What is hypopharyngeal cancer?
Hypopharyngeal cancer is a rare form of throat cancer. Healthcare providers also call it a head and neck cancer. It develops in the bottom part of the throat (called the hypopharynx), just behind your voicebox (larynx).
Most hypopharyngeal cancers are squamous cell carcinoma. This type of cancer happens in cells that make up the lining of the throat.
What’s the difference between hypopharyngeal cancer and laryngeal cancer?
Hypopharyngeal cancer and laryngeal cancer are both throat cancers. But they affect different parts of the throat.
Hypopharyngeal cancer develops in cells that make up the lower part of the pharynx, right above the esophagus. Laryngeal cancer grows inside tissues of the larynx (commonly called the voicebox).
What is the pharynx?
The pharynx is a tube that runs down the inside of your neck. It’s the part of the throat behind your nasal cavity and mouth. It acts as a bridge to other body parts so you can breathe, talk and swallow.
One end of the pharynx starts behind your nose (called nasopharynx). The other end connects to the esophagus (tube that takes food and drink to the stomach). It also connects to the larynx.
Cancer can develop in other parts of the pharynx:
- Nasopharynx cancer affects tissues at the base of the nose.
- Oropharynx cancer – back of tongue and tonsils.
What is the larynx?
The larynx sits in front of the pharynx. It leads to your trachea (windpipe). Inside the larynx are your vocal cords, which help you talk.
You can feel the vocal cords vibrate if you say something with your fingers touching your neck, just below your chin. The larynx is also a key part of the passageway to the lungs, allowing you to breathe.
How common is hypopharyngeal cancer?
Hypopharyngeal cancer makes up a small portion of head and neck cancer cases. Overall, about 65,000 people in the U.S. receive a head and neck cancer diagnosis each year. Hypopharyngeal cancer accounts for less than 3,000 of those cases. In general, hypopharyngeal cancer rates have declined in recent years.
Anyone can get hypopharyngeal cancer. But it typically affects more men than women, mostly after age 50.
What are common hypopharyngeal cancer risk factors?
Certain risk factors make it more likely you could develop hypopharyngeal cancer. Having one or more risk factors does not guarantee you’ll get the disease. Sometimes, though, cancer can occur without risk factors. However, making healthy choices (like quitting smoking) has the potential to prevent cancer.
Hypopharyngeal cancer risk factors include:
- Using any kind of tobacco (like smoking or chewing).
- Regularly drinking too much alcohol.
- Previous diagnosis of any head and neck cancer, such as salivary gland cancer.
- Receiving radiation therapy (to treat cancer or another problem) near the head or neck.
- Having Plummer-Vinson syndrome (a disorder linked to severe, long-term iron deficiency anemia and difficulty swallowing).
Symptoms and Causes
What causes hypopharyngeal cancer?
Cancer occurs when something causes the DNA inside healthy cells to mutate (change) in a certain way. This change causes cells to grow out of control.
Left untreated, cancer cells may form a mass or tumor. Some cancer cells spread to other areas of the body.
Much remains unknown about why healthy cells turn into cancer when they do. So far, research shows that tobacco and alcohol play a big role in causing many head and neck cancers. This is also true for hypopharyngeal cancer.
Alcohol and tobacco substances damage cells in the mouth and throat over time. They cause at least 3 out of 4 head and neck cancers. What’s clear: The more (and longer) you drink alcohol or use tobacco, the greater your risk of getting hypopharyngeal cancer.
What are the symptoms of hypopharyngeal cancer?
Hypopharyngeal cancer usually doesn’t cause clear-cut symptoms. People with early disease may notice no signs of throat cancer at all.
Many hypopharyngeal cancer symptoms can look like routine, very treatable conditions. Your healthcare provider can help you find out what’s wrong and guide you to the right treatment.
Hypopharyngeal cancer may cause:
- Changes to your voice (which may sound rough or hoarse).
- Lump you can feel along your neck.
- Sore throat that lasts for a long time.
- Swallowing problems (which may make eating hard or painful).
- Unexplained pain, ringing or fullness inside one or both ears.
Diagnosis and Tests
How do providers make a hypopharyngeal cancer diagnosis?
Your healthcare provider will start by examining your symptoms. Your provider may ask you questions about how long you’ve had symptoms and whether (or how much) you use alcohol or tobacco. These details can help your provider decide whether you need more tests.
During a physical exam, your provider will probably feel your neck to check for swollen lymph nodes. They may look down your throat with a small mirror to look for anything unusual.
What tests can diagnose hypopharyngeal cancer?
Healthcare providers may use one or more tests to diagnose hypopharyngeal cancer:
- Endoscopy: An ear, nose and throat (ENT) specialist typically performs this scoped procedure in the office to examine further down your throat. A long, flexible tube with a camera goes into the nose or mouth and down the throat.
- Biopsy: Your specialist may perform a separate biopsy procedure in the operating room to remove abnormal cells. Later, a pathologist (doctor in a lab) closely inspects tissue cells under a microscope, looking for signs of cancer. A biopsy can confirm or rule out hypopharyngeal cancer.
- Imaging tests: If a biopsy confirms cancer, your provider may order imaging tests to learn more about how cancer affects you. Imaging tests (like a CT scan, MRI scan, or PET/CT scan) use advanced computer technologies to capture detailed pictures of what’s happening inside the body.
What is hypopharyngeal cancer staging?
