Background

Hypopharyngeal cancer affects the lower throat, behind your voice box and above your food pipe. It involves tumors between the areas connecting the mouth and food pipe, from below the bone at the root of your tongue down to beneath your voice box cartilage. The two major causes are smoking and heavy alcohol use, so those who frequently smoke or drink a lot face greater risks. Different from cancer in your voice box, hypopharyngeal cancer has unique features and treatments. Advanced tumors can grow into your voice box, blocking your airway and causing choking. Surgery may require partly or entirely removing parts of your throat and voice box, based on the tumor location and stage. But this can leave you with lasting issues like trouble swallowing. 

Epidemiology

Hypopharyngeal cancer isn’t as common as other head and neck cancers. However, its occurrence varies worldwide. Certain regions experience higher rates than others. South-Central Asia, Central and Eastern Europe, Western Europe, and North America each have unique prevalence levels. Societal norms like alcohol and tobacco use significantly impact its spread. Additionally, practices such as chewing cancer-causing substances in pecific populations contribute. The risk increases with age, affecting more men than women. 

Anatomy

Pathophysiology

The hypopharynx is where hypopharyngeal cancer first begins. It starts with abnormal cells growing in that area. Genes, environment, and lifestyle choices can make that happen. The main cause is being exposed to certain harmful things for a long time. These are tobacco and alcohol. When you inhale smoke or have alcohol touch the hypopharynx lining, it irritates and inflames over time. This can change genes and cell signaling. HPV infection may also play a part, but less often. As the cancer grows, it invades nearby tissues. This causes trouble swallowing, sore throat that won’t go away, and a throat lump feeling. In advanced stages, it spreads to lymph nodes in that area or distant parts of the body. To prevent this, it’s key to stop smoking, cut back on alcohol. Early detection and treatment improves outcomes too. 

Etiology

Encountering harmful substances like asbestos or wood dust in the workplace can make it more likely to develop a hypopharyngeal cancer. Having a diet with few fruits and veggies could contribute too, since those provide protective compounds that fight disease. Downing lots of alcohol, especially along with tobacco products, greatly ups the chance of this cancer type due to ongoing irritation. Using tobacco products over a long time, smoked or smokeless, is another prime risk element, causing genetic changes in the hypopharynx area. Also, genetics can play a part if your relatives have had head or neck cancers before, leaving you more vulnerable. 

Genetics

Prognostic Factors

Early hypopharyngeal cancers without metastasis have better outcomes, with survival around 70%. But these cancers are often found late, with lymph node spread. So the overall 5-year survival is dismal—just 20%. Hypopharyngeal cancers’ prognosis lags behind other head and neck malignancies. The delayed diagnosis and rapid nodal involvement are key culprits. 

Clinical History

Hypopharyngeal cancers differ from cancers in other head and neck areas. They grow in less critical anatomy sites. So, symptoms are often missed until the cancer is large. Initial signs may include throat discomfort, feeling a lump, painful swallowing, ear pain. Cancer often spreads to neck lymph nodes early. A new neck lump might be the first noticeable symptom. Over time, swallowing gets harder – first solids, then liquids. Voice hoarseness happens if the tumor invades the larynx or paralyzes vocal cords. 

Physical Examination

• Checking the mouth may not directly show a hypopharynx cancer but can find cancers in the mouth lining or throat area. It could also detect signs of the tumor spreading into a throat muscle. In advanced cases, you may see buildup of fluids or saliva. 
• The neck exam is really important because these cancers often spread to lymph nodes early. Closely inspect the lymph nodes in the neck, especially levels III and IV and the area above the collarbone. Test if the voice box moves normally. If there’s no grating sound, it could mean a big tumor or spread to tissues near the spine. 
• Using a thin camera scope is very good at finding tumors in the back of the throat, voice box area, or just past it. You may see abnormal secretions, growths on the lining, or changes to the vocal cords. 
• Checking the cranial nerves may reveal if the tumor has invaded nerves like the glossopharyngeal or vagus, suggesting spread. Overall, the exam can also detect signs of cancer spread elsewhere or health issues like severe weight loss. 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

• Laryngeal Cancer  
• Esophageal Cancer  
• Laryngopharyngeal Reflux  
• Infectious Pharyngitis  

