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. 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. Genes involved in the pathogenesis of hypopharyngeal cancer include p16, NOTCH1, cyclin D1, and TP53. Hypopharyngeal cancer is associated with sideropaenic dysphagia and Paterson Brown Kelly syndrome.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.There are no established direct causes for hypopharngeal cancer. The prevalence of hypopharyngeal cancer is estimated to be approximately 10% of all proximal aerodigestive tract malignancies.<ref name=aa>Epidemiology of Hypophrayngeal carcinoma.The incidence of hypopharyngeal cancer is estimated to be 0.78 cases per 100,000 individuals in the United States each year.Hypopharyngeal cancer commonly affects individuals older than 50 years of age. Males are more commonly affected with hypopharyngeal cancer than females. If left untreated, hypopharyngeal cancer produces few symptoms early in the 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 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. The optimal therapy for hypopharyngeal cancer depends on the stage at the time of diagnosis. The feasibility of surgery depends on the stage of hypopharyngeal cancer at the time of diagnosis.
Classification
Hypopharyngeal cancer may be classified based on the location into 4 subtypes: pyriform sinus cancer, postcricoid area cancer, posterior wall of hypopharynx cancer, and hypopharynx cancer unspecified.
Pathophysiology
Hypopharyngeal cancer arises from squamous cells, which are cells that are normally involved in protection of aerodigestive tract. Genes involved in the pathogenesis of hypopharyngeal cancer include p16, NOTCH1, cyclin D1, and TP53. Hypopharyngeal cancer is associated with sideropenic dysphagia and Paterson-Brown-Kelly syndrome. 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.
Causes
There are no established direct causes for hypopharngeal cancer. Common risk factors for hypopharyngeal cancer can be found here.
Differentiating Hypopharyngeal Cancer from other Diseases
Hypopharyngeal carcinoma must be differentiated from accessory salivary gland tumor, lymphoma, and retropharyngeal abscess.
Epidemiology and Demographics
The prevalence of hypopharyngeal cancer is estimated to be approximately 10% of all proximal aerodigestive tract malignancies. The incidence of hypopharyngeal cancer is estimated to be 0.78 cases per 100,000 individuals in the United States. Hypopharyngeal cancer commonly affects individuals older than 50 years of age. Males are more commonly affected with hypopharyngeal cancer than females.
Risk Factors
Common risk factors in the development of hypopharyngeal cancer are smoking tobacco, chewing tobacco, heavy alcohol intake, and Plummer-Vinson syndrome.
Natural History, Complications and Prognosis
If left untreated, hypopharyngeal cancer produces few symptoms early in the 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 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.
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. Common symptoms include lump in the neck, dysphasia, and hoarseness.
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.
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.
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.
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.
Medical Therapy
The optimal therapy for hypopharyngeal cancer depends on the stage at the time of diagnosis.
Surgery
The feasibility of surgery depends on the stage of hypopharyngeal cancer at the time of diagnosis.
Primary Prevention
Effective measures for the primary prevention of hypopharyngeal cancer include smoking cessation and limiting or avoiding alcohol consumption.
Secondary Prevention
Secondary prevention measures of hypopharyngeal cancer include routine physical examination and imaging at scheduled intervals after treatment. Dental screening and screening for thyroid cancers are recommended among patients who had received radiation therapy to the oral cavity and cervical region, respectively.