Hypopharyngeal Cancer (Lower Throat Cancer)

Lower Throat Cancer, also known as Hypopharyngeal Cancer, occurs in a critical region of the human body. This type of cancer originates from the mucosal layer in the area immediately at the start of the esophagus, surrounded by the larynx. Its development leads to damage in this region, which directly affects swallowing function.

Therefore, early diagnosis is vital. The progression of the disease can cause serious problems with speech and swallowing abilities. Treatment options vary depending on the stage of the cancer and how far it has spread. Hence, it is very important to consult a healthcare provider without delay as soon as symptoms are noticed.

In Istanbul, you can learn about the risks of hypopharyngeal cancer surgery, the recovery process, and what to pay attention to after the surgery by reading the content prepared by Prof. Dr. Murat Topdağ, one of the doctors who performs hypopharyngeal cancer operations.

Ear, Nose, Throat, Head and Neck Surgery Specialist
Prof. Dr. Murat Topdağ

Born in Malatya in 1978, Murat Topdağ completed his primary and secondary education, then attended high school in Istanbul. He graduated from the English program of Cerrahpaşa Tıp Fakültesi. Prof. Dr. Murat Topdağ is married and has two children.

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What is Lower Throat (Hypopharynx) Cancer?

Hypopharyngeal cancer is located in the lower throat area. This region is situated in the lower neck, behind the voice box. The hypopharynx, which sits at the upper portion of the esophagus’s starting point, can host various types of cancer. The most common type is squamous cell carcinoma, which is closely associated with smoking. It is well known that smoking increases the risk of cancer. However, factors other than smoking can also lead to hypopharyngeal cancer. Rare types of cancer may also develop in this region.

What are the Symptoms of Hypopharyngeal Cancer?

Hypopharyngeal cancer is a serious disease that manifests with certain symptoms. The first signs of this type of cancer often include difficulty swallowing. Patients frequently feel that food gets stuck as it passes down the esophagus.

Additionally, abnormal swellings or hardened tissue can be noticed in the neck region, which usually indicates the presence of masses. Changes in voice, especially hoarseness or a raspy tone, are other common signs of this cancer. Associated symptoms can include painful swallowing, with pain sometimes radiating to the ear.

• Difficulty swallowing and a sensation of food sticking
• A lump or swelling in the neck
• Persistent changes in voice, hoarseness
• Pain during swallowing and sometimes when speaking, with pain radiating to the ear
• Blood in saliva or sputum

As the disease progresses, additional symptoms such as loss of appetite and uncontrolled weight loss may develop. These symptoms can lead to serious issues that directly affect quality of life. Therefore, seeking medical attention immediately upon noticing such signs is of great importance.

How is it Diagnosed?

The diagnosis of hypopharyngeal cancer is made by comprehensively evaluating the patient’s symptoms and conducting various diagnostic tests. First, the patient’s medical history is thoroughly reviewed, which is especially important in determining risk factors such as alcohol and tobacco use. Next, a physical examination is performed to look for lumps or abnormal growths in the neck area.

One of the main diagnostic methods is laryngoscopy. During this procedure, a thin tube (endoscope) is inserted into the patient’s throat. Thanks to the camera at the end of the endoscope, doctors obtain detailed images of the hypopharynx. These images are examined to identify any abnormal tissues or tumors. If necessary, a biopsy is performed during this process; tissue samples are sent to the laboratory for pathological examination.

Other diagnostic methods include:

• Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): These imaging techniques provide detailed information about the size and spread of the tumor.
• PET scan: This test is especially used to determine whether the cancer has spread to other parts of the body.

Hypopharyngeal Cancer Treatment Methods

In the treatment of hypopharyngeal cancer, the location and stage of the disease guide the treatment plan. This type of cancer often affects the larynx as well. A variety of treatments are available for the affected regions:

• Surgery involves removing the cancerous tissue and surrounding affected areas. During this procedure, part or all of the larynx may be removed.
• Radiotherapy and chemotherapy can be used together if preserving the larynx is the goal. These methods kill cancer cells and help prevent disease spread.