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Treating hypopharyngeal cancer aims to control the disease while preserving key functions like speech, swallowing, and breathing. Treatment combines surgery, radiation, and chemotherapy. Factors such as cancer stage, tumor size/location, and patient health determine the approach. Surgery removes tumors and lymph nodes, sometimes with part of the pharynx. Radiation therapy targets and kills cancer cells, used alone or after surgery. Chemotherapy complements radiation or treats advanced cases solo. New targeted therapies and immunotherapy offer precise options. After treatment, rehabilitation addresses impairments to improve quality of life. Close monitoring detects and manages any recurrence or complications. The combined treatment strategy provides optimal loco-regional cancer control while maximizing functional preservation. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Surgery for cancer in the throat area is chosen based on how far it has spread and where it started. For some cases, doctors may remove parts or all of the throat and neck. The full throat removal procedure is done for bigger tumors that have grown into certain areas. If cancer affects the back throat wall, a smaller or larger operation may be needed depending on how deep it goes. After surgery, some added procedures may rebuild the throat’s role and appearance. Doctors do this by stitching in grafts and using other special techniques for the best possible result. 

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

lifestyle-modifications

Hypopharyngeal cancer has smoking, heavy drinking as key risk factors. Quitting smoking, cutting alcohol can boost results, slash recurrence odds. The cancer and treatment may affect speech, swallowing. Therapy can adapt you to changes, enhance function. Regular checkups are vital for tracking recovery, catching recurrence signs quickly. 

phases-of-management

Early stage   

Chemotherapy:  

• Cisplatin: Cisplatin stops cancer cells from growing. Chemotherapy medicine with platinum disrupts DNA. 
• 5-Fluorouracil (5-FU): 5-FU interferes with cancer cell growth, too. Making both DNA and RNA can’t happen normally. Special combo     treatment, cisplatin plus 5-FU, can work better. 
• Taxanes (such as paclitaxel or docetaxel): Taxanes like paclitaxel and docetaxel also help treat hypopharyngeal cancer. These drugs disrupt structures inside cancer cells called microtubules. Cell division gets messed up when microtubules can’t function right. 

Chemotherapy targeting hypopharyngeal cancer brings potential difficulties, chiefly during the treatment phase and with notable severity. Lowered blood cell and immune system function heightens the chance of dangerous infections. Other issues comprise hair loss,            exhaustion, nerve damage, and nausea/vomiting. Chemotherapy drugs leaking outside the vein can ignite severe discomfort, even endangering the limb. Moreover, chemotherapy may worsen acute radiation therapy complications like mouth sores. Such troubles emphasize watchful tracking and management’s crucial role throughout treatment. 

 Targeted Therapy:  

• Cetuximab: Cetuximab is an anti-body that targets EGFR. EGFR stands for epidermal growth factor receptor. This receptor gets                         overexpressed in hypopharyngeal cancer cells. Cetuximab blocks EGFR, thus halting abnormal growth. Nivolumab and Pembrolizumab: Nivolumab and Pembrolizumab are immune checkpoint inhibitors. These are effective against hypopharyngeal cancers with certain gene mutations. They prevent proteins that suppress immune response to cancer cells. 

Late Stage  

Tumors in the lower part of the throat (hypopharynx) are usually treated by removing part or all of the voice box and throat, along with taking out neck lymph nodes. After surgery, chemo and radiation therapy are given. If the tumor can’t be removed, radiation alone or chemo plus radiation are used instead. 

Tumors in the area just below the voice box (post-cricoid region) are tricky. They often aren’t caught early, so treatment starts when they’re bigger. Major surgery is needed to remove the tumor, rebuild the area, and give other treatments like chemo or radiation. Part of the esophagus may need to come out too, since these tumors can spread to tissues behind the voice box. 

Before operating, doctors must decide if the patient is healthy enough. Surgery has many risks, like trouble swallowing. Skin from the arm (radial forearm free flap) is often used to rebuild the throat, connecting it to blood vessels for proper healing. Lymph nodes from neck levels II to VI are usually removed too. Patients need to be carefully evaluated for their ability to handle major complex operations with tissue reconstruction. 

Medication

Future Trends

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References