Hypopharyngeal cancer

This page was reviewed under our medical and editorial policy by

Beomjune B. Kim, DMD, MD, FACS, Head and Neck and Microvascular Reconstructive Surgeon

This page was updated on May 26, 2023.

Hypopharyngeal cancer is a relatively rare disease, diagnosed in about 3,000 people every year in the United States. It's a type of throat cancer, which also belongs to a group of diseases called head and neck cancers.

What is the hypopharynx?

The hypopharynx (also called the gullet) is the lowest section of the throat, situated above the top of the esophagus (the tube that leads to the stomach) and below the epiglottis (a hinged lid of cartilage that covers the opening of the windpipe during swallowing, so food and liquid don’t end up in the lungs). Pharynx is another word for the throat.

Hypopharynx cancer types

Nearly all cancers of the hypopharynx and larynx (also called a voice box) begin in the flat cells, called squamous cells, that line these two abutting structures. Squamous cell carcinoma makes up about 95 percent of hypopharyngeal and laryngeal cancers, according to the American Society of Clinical Oncology (ASCO), but other rare varieties may arise from the minor salivary glands or from connective tissue supporting the hypopharynx and larynx.

Overall, mouth and throat cancers comprise 3 percent of all cancers diagnosed every year in the United States, according to the U.S. Centers for Disease Control and Prevention.

Hypopharyngeal cancer causes and risk factors

Tobacco and alcohol increase the risk for developing hypopharyngeal or laryngeal cancer. Use of tobacco products such as cigarettes, cigars, chewing tobacco and snuff is tied to 85 percent of all head and neck cancers, according to ASCO. Smoking marijuana and inhaling secondhand smoke may also raise the risk. The more someone smokes, the greater his or her risk.

People who regularly drink alcohol in any form, or often drink a lot at one sitting, are at risk too. Even a single drink per day makes a difference. Combining both alcohol and tobacco heightens the risk above that of people who don’t do either.

Tobacco and alcohol aren’t the only risk factors for developing hypopharyngeal cancer. The risk also goes up for people who are male, older than age 55, and African American or white but not Asian, Pacific Islander, Hispanic or Native American.

Men’s greater risk likely comes from their higher rates of tobacco and alcohol use, but women have also adopted these habits, and their cancer risk is rising. Greater risk is associated with being middle-aged or older because this type of cancer usually takes a long time to develop—more than half of people with hypopharyngeal or laryngeal cancer are diagnosed at 65 or older, according to the American Cancer Society (ACS).

People who eat a nutritionally poor diet and don’t get enough vitamins A and E from fresh fruit and vegetables may also have an increased risk for developing hypopharyngeal cancer.

People who are routinely exposed to certain chemicals, wood dust, paint fumes or asbestos may also have an increased risk for developing hypopharyngeal cancer. Construction, metalworking, textile and petroleum are among the industries in which workers may be exposed.

Additionally, certain health issues may heighten hypopharyngeal cancer risk. These include those listed below.

Fanconi anemia, an inherited genetic illness with a very high risk of mouth and throat cancer, may also result in leukemia or myelodysplastic syndrome.

Dyskeratosis congenita, another genetic disorder, carries a significant risk of head and neck cancer, particularly in young people. It may cause aplastic anemia and skin and nail problems.

Plummer-Vinson syndrome causes difficulty swallowing and anemia (resulting from iron deficiency).

Gastroesophageal reflux disease (GERD), in which stomach acid regularly goes up into the esophagus, boosts the chances of esophageal cancer and may contribute to developing hypopharyngeal cancer.

Unprotected sex may spread human papillomavirus (HPV), linked to hypopharyngeal and laryngeal cancers in rare instances. Some strains of this common virus are associated with cancers of the cervix, anus, genitals and throat, mainly the oropharynx, which is the midsection or back of the throat, located just above the hypopharynx. Getting an HPV vaccine is recommended beginning at age 11 or 12 (up to age 45) to lower transmission and related cancer rates.

