Head & Neck Oncology Program

Hypopharyngeal Cancer

Stages and Treatment Options

If a patient has cancer of the hypopharynx, the doctor will do more tests to find out if cancer cells have spread to other parts of the body. This process is called staging, and it helps the doctor to plan the patient's treatment.

The following stages are used for cancer of the hypopharynx:

Stage 1: The cancer is in only one part of the hypopharynx and has not spread to lymph nodes in the area. (Lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells.) Treatment may be one of the following:

Surgery to remove the larynx and the pharynx (laryngopharyngectomy)
Surgery followed by radiation therapy
Radiation therapy alone

Stage II: The cancer is in more than one part of the hypopharynx or has spread to tissue next to the hypopharynx, but it has not grown into the voice box (larynx). The cancer has not spread to lymph nodes in the area. Treatment may be one of the following:

Surgery to remove the larynx and the pharynx (laryngopharyngectomy) and lymph nodes in the neck, followed by radiation therapy
A clinical trial of chemotherapy followed by radiation therapy or surgery

Stage III: At this stage, the cancer has progressed so that either of the following may be true:

The cancer is in more than one part of the hypopharynx or has spread to tissue next to the hypopharynx. The cancer has grown into the larynx.
The cancer is in the hypopharynx or has spread to the tissue around the hypopharynx. The cancer has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than three centimeters (just over one inch).

Treatment may be one of the following:

Surgery plus radiation therapy
A clinical trial of chemotherapy followed by surgery or radiation therapy
A clinical trial of chemotherapy combined with radiation therapy

Stage IV: At stage IV, any one of the following may be true:

The cancer has spread to the connecting tissue or soft tissues of the neck. The lymph nodes in the area may or may not contain cancer.
The cancer is in the hypopharynx or has spread to the tissues around the hypopharynx. The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than six centimeters (over two inches).
The cancer has spread to other parts of the body.

If the cancer can be removed by surgery, treatment may be one of the following:

Surgery plus radiation therapy
A clinical trial of chemotherapy followed by surgery or radiation therapy
A clinical trial of chemotherapy combined with radiation therapy
Radiation therapy with or without chemotherapy. Clinical trials are testing new ways of giving radiation therapy in smaller doses (hyperfractionated radiation therapy).

Recurrent: Recurrent cancer is cancer that has come back (recurred) after it has been treated. It may come back in the hypopharynx or in another part of the body. Treatment may be surgery to remove the cancer, radiation therapy, or a clinical trial of chemotherapy.

About the Treatments and Side Effects

The two primary treatment options for patients with cancer of the hypopharynx are surgery and radiation therapy. Chemotherapy is being tested in clinical trials.

Because the hypopharynx helps people with breathing, eating, and talking, a patient may need special help adjusting to the side effects of the cancer and its treatment. The patient's doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help the patient recover from treatment. The patient may need plastic surgery or help learning to eat and speak if all or part of the hypopharynx is taken out.

Surgery

Surgery is a common treatment for cancer of the hypopharynx. A doctor may remove the larynx and part of the throat in an operation called a laryngopharyngectomy. If the cancer is in the lymph nodes, the lymph nodes may be removed (lymph node dissection).

Side effects of surgery: The side effects of surgery depend on the location of the tumor and the type of operation, among other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can usually be controlled with medicine. The recovery period after an operation varies from patient to patient.

Radiation therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Giving drugs with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials. If a patient stops smoking before radiation therapy, he or she will have a better chance of surviving longer. External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly.

Side effects of radiation therapy: The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on.

Side effects of chemotherapy: Chemotherapy drugs generally fight rapidly dividing cells in the body. Cells that divide rapidly include both the targeted cancer cells and healthy cells in the blood, digestive tract, and hair follicles. Depending on which anticancer drugs a patient receives, he or she may experience symptoms when healthy cells are damaged along with the cancer cells. If healthy blood cells are destroyed by chemotherapy, the patient may be more susceptible to infections, bruising or bleeding, and fatigue. When cells in the hair roots or digestive tract are affected by anticancer drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not all chemotherapy patients develop all of these side effects, and the symptoms usually go away during the recovery period or after the treatments are done. Doctors can prescribe medicines and other treatments to control most of the symptoms.

This page was last updated on: March 3, 2008.