During treatment, when part of the affected throat and larynx are removed, the resulting space can sometimes be reconstructed using skin from surrounding tissues. Also, if the disease has spread to the neck lymph nodes, treatment of the neck area must be included. This is an important part of the treatment strategy and is carried out using:

• Surgery
• Radiotherapy
• Chemotherapy

Treatment choices are personalized according to the progression of the disease and the patient’s overall health status.

What are the Risk Factors and Causes of Hypopharyngeal Cancer?

Hypopharyngeal cancer, also called lower throat cancer, commonly occurs in middle-aged and older men. Excessive alcohol use and tobacco products are among the main factors thought to contribute to the development of this cancer type. Apart from these two factors, research on the causes of the disease has not produced definitive results.

Scientists continue to conduct extensive studies to identify other risk factors that may trigger the onset of the disease. Such studies could help in understanding and diagnosing hypopharyngeal cancer at an early stage.

On the other hand, adopting a healthy lifestyle and having regular check-ups can lower the risk of this type of cancer. The known risk factors for hypopharyngeal cancer include:

• Heavy alcohol consumption
• Use of tobacco products
• Certain illnesses (e.g., Plummer-Vinson disease)

While some risk factors are known, more research is needed to fully understand the exact causes of the disease. Such research helps in discovering new ways to prevent and treat hypopharyngeal cancer.

Stages of Lower Throat (Hypopharynx) Cancer

• Stage 0: Cancer cells, called carcinoma in situ, involve only the top layer of cells that cover the surface of the lower throat. There is no spread to lymph nodes or distant organs.
• Stage I: The tumor is 2 cm or smaller in diameter, growing in a limited area of the lower throat. There is no spread to nearby lymph nodes or other parts of the body.
• Stage II: The tumor has grown into multiple areas of the lower throat or is larger than 2 cm but smaller than 4 cm. There is no spread to nearby lymph nodes or distant areas.
• Stage III: The tumor is larger than 4 cm, affects the movement of the vocal cords, or has grown into the esophagus. There is no spread to nearby lymph nodes or distant organs. The tumor can be of any size and may have spread beyond the lower throat. The vocal cords may be affected. It has spread to a single lymph node on the same side of the neck, smaller than 3 cm. There is no spread to distant areas.
• Stage IVA: The tumor has grown into the thyroid or cricoid cartilage, the hyoid bone, the thyroid gland, or nearby muscle or fatty tissues. It has not spread to nearby lymph nodes, or it has spread to a single lymph node on the same side of the neck that measures smaller than 3 cm. There is no spread to distant areas. The tumor can be of any size and moderately advanced beyond the lower throat. It has spread to a single lymph node on the same side of the neck measuring between 3 and 6 cm, or to multiple lymph nodes, or to lymph nodes on the opposite side of the neck. There is no spread to distant areas.
• Stage IVB: The tumor exhibits locally advanced disease extending to the area in front of the spine in the neck, encasing a carotid artery, or growing into the mediastinum. It may have spread to nearby lymph nodes. There is no spread to distant areas. The tumor can be any size and has spread beyond the lower throat. At least one lymph node measures over 6 cm, or there is spread outside the lymph node. There is no spread to distant areas.
• Stage IVC: The tumor can be any size and may or may not involve structures beyond the lower throat. It may have spread to nearby lymph nodes. It has metastasized to distant parts of the body.

Risk Factors for Lower Throat Cancer

Lower throat cancer, also known as hypopharyngeal cancer, can develop under the influence of many factors. Smoking is one of the most common triggers. The harmful substances in cigarette smoke directly damage the throat tissue, significantly increasing the risk of cancer.

Similarly, chewing tobacco brings about similar risks. These substances increase mucosal damage, fostering a predisposition for cancer to develop.

• Smoking
• Chewing tobacco

Increased alcohol use, especially heavy and prolonged use, raises the risk of lower throat cancer. Alcohol irritates the mucosal lining, making the tissues more susceptible to cancer.

• Increased alcohol consumption

Poor nutrition, particularly a diet lacking essential dietary elements, can reduce the body’s resistance to cancer. Certain conditions, such as Plummer-Vinson Syndrome, can also raise the risk. This syndrome is related to long-term, severe iron deficiency anemia, which can damage tissues in the throat region.

• Diet lacking essential nutrients
• Plummer-Vinson Syndrome

These factors can significantly increase the risk of lower throat cancer. Therefore, being aware of them and reducing them as much as possible plays a critical role in preventing the disease.