Hypopharyngeal cancer symptoms

Possible symptoms of hypopharyngeal cancer may include:

  • Choking, difficulty swallowing or feeling something is stuck in the throat
  • Persistent sore throat
  • Bad breath
  • Changes in the voice
  • Lumps or enlarged lymph nodes in the neck
  • Ear pain
  • Symptoms common to many cancers, such as fatigue and weight loss

All of these symptoms may be caused by something other than cancer, and patients may not experience any of them, or may have other symptoms. Unfortunately, hypopharyngeal cancer often isn’t detected until it’s progressed because it may not cause noticeable symptoms in early stages.

Hypopharyngeal cancer diagnosis and detection

For people who smoke or drink alcohol, a doctor may inspect the mouth, throat and neck for abnormal bumps or lesions during an annual physical. If possible cancer signs are detected, several methods may be used to investigate.

First, the doctor may conduct a more thorough physical exam, perhaps using a mirror to look down the patient's throat. His or her blood or urine may be tested for cancer indications.

To see deep into the throat, a flexible lighted scope is inserted through the patient's nose or mouth. Preparation for the tube may involve spraying an anesthetic to numb the pathway.

A more involved procedure that allows for gathering a tissue sample, or biopsy, would require the patient to be sedated or given a general anesthetic. A biopsy is important, as it confirms diagnosis, and tests on the tumor sample may reveal characteristics to guide treatment. Both the hypopharynx and larynx may be examined, as well as sections of the nose, ear and windpipe. This broader procedure is called a triple endoscopy.

If cancer is found, various types of imaging may be employed to learn more about it, such as if and where it’s spread, or metastasized. Among these imaging tests are:

Hypopharyngeal cancer staging

Results from these scans and tests give the care team the information needed to assign the cancer a stage. Staging methods vary, but generally cancer is scored based on the size and location of the original tumor, whether it’s spread to lymph nodes or metastasized to other tissues, and whether it’s an earlier cancer that has returned. The higher the number (from 0 to 4), the more advanced the cancer. These numbers may be subdivided into groups designated by letters to specify the stage even further.

Hypopharyngeal cancer may spread to tissues crowded into the neck—including the larynx, esophagus, trachea (windpipe), hyoid bone (beneath the tongue), lymph nodes and carotid arteries—or metastasize to more distant locations in the chest, spinal column and elsewhere.

Hypopharyngeal cancer treatment

The standard treatment for many cancers, including hypopharyngeal, involves surgical removal of tumors and surrounding tissue and affected lymph nodes, along with radiation therapy and chemotherapy to kill cancer cells. Radiation and chemotherapy may be given before or after surgery.

The care team may suggest removing part of the pharynx and all of the larynx (laryngopharyngectomy) or portions of the pharynx and larynx (partial laryngopharyngectomy). The partial procedure preserves the patient's ability to speak. A third type of operation, neck dissection, removes lymph nodes and other tissues.

The care team may offer the patient the option to join a clinical trial to test a new treatment that hasn’t yet received full government approval. Trials help determine whether a treatment works and is safe compared with standard care—and the knowledge gained may help others in the future.

Hypopharyngeal cancer survival rate

Survival rates estimate what percentage of people with a certain type of cancer live within a specific timeframe, compared to people who don't have that cancer type.

More than a third (37 percent) of all people with new hypopharyngeal cancer cases live five years after diagnosis, according to the ACS, which gathers its data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program database.

The program further groups hypopharyngeal cancer survival into three categories based on when it’s first diagnosed:

  • Localized (cancer hasn’t spread beyond the site of origin)
  • Regional (cancer has spread into neighboring tissue and lymph nodes)
  • Distant (cancer has metastasized to sites far from the original tumor)

The estimated five-year relative survival rates for hypopharyngeal cancer are listed below.

  • Localized: 61 percent
  • Regional: 39 percent
  • Distant: 28 percent

These figures don’t apply to recurrent cancer and don’t consider other factors that may influence each patient's individual case, especially newer treatments that weren’t around when these numbers were pulled. They are only general estimates. Always talk to the care team to get a more specific prognosis tailored to each patient.

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