Hypopharyngeal Cancer

What is hypopharyngeal cancer?

Hypopharyngeal cancer is an uncommon throat cancer that develops in your hypopharynx, which is in the lower part of your throat (pharynx) just behind your voice box (larynx). It causes cancerous tumors that often spread (metastasize) quickly to other areas of your body. You may not have noticeable symptoms until after tumors have spread. Treatment includes surgery and/or radiation therapy and chemotherapy to remove tumors and relieve symptoms.

How common is hypopharyngeal cancer?

It’s not common. Each year, an estimated 2,000 to 4,000 people in the U.S. receive a hypopharyngeal cancer diagnosis. For comparison, the American Cancer Society estimates more than 238,000 people received a lung cancer diagnosis in 2023.

What are hypopharyngeal cancer symptoms?

Hypopharyngeal cancer may not cause symptoms right away. When it does, symptoms may include:

• Sore throat or feeling like something is caught in your throat.
• Hoarseness.
• Difficulty swallowing.
• Ear pain.
• Swollen lymph nodes in your neck.
• Choking for no obvious reason.
• Fatigue.
• Changes to your voice.
• Difficulty breathing or noisy breathing (stridor).
• Coughing up blood.
• Unexplained weight loss.

Hypopharyngeal cancer symptoms are similar to other less serious conditions. Having any of the symptoms listed above doesn’t mean you have hypopharyngeal cancer. But you should talk to a healthcare provider if you have symptoms that last for more than two weeks.

What causes hypopharyngeal cancer?

Hypopharyngeal cancer develops in cells that line your hypopharynx. These cells mutate and become cancerous cells that multiply and create tumors. Experts don’t exactly why this happens, but they do know certain risk factors significantly increase the chance you’ll develop hypopharyngeal cancer like:

• Smoking: This is the single largest risk factor for developing throat cancer, including hypopharyngeal cancer. That includes smoking cigarettes, cigars, pipes and electronic cigarettes, using chewing tobacco and snuff.
• Frequent, heavy alcohol use: Frequent, heavy consumption means having more than two drinks a day if you’re a man and assigned male at birth (AMAB) or one daily drink if you’re a woman and assigned female at birth.
• HPV infections: Human papillomavirus is a sexually transmitted infection (STI) that you can contract by having oral sex with someone who has the virus.

What are the complications of this condition?

Early on, hypopharyngeal cancer often spreads to lymph nodes in your neck. That’s why a lump in your neck is something you should discuss with a healthcare provider. Without treatment, hypopharyngeal cancer can spread to your:

• Esophagus.
• Other parts of your throat.
• Thyroid.
• Trachea (windpipe).
• Hyoid bone.
• The lining of your chest cavity.
• Tissues around the upper part of your spine.
• Carotid artery.

How is hypopharyngeal cancer diagnosed?

A healthcare provider will ask you about your symptoms, including how long you’ve had them. They may ask about your tobacco and alcohol use because those activities may increase your risk of developing hypopharyngeal cancer.

They’ll do a physical examination that may include feeling your neck for swollen lymph nodes and examining your throat.

Depending on your symptoms, your provider may refer you to an ear, nose and throat (ENT) specialist or otolaryngologist, a provider who specializes in diagnosing and treating head and neck conditions. Your ENT may order the following tests to determine if you have hypopharyngeal cancer:

• Endoscopy: In this test, a provider places a long thin tube (endoscope) in your throat to check your lower throat. They may also order a laryngoscopy to examine your larynx.
• Biopsy: Your provider may order a fine-needle aspiration (FNA) to obtain tissue that a pathologist will view under a microscope for signs of cancerous cells.
• Imaging tests: If biopsy results show you have hypopharyngeal cancer, your otolaryngologist may refer you to an oncologist. Your oncologist may order imaging tests to see if cancer has spread from your lower throat to other areas of your body. Imaging tests may include computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET) scans.

Cancer staging

Cancer staging is how oncologists describe cancer in more detail, like tumor location, if or where it’s spread or if cancer affects other areas of your body.

Hypopharyngeal cancer stages range from Stage I (cancer in your lower throat that hasn’t spread) to Stage IV (cancer that has spread to other parts of your throat and mouth, your nasopharynx and the base of your skull, and more distant parts of your body like the lining of your chest cavity).