Staging is part of the cancer diagnosis process. It groups cancers according to specific characteristics (such as tumor size and cancer spread).
Cancer staging is complex. Your provider will review all of your test results before determining the cancer stage.
In general, a lower cancer stage (such as stage 0 or 1) means earlier disease. Higher stages (stages 2 to 4) describe increasingly advanced disease. A larger tumor and cancer that has spread beyond the throat are examples of more advanced disease.
Where might hypopharyngeal cancer spread?
Cancer cells can act unpredictably. Nearby lymph nodes are usually one of the first places providers check for cancer spread.
In more advanced cases, hypopharyngeal cancer cells may spread to:
- Other parts of the pharynx.
- Thyroid gland.
- Trachea (windpipe).
- Other areas, such as the spine.
Management and Treatment
How is hypopharyngeal cancer treated?
Your care team will design a treatment plan based on your situation. Treatments that are used are surgery, radiation therapy, chemotherapy and immunotherapy. Your treatment recommendation will be based on a number of factors and may involve more than one treatment type.
- Chemotherapy: Powerful medicines treat cancer cells throughout the body. You may have chemotherapy to shrink a tumor. Or it may help destroy any cancer cells that remain in the body after surgery. Providers usually recommend chemotherapy with radiation therapy to treat hypopharyngeal cancer.
- Radiation therapy: Sophisticated machines direct targeted radiation beams to destroy cancer cells while protecting unaffected tissues. Your provider will recommend a type of radiation therapy (and how long you’ll need treatment) based on the specifics of your case.
- Immunotherapy: These newer medicines give your body’s natural defenses an extra boost. Immunotherapy helps your immune system spot and destroy cancer cells more effectively.
What types of surgery for hypopharyngeal cancer may I need?
Your provider will consider a tumor’s size and location as well as other factors. Some people need more than one surgery.
First, your surgeon will remove as much of a tumor as possible. They may also remove other tissues where cancer may have spread, such as lymph nodes or neck structures.
Surgery options include:
- Pharyngectomy: The surgeon removes part or all of the pharynx.
- Laryngopharyngectomy: The surgeon removes part or all of the pharynx and the larynx.
What can I expect after hypopharyngeal cancer surgery?
Your recovery process depends on how complicated your surgery is. Your surgeon will prepare you for what to expect.
Surgery may affect how you eat, breathe or talk in small or big ways. In some cases, changes (like a laryngectomy) may be permanent. Before your surgery, you may want to ask your provider about:
- Reconstructive surgery: In advanced cases, surgeons sometimes rebuild structures (such as the pharynx or create a voice prosthesis) during the same or a second procedure. Reconstructive surgery may serve to optimize your overall function.
- Trans-oral robotic surgery: This surgical advance allows surgeons to treat certain throat cancers in a less invasive way. These techniques may help preserve more of the body’s natural functions. But it requires specialized training that not all surgeons have. And it’s not an option for all throat cancers.
- Speech or swallowing therapy: Your provider may recommend you work with a rehabilitative specialist, such as a speech therapist, after surgery. This trained professional can help you adapt to any speaking or swallowing challenges.
Outlook / Prognosis
What is the prognosis for people with hypopharyngeal cancer?
The prognosis for people with hypopharyngeal cancer varies. Earlier disease responds better to treatment. Unfortunately, hypopharyngeal cancer often gets diagnosed at later stages. That’s because throat cancer symptoms may not be noticeable until the cancer has become more advanced.
Researchers continue to explore new therapies through clinical trials. Ask your provider if a hypopharyngeal cancer trial may be a treatment option for you.
Can hypopharyngeal cancer be cured?
Yes, surgery to remove a hypopharyngeal tumor may offer a cure in certain situations. A cure is most likely for small tumors with no cancer spread. For more advanced cases, newer cancer drugs and radiation therapies may offer promising treatment potential.
What can I expect after hypopharyngeal cancer treatment ends?
Talk to your provider about how often you may need follow-up visits after cancer treatment ends. Hypopharyngeal cancer sometimes comes back. Also, having one type of head and neck cancer puts you at increased risk for developing another type, such as laryngeal cancer.
Regular follow-up visits can help you and your provider stay on top of any changes in your health. You can reduce your risk of head and neck cancer by:
- Not smoking.
- Avoiding alcohol or limiting how much (or how often) you drink.
- Eating a balanced diet with plenty of fruits and vegetables.
What should I ask my healthcare provider about hypopharyngeal cancer?
If you have hypopharyngeal cancer, you may want to ask your provider:
- What is the cancer’s stage?
- What treatment options do you recommend? Why?
- Will treatment affect how I swallow, breathe or talk?
- Am I a candidate for trans-oral robotic surgery?
- What support services might help me during or after treatment?
- Am I eligible for any clinical trials?
- What can I do to reduce my cancer risk long-term?
A note from Cleveland Clinic
Hypopharyngeal cancer is a rare type of throat cancer (also called head and neck cancer). It may cause common symptoms (like a sore throat or ear pain). Get checked out if you have a sore throat or unexplained ear pain that doesn’t go away. You can’t always prevent cancer. But in this case, not smoking and limiting alcohol can make a big difference in reducing your risk. It’s never too late to quit smoking or make other healthy changes. If you’ve been diagnosed with hypopharyngeal cancer, ask your provider if surgery or clinical trials may benefit you.
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