Hypopharyngeal cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]
Overview
Hypopharyngeal cancer is a disease in which malignant cells proliferate in the hypopharynx.[1] Most hypopharyngeal cancers form in squamous cells, the thin, flat cells lining the inside of the hypopharynx. It first forms in the outer layer (epithelium) of the hypopharynx, which is split into three areas. Progression of the disease is defined by the spread of cancer into one or more areas and into deeper tissues.
Classification
Hypopharyngeal cancer may be classified according to location into 4 subtypes: pyriform sinus cancer, postcricoid area cancer, posterior wall of hypopharynx cancer, and hypopharynx cancer unspecified.[2]
Historical Perspective
Pathophysiology
On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are characteristic findings of hypopharyngeal cancer. On microscopic histopathological analysis, spindle cells, basaloid cells, and nuclear atypia are characteristic findings of hypopharyngeal cancer. Genes involved in the pathogenesis of hypopharyngeal cancer include p16, NOTCH1, and cyclin D1. Hypopharyngeal cancer is associated with sideropaenic dysphagia and Paterson Brown Kelly syndrome.[3]
Causes
Causes of hypopharyngeal cancer include smoking, chewing tobacco, heavy alcohol consumption, and Plummer-Vinson syndrome.[4]
Differentiating Hypopharyngeal Cancer from other Diseases
Hypopharyngeal carcinoma must be differentiated from accessory salivary gland tumor, lymphoma, and retropharyngeal abscess.[5]
Epidemiology and Demographics
The prevalence of hypopharyngeal cancer is relatively less, representing only 10% of all proximal aerodigestive tract malignancies.[5] The incidence of hypopharyngeal cancer is estimated to be 0.78 cases per 100,000 individuals in the United States each year.[6] Males are more commonly affected with hypopharyngeal cancer than females. Hypopharyngeal cancer commonly affects individuals older than 50 years of age.
Risk Factors
Common risk factors in the development of hypopharyngeal cancer are smoking tobacco, chewing tobacco, heavy alcohol intake, and Plummer-Vinson syndrome.[5]
Natural History, Complications and Prognosis
If left untreated hypopharyngeal cancer produces few symptoms early in its course. Once the tumor has expanded from its site of origin, it may obstruct the aerodigestive tract. Common complications of hypopharyngeal cancer include airway obstruction, dysphagia, odynophagia, and disfigurement of the neck or face. The prognosis varies with the type of hypopharyngeal cancer. Squamous cell carcinoma of hypopharynx has the most unfavorable prognosis.[5]
Staging
According to the TNM staging system, there are 5 stages of hypopharyngeal cancer based on the tumor size, lymph node involvement, and distant metastasis.
History and Symptoms
The hallmark of hypopharyngeal cancer is dysphagia. A positive history of odynophagia and hoarseness is suggestive of hypopharyngeal cancer. The most common symptoms include lump in the neck, dysphaia, and hoarseness.[5]
Physical Examination
Patients with hypopharyngeal carcinoma are usually well appearing. Physical examination of patients with hypopharyngeal carcinoma is usually remarkable for neck swelling, hearing loss, and partial airway obstruction.
Laboratory Findings
There are no diagnostic laboratory findings associated with hypopharyngeal cancer.
Chest X Ray
There are no chest x ray findings associated with hypopharyngeal cancer.
CT
Head and neck CT scan may be helpful in the diagnosis of hypopharyngeal cancer. Findings on CT scan suggestive of hypopharyngeal cancer include solid soft tissue nodule, region of superficial thickening with increased enhancement, and obliteration of fat planes.[5]
MRI
MRI may be helpful in the diagnosis of hypopharyngeal cancer. Findings on MRI suggestive of hypopharyneal cancer include intermediate to low signal mass and soft tissue enhancement.[5]
Other Imaging Findings
Other diagnostic studies for hypopharyngeal cancer include barium swallow, which demonstrates irregular filling defects. Small sessile or superficially spreading lesions can be difficult or impossible to diagnose. Larger lesions may be visualized as irregular filling defects. Fluoro-D-glucose positron emission tomography may be performed to detect metastases of hypopharyngeal cancer.[7]
Other Diagnostic Studies
Biopsy may be diagnostic of hypopharyngeal cancer. Findings on biopsy diagnostic of hypopharyngeal cancer include spindle cells, basaloid cells, and nuclear atypia.[3]
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ National Cancer Institute. General Information About Hypopharyngeal Cancer
- ↑ Merletti F, Faggiano F, Boffetta P, Lehmann W, Rombolà A, Amasio E; et al. (1990). "Topographic classification, clinical characteristics, and diagnostic delay of cancer of the larynx/hypopharynx in Torino, Italy". Cancer. 66 (8): 1711–6. PMID 2208025.
- ↑ 3.0 3.1 Helliwell TR (2003). "acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx". J Clin Pathol. 56 (2): 81–5. PMC 1769882. PMID 12560383.
- ↑ Causes of hypopharyngeal cancer. Wikipedia. https://en.wikipedia.org/wiki/Hypopharyngeal_cancer#cite_note-National_Cancer_Institute._General_Information_About_Hypopharyngeal_Cancer-1
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Hypophrayngeal carcinoma Differential diagnosis. Dr Aditya Shetty and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/hypopharyngeal-squamous-cell-carcinoma
- ↑ http://www.cancer.gov/types/head-and-neck/hp/hypopharyngeal-treatment-pdq
- ↑ Hypophrayngeal carcinoma PET scan. Dr Aditya Shetty and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/hypopharyngeal-squamous-cell-carcinoma