They also describe hypopharyngeal cancer by its grade. A cancer grade can help oncologists predict how quickly cancer will spread. Hypopharyngeal cancer grades range from GX (cancer isn’t likely to spread or is less likely to spread) to G3 (cancer is likely to spread very quickly).

What are treatments for hypopharyngeal cancer?

The most common treatments are surgery to remove the tumor and radiation therapy to kill any cancerous cells that may remain after surgery. Your oncologist may combine surgery with chemotherapy or immunotherapy.

Hypopharyngeal cancer surgical options are:

• Partial or total pharyngectomy: This surgery involves removing all or part of your throat. Surgery may include a laryngectomy to remove your larynx (voice box). Your throat helps you breathe, so surgery includes creating a stoma to hold a laryngectomy tube. This tube is how you’ll breathe in air after surgery.
• Laryngectomy: If you have a laryngectomy, your surgeon may create a tracheoesophageal puncture (TEP), which is a small hole between your trachea and esophagus. A TEP is how providers insert a voice prosthesis (laryngectomy speaking device).
• Neck dissection: Your surgeon may do this to remove affected lymph nodes in your neck.
• Transoral robotic surgery (TORS): This surgery allows surgeons to remove tumors in hard-to-reach places like your lower throat.
• Reconstructive surgery: Surgery that removes all or part of your throat or voice box may require reconstructive surgery to help restore function such as eating, breathing and the ability to use your voice prosthesis.

Throat surgery for cancer affects your ability to speak, eat and breathe. Before your surgery, ask your surgeon how treatment will affect you. For example, you may work with a speech-language pathologist to learn ways to manage any speech or swallowing issues from surgery.

Is there a way to prevent hypopharyngeal cancer?

You can reduce your risk of hypopharyngeal cancer by:

• Quitting tobacco and avoiding secondhand smoke.
• Avoid alcohol or limit how much you drink.
• Protect yourself from HPV by being vaccinated against the virus and practicing safe sex.

What can I expect if I have hypopharyngeal cancer?

Hypopharyngeal cancer can come back (recur). It also increases your risk of developing a new kind of cancer in a different area of your body. Healthcare providers may refer to this as second cancer.

As a result, you should expect to have regular follow-up appointments so your oncology care team can check on your overall health and watch for signs of recurrent or metastatic hypopharyngeal cancer or second cancer Your follow-up care may include imaging tests and physical examinations. The schedule may include appointments every:

• Two months for the first year after treatment.
• Four months for the second year.
• Six months for the third year.
• Once a year for the fourth and fifth years. In some cases, your oncology care team may recommend lifelong follow-up.

What are hypopharyngeal survival rates?

When you think about survival rates, it’s important to remember that survival rates are estimates based on other people’s experiences with hypopharyngeal cancer. Survival rates vary widely depending on whether a tumor remains where it started or spreads (metastasizes) to nearby tissues and lymph nodes (regional) or other areas in your body (distant).

These rates also vary depending on your overall health and other factors. Ask your oncologist to explain what a survival rate means in your situation. They know you and your overall health, which makes them your best resource for information.

The five-year survival rates based on tumor location are:

Is there a cure for hypopharyngeal cancer?

In some cases, surgery and other treatments may cure hypopharyngeal cancer. That typically happens if a tumor measures 2 centimeters or less and hasn’t spread. Unfortunately, most people with this cancer don’t receive a diagnosis until the condition is in advanced stages.

How do I take care of myself?

If you had throat surgery, you’ll need to learn new ways to breathe and speak. That’s a lot of change to manage, so don’t hesitate to ask your speech-language pathologist for help. They may have suggestions about support groups for people recovering from throat surgery.

Here are some other ways you can take care of yourself:

• Consider cancer survivorship. Hypopharyngeal cancer can come back or cause a second cancer. You may feel anxious about your future. Most cancer survivorship programs include mental health support.
• Continue to avoid tobacco and limit how much alcohol you drink.
• Eat well. Throat surgery may affect your ability to eat and drink. Ask your speech-language pathologist for ways to manage any issues that keep you from eating well. Ask a nutrition expert to recommend meals and meal plans.

When should I see my healthcare provider?

That depends on your situation, including treatment. Ask your oncology care team to explain the kind of symptoms or issues you can expect, and when you should contact them.

What questions should I ask my oncologist?

• What is the cancer’s stage?
• What treatment options do you recommend?
• If I have surgery, what are the support programs to help me deal with the changes that surgery may cause?
• How will treatment affect my quality of life?
• Am I eligible for any clinical trials?