The hypopharynx is the lowest part of the pharynx (throat); it lies behind and to the sides of the voice box (larynx) and opens into the oesophagus (food pipe). Cancers that develop in this area are called hypopharyngeal cancer. Because the area lies deep in the throat, symptoms may be noticed late, which is why complaints that do not go away should be assessed promptly.
What is hypopharyngeal cancer?
Almost all hypopharyngeal cancers are squamous cell carcinomas. The tumour most often develops in the pocket-shaped recesses on either side of the voice box (the piriform sinuses); less often it is found on the back wall of the throat or in the area just above the entrance to the oesophagus (the postcricoid area). The hypopharynx has a rich network of lymphatic vessels, so tumour cells can spread to the lymph nodes in the neck early. Because of its closeness to the voice box, the vocal cords may also be affected as the tumour grows.
Risk factors
Long-term tobacco and alcohol use are the most prominent risk factors, and their effect is greater when combined. Long-standing swallowing difficulty related to iron deficiency, poor nutrition and reflux are also among the conditions that may increase the risk of cancer in this area.
Symptoms
- Pain on swallowing or a feeling of something stuck in the throat
- Difficulty swallowing that begins with solid food and, over time, extends to liquids
- Constant earache on one side
- Hoarseness or a change in the voice
- A painless lump in the neck
- Unintended weight loss
- Shortness of breath at a later stage
Most of these symptoms may also have benign causes, but if they last more than a few weeks they need to be assessed.
Diagnosis
At the ear, nose and throat examination, the hypopharynx is inspected with a flexible endoscope. If a suspicious area is seen, a biopsy is taken, usually during an endoscopic examination performed under general anaesthesia in the operating theatre; the upper part of the oesophagus is assessed at the same time. The extent of the tumour and the state of the lymph nodes in the neck are determined with computed tomography, magnetic resonance imaging and, where necessary, a PET scan. All the findings are considered together to establish the stage (stage I–IV).
Treatment
Treatment is planned according to the size of the tumour, whether it involves the voice box, the state of the lymph nodes in the neck and your general health. In early-stage tumours, radiotherapy or limited surgery alone may be sufficient. In more advanced stages, giving radiotherapy together with chemotherapy may make it possible to preserve the voice box. When the tumour involves the voice box extensively, an operation in which the voice box is removed together with the hypopharynx (laryngopharyngectomy) may be needed; in that case, tissue transfer (reconstruction) is used to rebuild the swallowing passage. The lymph nodes in the neck are usually included in treatment.
What to expect after treatment
Recovery of swallowing can take time, and a feeding tube may be needed for a while. When the voice box has been removed, breathing takes place through a permanent opening in the neck (stoma), and different methods of speaking are taught. Swallowing and speech therapy and nutritional support are important parts of the recovery process.
When should you see a doctor?
If complaints such as persistent difficulty swallowing, earache on one side, hoarseness or a lump in the neck last more than a few weeks, you are advised to see an ear, nose and throat specialist.
Frequently asked questions
Why is hypopharyngeal cancer often noticed late?
Because the area lies deep in the throat, early symptoms are mild and vague; a feeling of something stuck in the throat or an earache is often put down to ordinary causes.
Is the voice box always removed in hypopharyngeal cancer?
No. In early-stage tumours, and when radiotherapy and chemotherapy are given together, the voice box can often be preserved; the decision depends on how far the tumour has spread.
Can hoarseness be a sign of hypopharyngeal cancer?
Yes; because the tumour lies next to the voice box, it can affect the vocal cords as it grows. Hoarseness that does not go away needs to be assessed.
This page is general information. Decisions about diagnosis and treatment are made for you personally, and only after an examination. If you have symptoms, see a doctor.