Hypopharyngeal cancer diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2]

Overview

The diagnostic study of choice for hypopharyngeal cancer is CT scan with contrast of head and neck. The definitive diagnosis of hypopharyngeal cancer is biopsy of the tumor.

Diagnostic Study of Choice

• Diagnostic study of choice for hypopharyngeal cancer is CT scan with contrast of head and neck.
• Definitive diagnosis of hypopharyngeal cancer is biopsy through endoscopy.

Staging

According to the American Joint Committee of Cancer (AJCC) TNM staging system, there are 5 stages of hypopharyngeal cancer based on the tumor size, lymph node involvement, and distant metastasis.

• The following stages are used for hypopharyngeal cancer:

AJCC Stage	Stage Grouping	Stage description
0	Tis N0 M0	The tumor is only in the top layer of cells lining the inside of the hypopharynx and has not grown any deeper (Tis). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
I	T1 N0 M0	The tumor has grown deeper, but it is only in one part of the hypopharynx, and it is no more than 2 centimeters (cm) across (T1). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
II	T2 N0 M0	The tumor has grown into more than one part of the hypopharynx, OR it has grown into a nearby area, OR it is larger than 2 but no larger than 4 cm across and has not affected the vocal cords (T2). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
III	T3 N0 M0 OR T1 to T3 N1 M0	The tumor is larger than 4 cm across, OR the tumor is affecting the movement of the vocal cords, OR the tumor has grown into the esophagus (T3). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). OR The tumor can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a vocal cord (T1 to T3). The cancer has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0).
IVA	T4a N0 or N1 M0 OR T1-T4a N2 M0	The tumor has grown into the thyroid or cricoid cartilage, the hyoid bone, the thyroid gland, or nearby areas of muscle or fat. This is also known as moderately advanced local disease (T4a). The cancer has not spread to nearby lymph nodes (N0), or it has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0). OR The tumor can be any size and might or might not have grown into structures outside the hypopharynx (as far as moderately advanced disease), and it might or might not have affected a vocal cord (T1 to T4a). The cancer is N2: It has spread to a single lymph node on the same side of the neck as the tumor, which is larger than 3 centimeters (cm) but no larger than 6 cm across, OR It has spread to more than one lymph node on the same side of the neck as the tumor, none of which is larger than 6 cm across, OR It has spread to at least one lymph node on the other side of the neck, none of which is larger than 6 cm across. The cancer has not spread to distant parts of the body (M0).
IVB	T4b Any N M0 OR Any T N3 M0	The tumor is growing into the area in front of the spine in the neck, surrounds a carotid artery, or is growing down into the space between the lungs. This is also known as very advanced local disease (T4b). The cancer might or might not have spread to nearby lymph nodes (any N). It has not spread to distant parts of the body (M0). OR The tumor can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a vocal cord (any T). The cancer has spread to at least one lymph node that is larger than 6 cm across, OR it has spread to a lymph node and then grown outside of the lymph node (N3). It has not spread to distant parts of the body (M0).
IVC	Any T Any N M1	The tumor can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a vocal cord (any T). The cancer might or might not have spread to nearby lymph nodes (any N). The cancer has spread to distant parts of the body (M1).