Hypopharyngeal cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science.

This page was updated on June 3, 2022.

If you’ve been diagnosed with hypopharyngeal cancer, your first questions may be: What does that name mean? What are my chances of survival?

Where is your hypopharynx, and how does cancer start there?

Pharynx is another word for throat. The hypopharynx (also called the gullet) sits immediately behind the larynx, which is the top section of your windpipe that houses your vocal cords.

Hypopharyngeal cancer is a type of throat cancer, which also belongs to a group of diseases called head and neck cancers. The hypopharynx 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 sort of hinged lid of cartilage that covers the opening of the windpipe when you swallow, so food and liquid don’t end up in your lungs).

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 make 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 Centers for Disease Control and Prevention.

Risk factors

Tobacco and alcohol increase the chances of 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 the ASCO. Smoking marijuana and inhaling secondhand smoke may also raise the risk. The more you smoke, the greater your risk.

If you regularly drink alcohol in any form, or often drink a lot at one sitting, you’re at risk too. Even just a single drink per day makes a difference. If you combine both alcohol and tobacco, you heighten your risk above that of people who don’t do either.

Tobacco and alcohol aren’t the only things associated with increased risk. It also goes up if you’re male, older than age 55, and Black 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 more women have 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).

If you eat a nutritionally poor diet and don’t get enough vitamins A and E from fresh fruit and vegetables, your risk goes up, too. Your job may be a risk factor if it routinely exposes you to certain chemicals, wood dust, paint fumes or asbestos. Construction, metalworking, textile and petroleum are among the industries in which workers may be exposed.

Additionally, certain health issues may heighten cancer risk. These include:

  • 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 is known for causing 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), which is known to cause 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. Vaccination against HPV is recommended at age 11 or 12 (up to age 26) to lower transmission and related cancer rates.

Symptoms and diagnosis

Signs that you may have hypopharyngeal cancer include:

  • Choking, difficulty swallowing or feeling something is stuck in your throat
  • Persistent sore throat
  • Bad breath
  • Changes in your voice
  • Lumps or enlarged lymph nodes in your 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 you may not experience any of them, or you 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.

If you smoke or drink alcohol, your doctor may inspect your mouth, throat and neck for abnormal bumps or lesions during your annual physical. If you or your doctor discover possible cancer signs, several methods may be used to investigate.

First, your doctor may conduct a more thorough physical exam, perhaps using a mirror to look down your throat. Your blood or urine may be tested for cancer indications.

To see deep into your throat, a flexible lighted scope is inserted through your nose or mouth. Preparation for the tube may consist of spraying an anesthetic to numb the pathway. A more involved version that allows for gathering a tissue sample, or biopsy, would require you 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:

Results from these scans and tests give your care team the information needed to assign your 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.

Treatment and survival rates

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.

Your doctors 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 your ability to speak. A third type of operation, neck dissection, removes lymph nodes and other tissues.

Your doctor may offer you the option to join a clinical trial to test a new treatment that hasn’t yet received full government approval. Trials provide researchers with the opportunity to see whether a treatment works and is safe compared with standard care—and the knowledge gained may help others in the future.

Survival rates are ways of estimating what percentage of people with a certain type of cancer live within a specific timeframe, usually five years.

About a third (32 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 results for hypopharyngeal cancer into three categories based on when it’s first diagnosed:

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

It estimates the five-year relative survival rates for these categories as:

  • Localized: 52 percent
  • Regional: 34 percent
  • Distant: 23 percent

These figures don’t apply to recurrent cancer and don’t consider other factors that may influence your individual case, especially newer treatments that weren’t around when these numbers were pulled. They are only general estimates.

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