Hypopharyngeal Cancer Diagnosis Process and Methods Used

The first step in diagnosing hypopharyngeal cancer is to evaluate the patient’s reported complaints and the findings from a physical examination. In light of this information, preliminary views are formed regarding the presence and extent of the disease. Subsequently, various diagnostic methods come into play for a more detailed examination:

Endoscopic examination of the larynx and throat: In this method, endoscopes are used through the mouth or nose to thoroughly visualize the lower throat and larynx region. This allows identification of any abnormal findings.

• Advanced imaging techniques:
• Computed Tomography (CT),
• Magnetic Resonance (MR),
• Positron Emission Tomography (PET).

These techniques help assess the cancer’s relationship with surrounding tissues and possible spread to lymph nodes in the neck or more distant organs. Finally, to confirm the diagnosis, a biopsy is performed. During this procedure, tissue samples are taken from the problematic region and examined under a microscope.

Following all these investigations, the disease is divided into four stages, and different treatment methods are suggested for each stage. This process is crucial for early detection and effective intervention.

Postoperative Recovery Process

The postoperative recovery process is critically important for hypopharyngeal cancer patients. Enhanced Recovery After Surgery (ERAS) protocols enable patients to recover more quickly. These protocols include early mobilization, pain management, and nutritional support. Strict adherence to ERAS reduces morbidity and shortens hospital stays. Effective pain control is a major part of the postoperative period. A multimodal analgesia approach combined with nerve-sparing techniques minimizes the risk of prolonged pain. The following elements form the basis of the recovery process:

• Early Mobilization and Rehabilitation: Having the patient move early reduces the risk of complications. Rehabilitation programs are tailored individually to support rapid recovery.
• Pain Management: Multimodal analgesia applied during and after surgery improves patient comfort and accelerates recovery.
• Nutritional Support: Preoperative carbohydrate loading and postoperative nutritional supplements help the patient remain strong. Inadequate nutrition can adversely affect recovery.

Early detection and management of complications are also crucial in the recovery phase. Infections, respiratory problems, and other potential issues require prompt intervention. The patient’s condition should be closely monitored at all times. This approach allows complications to be addressed effectively and improves overall recovery.

Dietary and Lifestyle Changes for Patients After Surgery

After undergoing surgery for hypopharyngeal cancer, patients may need to make certain significant changes in their diet and lifestyle. During and after treatment, swallowing difficulties, loss of taste, and weight loss can occur, necessitating a specialized diet plan. First and foremost, the eating habits must be tailored to the sensitivity of the mouth and throat for patients who experience swallowing difficulties.

• Soft foods should be consumed because they do not irritate the throat.
• Pureed vegetables and fruits are good options for nutrition.
• Liquid and semi-solid foods make the swallowing process easier.

Treatments such as radiotherapy and chemotherapy may cause dry mouth. In this case, the following methods can be used to support the eating process:

• Frequent intake of water and hydrating drinks.
• Rinsing the mouth with water before and after meals.
• Choosing soft, moist foods.

Some patients may experience a reduced sense of taste after surgery. In such a situation, enhancing the flavor of foods becomes important:

• Using strongly flavored foods and spices.
• Marinating techniques for meat and fish dishes.
• Adding garlic and lemon to meat dishes.

Additionally, adjustments to the diet should be made to combat weight loss:

• Eating small, frequent meals rather than large portions.
• Including extra foods rich in protein and calories.
• Using doctor-recommended nutritional supplements throughout the day.

Frequently Asked Questions

Is there a chance of survival in stage 4 lower throat (hypopharynx) cancer?

In stage 4 lower throat cancer, which is the most advanced stage of the disease, response to treatment is generally limited. Treatment outcomes can vary from person to person; however, the overall five-year survival rate at this stage is around 39.1%.

Looking at images or photos of people with lower throat (hypopharynx) cancer to self-diagnose can be misleading, so consult your physician if you are concerned.

References:

https://my.clevelandclinic.org/health/diseases/12181-hypopharyngeal-cancer

https://www.hopkinsmedicine.org/health/conditions-and-diseases/hypopharyngeal-cancer

Prof. Dr. Murat Topdağ