Hypopharyngeal cancer medical therapy

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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],Faizan Sheraz, M.D. [3]

Overview

The medical therapy with the combination of the radiotherapy has been used compared to surgical therapy for the treatment of hypopharyngeal cancer.The optimal therapy for hypopharyngeal cancer depends on the stage at the time of diagnosis. The combined treatment helps with organ preservation. swallowing, speech and laryngeal preservation are important to consider during the treatment.

Medical Therapy

The medical therapy with radiotherapy has been used compared to surgical therapy for the treatment of hypopharyngeal cancer due to organ preservation. The optimal therapy for hypopharyngeal cancer depends on the stage at the time of diagnosis. The following factors are important to consider:

*Swallowing
*Speech
*Larynx

Treatment according to stages is as follows:

Stages
Stage 1	Laryngopharyngectomy and neck dissection with or without high-dose radiation therapy to the lymph nodes of the neck Partial laryngopharyngectomy with or without high-dose radiation therapy to the lymph nodes on both sides of the neck
Stage 2	Laryngopharyngectomy and neck dissection High-dose radiation therapy to the lymph nodes of the neck may be given before or after surgery Chemotherapy given during or after radiation therapy or after surgery
Stage 3	Radiation therapy before or after surgery Chemotherapy given during or after radiation therapy or after surgery Radiation therapy followed by surgery to remove cancer containing lymph nodes in the neck that remain or come back after radiation therapy If all or part of the hypopharynx is removed, the patient may need reconstructive surgery
Stage 4	Chemotherapy given with radiation therapy Radiation therapy Radiation therapy followed by surgery to remove cancer containing lymph nodes in the neck that remain or come back after radiation therapy Chemotherapy for cancer that has metastasized (spread) to other parts of the body Treatment of stage IV hypopharyngeal cancer that cannot be treated with surgery may include: Chemotherapy given at the same time as radiation therapy The goal of treatment is to completely remove the cancer and prevent it from metastasizing to other parts of the body When the tumor is larger or has spread to lymph nodes in the neck, a combination of radiation and chemotherapy is often used to preserve the larynx

Supportive Treatment

Many patients also need swallowing rehabilitation after treatment to help them adjust to the changes in the structure of the throat.

Radiation Therapy

• Radiation therapy is used as a single modality treatment in early lesions.
• Laser surgery is gradually replacing radiotherapy for early lesions as the outcome of both are similar while the laser therapy requires a shorter in-patient period following the procedure.
• Radiation is delivered by external beam in dedicated radiotherapy units.
• Radiation affects both normal tissue and cancer tissue, and the salivary glands and oral mucosa are particularly affected.
• Dryness is a common post-radiotherapy complaint.
• The mandible is commonly devascularised following radiotherapy and very prone to osteomyelitis and necrosis, secondary to dental sepsis.
• Thyroid hormone is recommended before and after radiation therapy.