The Farber Center: For Radiation Oncology

Hypopopharynx Cancer is a disease in which malignant cells grow in the hypopharynx (the bottom part of the pharynx (throat). Progression of the disease is defined by the spread of cancer into one or more areas and into deeper tissues. Cancer of the hypopharynx is uncommon; approximately 2,500 new cases are diagnosed in the United States each year. It is more common in males, blacks and ages 50-60’s.

• Enlarged neck lymph nodes
• Sore throat
• Ear pain
• Difficulty swallowing
• Painful swallowing
• Feeling that something is caught in the throat
• Pain

Risk Factors

• Smoking
• Chewing Tobacco
• Heavy Alcohol use
• Poor Dietary habits or environmental
• Plummer-Vinson syndrome. A disorder marked by anemia caused by iron deficiency, and a web-like growth of membranes in the throat that makes swallowing difficult. Having Plummer-Vinson syndrome may increase the risk of developing esophageal cancer. Also called Paterson-Kelly syndrome and sideropenic dysphagia.

Physical exam of the throat: An exam in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.

Endoscopy: A procedure used to look at areas in the throat that cannot be seen with a mirror during the physical exam of the throat. An endoscope (a thin, lighted tube) is inserted through the nose or mouth to check the throat for anything that seems unusual. Tissue samples may be taken for biopsy.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Head, neck, and chest x-rays: An x-ray of the head, neck, and organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Barium esophagogram: An x-ray of the esophagus. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken.

Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth or nose and down the throat into the esophagus. Tissue samples may be taken for biopsy.

Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

T stands for tumor (its size and how far it has spread within hypopharynx and to nearby organs).

T1: small tumor, not larger than 2 centimeters (cm), that is limited to a single site in the lower throat.

T2: tumor that involves more than one site in the lower throat, but does not touch the voice box; or, a tumor that measures larger than 2 cm, but not larger than 4 cm.

T3: tumor that is larger than 4 cm or a tumor that has spread to the larynx.

T4a: tumor that has spread into nearby structures, such as the thyroid, the arteries that carry blood to the brain, or the esophagus.

T4b: tumor has spread to the prevertebral fascia (space in front of the spinal cord), encases the arteries, or involves mediastinal (chest-area) structures.

N stands for spread to nearby lymph nodes in the neck

N0: There is no evidence of cancer in the regional nodes.

N1: Cancer has spread to a single node on the same side as the primary tumor and the cancer found in the node is 3 cm or smaller.

N2: Describes any of the following conditions:

N2a: Cancer has spread to a single lymph node on the same side as the primary tumor, and is larger than 3 cm, but not larger than 6 cm.
N2b: Cancer has spread to more than one lymph node on the same side as the primary tumor, and none measure larger than 6 cm.
N2c: Cancer has spread to more than one lymph node on either side of the body, and none measure larger than 6 cm.

N3: Cancer found in the lymph nodes is larger than 6 cm.

M is for metastasis (spread to distant organs).

M0: The cancer has not spread to distant sites.

M1: The cancer has spread to distant sites.

Stage Grouping

Stage 0
Tis, N0, M0

Stage I
T1, N0, M0

Stage II
T2, N0, M0

Stage III
T3, N0, M0, OR T1 to T3, N1, M0

Stage IVA
T4a, N0 or N1, M0, OR T1 to T4a, N2, M0

Stage IVB
T4b, Any N, M0, OR Any T, N3, M0

Stage IVC
Any T, Any N, M1

The treatment of hypopharyngeal cancer is controversial, in part because of its low incidence and the inherent difficulty in conducting adequately powered, prospective, randomized clinical studies.Therefore, it is difficult to define the ideal therapy for a specific site or stage of hypopharyngeal cancer. In general, both surgery and radiation therapy are the mainstays of most curative efforts aimed at this cancer.

Early stage tumors can be treated with:

Surgery (may need radiation with or without chemotherapy afterward)

Radiation (may need surgery afterward)

For more locally advanced tumors

Chemotherapy followed by any combination of surgery, radiation with or without more chemotherapy

Radiation therapy + chemotherapy

Surgery with postoperative radiation with or without chemotherapy

Possible Treatment Side Effects
Dr. Farber, Dr. Spierer, and their staff at The Farber Center for Radiation Oncology will discuss potential side effects with you before, during, and after treatment, and ensure that your experience is personalized.