Hypopharynx (pyriform sinus, posterior phanryngeal wall, post-cricoid region)

Head and Neck Cancer Introduction Page
oral cavity
oropharynx
(soft palate, tonsil, base of tongue)
larynx (voice box)
hypopharynx (pyriform sinus, posterior phanryngeal wall, post-cricoid region)
nasal cavity/paranasal sinuses
nasopharynx
salivary glands
paragangliomas (glomus tumors)
thyroid


Hypopharynx (pyriform sinus, posterior pharyngeal wall, post-cricoid region)

Background
Signs and Symptoms
Clinical evaluation
Treatment
Follow-Up

Background


Illustration courtesy of Lippincott Williams & Wilkins © 2004

The hypopharynx includes the pyriform sinuses, post-cricoid area, as well as the posterior pharyngeal wall. It is at the top of the food passage, in the region around the voice box that leads directly into the esophagus. People who use tobacco or alcohol have a higher rate of developing hypopharyngeal cancer, and as with other sites, the combination of tobacco and alcohol increases the risk even more.

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Signs and Symptoms

The majority of patients complain of a sore throat, difficult, painful swallowing, or ear pain. The ear pain, called “referred pain,” is brought on by the nerves that are connected to the ear. Weight loss and hoarseness can also occur.

Clinical evaluation

As with all head and neck tumors, a careful and detailed head and neck examination is required, which includes the use of a flexible fibre-optic endoscopy. An endoscopy, often done in the doctor’s office, involves placing a small, flexible instrument through the nose in order to see all the structures of the head and neck. The procedure is painless. Once a lesion is discovered in the hypopharynx, a biopsy must be obtained. Often this procedure is performed in an operating room, using a direct laryngoscopy. If there are enlarged lymph nodes in the neck, a fine needle aspiration biopsy is usually done. A fine needle aspiration biopsy involves inserting a small needle into the mass and withdrawing cells. The pathologist examines these cells under a microscope to see if they are cancerous. Radiologic imaging, including CT scan, which uses X-rays to create a two-dimensional image of the area, and PET scan, which creates computerized images of the metabolic changes that occur in tissue, are usually performed as part of the staging evaluation. A chest X-ray is also a valuable diagnostic tool.

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Treatment

Early stage hypopharyngeal cancers can be treated with either surgery or radiation therapy. A variety of surgical techniques are available that attempt to remove the tumor without removing the entire larynx (voice box). Reconstruction is sometimes required. As part of the operation, the lymph nodes on one or both sides of the neck might need to be removed. Depending upon the pathologic findings, surgery alone may be adequate treatment. However, many patients will require additional treatment with radiation therapy. If the surgical margins (or edges), are close, or if the disease turns out to be more extensive than originally thought, radiation is usually given. If cancer has spread to the lymph nodes in the neck, radiation is also given.

A variety of other factors help determine the use of radiation therapy after surgery. If radiation therapy is selected for early-stage hypopharynx cancer, external beam radiation is utilized. Treatment is given to the hypopharynx as well as to the lymph nodes on both sides of the neck.

More advanced tumors of the hypopharynx are far more complicated to manage. Most of these patients will require a total laryngectomy (complete removal of the voice box) as well as a partial pharyngectomy (removal of a portion of the pharynx) if surgery is selected. For this reason, a variety of treatments, known collectively as “larynx preservation protocols” have been developed. This involves the use of combined chemotherapy and radiation therapy. Often, surgery to the neck is added after the chemotherapy/radiotherapy. It is absolutely essential for the patient to undergo a multidisciplinary evaluation, which includes the head and neck surgeon, radiation oncologist and medical oncologist, so that an appropriate decision about management can be made.

Continuum Cancer Centers of New York uses this multidisciplinary team approach. In addition to the surgeon, radiation oncologist, and medical oncologist, experts in diagnostic imaging, pathology, nutrition, nursing, and cancer support services, are all included in the development of a treatment plan for each patient.

Click Here for more information about radiation oncology treatments for head and neck cancer.

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Follow-up

After treatment is completed, the patient enters the follow-up phase. Usually, all of the treating physicians are involved in follow-up evaluations. For the first year, patients are usually seen every one to two months. During the second year, they are often seen every two to three months. After the second year, patients are usually seen every three to six months. Of course, the follow-up schedule is individualized for each patient.

Imaging procedures like CT scans, PET scans, or fused PET/CT scans, are done according to a routine that is individualized for each patient. Not all patients require these studies. A chest X-ray is usually done on an annual basis. Regular dental evaluation is done, because good dental care is essential to the head and neck health.

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