinical trial of chemotherapy given at the same time as radiation therapy.

• A clinical trial of surgery followed by chemotherapy given at the same time as radiation therapy.

Treatment and follow-up of stage III hypopharyngeal cancer is complex and is ideally overseen by a team of specialists with experience and expertise in treating this type of cancer. If all or part of the hypopharynx is removed, the patient may need plastic surgery and other special help with breathing, eating, and talking.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III hypopharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IV Hypopharyngeal Cancer

Treatment of stage IV hypopharyngeal cancer that can be treated with surgery may include the following:

• Radiation therapy before or after surgery.

• A clinical trial of chemotherapy followed by surgery and/or radiation therapy.

• A clinical trial of surgery followed by chemotherapy given at the same time as radiation therapy.

Surgical treatment and follow-up of stage IV hypopharyngeal cancer is complex and is ideally overseen by a team of specialists with experience and expertise in treating this type of cancer. If all or part of the hypopharynx is removed, the patient may need plastic surgery and other special help with breathing, eating, and talking.

Treatment of stage IV hypopharyngeal cancer that cannot be treated with surgery may include the following:

• Radiation therapy.

• Chemotherapy given at the same time as radiation therapy.

• A clinical trial of radiation therapy with chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV hypopharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment Options for Recurrent Hypopharyngeal Cancer

Treatment of recurrenthypopharyngealcancer may include the following:

• Surgery.

• Radiation therapy.

• Chemotherapy.

• A clinical trial of chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent hypopharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

To Learn More About Hypopharyngeal Cancer

For more information from the National Cancer Institute about hypopharyngeal cancer, see the following:

• Head and Neck Cancer Home Page

• Throat (Laryngeal and Pharyngeal) Cancer Home Page

• Oral Complications of Chemotherapy and Head/Neck Radiation

• Drugs Approved for Head and Neck Cancer

• Head and Neck Cancer: Questions and Answers

• Smoking Home Page (Includes help with quitting)

For general cancer information and other resources from the National Cancer Institute, see the following:

• What You Need to Know About? Cancer

• Understanding Cancer Series: Cancer

• Cancer Staging

• Chemotherapy and You: Support for People With Cancer

• Radiation Therapy and You: Support for People With Cancer

• Coping with Cancer: Supportive and Palliative Care

• Cancer Library

• Information For Survivors/Caregivers/Advocates

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Changes to This Summary (10/21/2011)

The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

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A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

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