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Hypopharyngeal Cancer

Deciding on a Treatment Plan

Your doctors will typically use National Comprehensive Cancer Network® Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers to decide on the appropriate treatment course.9Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 7, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. If these guidelines are not followed, they will discuss it with you and explain why your situation might be special.

Before starting treatment, your doctor will make sure that the following steps are completed.

Pretreatment Evaluation

  • A full history and physical examination, including a complete head and neck exam (mirror and fiberoptic exam if needed)
  • An evaluation by the members of a head and neck cancer team
  • A biopsy of the primary site or FNA of the neck to confirm a diagnosis of cancer
  • Imaging of the lungs to check for spread, if needed
  • Imaging of the primary tumor and the neck with CT and/or MRI
  • Maybe a PET-CT for advanced cancers
  • Examination under anesthesia with endoscopy
  • A dental evaluation
  • Nutrition, speech, and swallowing evaluation and maybe even a hearing evaluation
  • Pulmonary function tests may be considered if a candidate for conservation surgery
  • Pretreatment medical clearance and evaluation of the risks of anesthesia

Then your doctor will recommend a course of treatment for you, depending on a number of factors. As with all cancers in the head and neck, there are three general options to consider:

For hypopharynx cancer, there is not one clear treatment method. You should have an extensive discussion with your cancer team to decide upon the best treatment course for you personally. The options that your doctor will recommend will likely be as follows based on the NCCN Guidelines® for Head and Neck Cancers, depending on the stage of cancer you have.9Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 7, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Most T1, N0 

Select T2, N0 (not requiring total laryngectomy)

For cancers in this category that do not require removal of the voice box to get the cancer completely out, there are several options:

  • Radiation alone, followed by surgery if the cancer remains
  • Partial laryngopharyngectomy with neck dissection
  • A clinical trial

If the first treatment that you and your doctor decide upon is surgical removal of the cancer, then the cancer has to be analyzed under the microscope to determine if additional treatment is needed. Your doctors will be on the lookout for any adverse features (red flags).

  • If there are no adverse features, then no additional treatment is necessary.
  • If the adverse features include spread of cancer outside of the capsule of the lymph node with or without positive margins, then chemotherapy and radiation will be recommended.
  • If there is cancer at the margins of the surgical removal, then either additional surgical removal, or radiation alone are recommended. Chemotherapy and radiation may be considered but only for T2 tumors.

If there are other adverse features, then either radiation alone is recommended or radiation along with chemotherapy may be considered.

 

Advanced cancer requiring pharyngectomy with total laryngectomy

T1, N+

T2-3, Any N

For cases in which removing the hypopharynx cancer will require a total laryngectomy, there are a few options for the initial treatment:

  • Chemotherapy along with radiation, followed by surgical removal if any cancer is left over or comes back
  • Surgery to remove the larynx and pharynx (laryngopharyngectomy) with neck dissection, followed by either radiation alone or chemotherapy with radiation, depending on pathology. If there are no adverse features, then no additional treatment is necessary.
  • Induction chemotherapy followed by either radiation alone, chemotherapy with radiation or surgery, depending on the response to initial chemotherapy.
  • A clinical trial
T4a, Any N  In these cases of a large primary tumor, there are still a few options:

  • Surgical removal along with a neck dissection followed by radiation alone or chemotherapy with radiation, depending on pathology
  • Chemotherapy with radiation, followed by surgery if cancer remains or comes back
  • Induction chemotherapy followed by radiation alone, radiation with chemotherapy or surgical removal, depending on the response to initial chemotherapy
  • A clinical trial

 

References

1 Harrison DF. Pathology of hypopharyngeal cancer in relation to surgical management. The Journal of laryngology and otology. Apr 1970;84(4):349-367.

2 Shah JP, Shaha AR, Spiro RH, Strong EW. Carcinoma of the hypopharynx. Am J Surg. Oct 1976;132(4):439-443.

3 Menvielle G, Luce D, Goldberg P, Leclerc A. Smoking, alcohol drinking, occupational exposures and social inequalities in hypopharyngeal and laryngeal cancer. International journal of epidemiology. Aug 2004;33(4):799-806.

4 Larsson LG, Sandstrom A, Westling P. Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden. Cancer research. Nov 1975;35(11 Pt. 2):3308-3316.

5 Marchand JL, Luce D, Leclerc A, et al. Laryngeal and hypopharyngeal cancer and occupational exposure to asbestos and man-made vitreous fibers: results of a case-control study. Am J Ind Med. Jun 2000;37(6):581-589.

6 Dolan RW, Vaughan CW, Fuleihan N. Symptoms in early head and neck cancer: an inadequate indicator. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. Nov 1998;119(5):463-467.

7 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

8 Krause CJ, Carey TE, Ott RW, Hurbis C, McClatchey KD, Regezi JA. Human squamous cell carcinoma. Establishment and characterization of new permanent cell lines. Arch Otolaryngol. Nov 1981;107(11):703-710.

9 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 7, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

10 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.