Hypopharyngeal cancer
Encyclopedia
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
in which malignant
Malignant
Malignancy is the tendency of a medical condition, especially tumors, to become progressively worse and to potentially result in death. Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis...
cells grow in the hypopharynx
Hypopharynx
In human anatomy, the hypopharynx is the bottom part of the pharynx, and is the part of the throat that connects to the esophagus....
(the area where the larynx and esophagus meet).
It first forms in the outer layer (epithelium
Epithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
) of the hypopharynx (last part of the pharynx), which is split into three areas. Progression of the disease is defined by the spread of cancer into one or more areas and into deeper tissues.
This type of cancer is rare. Only about 2,500 cases are seen in the US each year. Because of this, Hypopharyngeal Cancer is difficult to catch in its earliest stages and has one of the highest mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
s of any head and neck cancer
Head and neck cancer
Head and neck cancer refers to a group of biologically similar cancers that start in the upper aerodigestive tract, including the lip, oral cavity , nasal cavity , paranasal sinuses, pharynx, and larynx. 90% of head and neck cancers are squamous cell carcinomas , originating from the mucosal lining...
.
Symptoms
Symptoms of Hypopharyngeal Cancer include:- Swollen lymph nodeLymph nodeA lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s in the neck (first sign of a problem in half of all patients) - Sore throat in one location that persists after treatment
- Pain that radiates from the throat to the ears
- Difficult or painful swallowing (often leads to malnutrition and weight loss because of a refusal to eat)
- Voice changes (late stage cancer)
Causes of hypopharyngeal cancer
Factors that contribute to the development of Hypopharyngeal Cancer include:- SmokingSmokingSmoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
- Chewing tobaccoChewing tobaccoChewing tobacco Chewing tobacco Chewing tobacco (also known colloquially as hoobastank, backy, tobac, doogooos,Hogleg, chewpoos, chits, chewsky, chawsky, dip, flab, chowers, guy, or a wad, as well as referred to as dipsky, snuff, a pinch, a yopper, a Packing a bomb, a tobbackey or packing a...
- Heavy alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
use - Poor dietDiet (nutrition)In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...
Smoking, like lung cancer
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
, can cause Hypopharyngeal Cancer because it contains carcinogens that alter the DNA or RNA in a dividing cell. These alterations may change a normal DNA sequence to an oncogene
Oncogene
An oncogene is a gene that has the potential to cause cancer. In tumor cells, they are often mutated or expressed at high levels.An oncogene is a gene found in the chromosomes of tumor cells whose activation is associated with the initial and continuing conversion of normal cells into cancer...
, a gene that causes cancer after exposure to a carcinogen.
Squamous cells
Squamous epithelium
In anatomy, squamous epithelium is an epithelium characterised by its most superficial layer consisting of flat, scale-like cells called squamous epithelial cells...
, a type of cell that lines hollow organs like the throat, mouth, lungs, and outer layer of skin, are particularly vulnerable when exposed to cigarette smoke.
Chewing tobacco can have the same effects as smoking and is also linked to Hypopharyngeal Cancer. The chewing tobacco is placed into the mouth, leaving it exposed to enzymes, like amylase
Amylase
Amylase is an enzyme that catalyses the breakdown of starch into sugars. Amylase is present in human saliva, where it begins the chemical process of digestion. Food that contains much starch but little sugar, such as rice and potato, taste slightly sweet as they are chewed because amylase turns...
, which partly digests the carcinogenic material. Saliva is swallowed, along with the cancer-promoting material, which passes through the hypopharynx on its way to the esophagus.
Heavy alcohol use is linked to Hypopharyngeal Cancer as well. Alcohol damages the lining of the hypopharynx, increasing the amount of chemicals that are allowed to seep into the underlying membranes. Heavy alcohol use is also associated with nutritional deficiencies.
A disease called Plummer-Vinson syndrome
Plummer-Vinson syndrome
Plummer–Vinson syndrome , also called Paterson–Brown–Kelly syndrome or sideropenic dysphagia presents as a triad of dysphagia , glossitis, and iron deficiency anemia...
, a genetic disorder that causes a long-term iron deficiency, may also lead to Hypopharyngeal Cancer. Other factors like a deficiency in certain vitamins also appear to contribute to this type of cancer.
Stages and survival rates
Staging cancerCancer staging
The stage of a cancer is a description of the extent the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to , and whether it has spread to distant organs...
is a way of marking the cancer’s progression and is measured on a 0 to 4 (IV) scale. To determine
each stage, smaller categories must be defined first: T. N. M. (tumor, lymph nodes, and metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
). These were developed by the American Joint Committee on Cancer
American Joint Committee on Cancer
The American Joint Committee on Cancer is an organization best known for defining and popularizing cancer staging standards, officially the AJCC staging system....
.
Early stage
| Stages of Hypopharyngeal Cancer | |||
|---|---|---|---|
| Tumor (T) | Lymph Nodes (L) | Metastasis (M) | |
| Stage 0 | Epithelium Only | None | M0 |
| Stage 1 | T1 | None | M0 |
| Stage 2 | T2 | None | M0 |
| Stage 3 | T1-T3 Or T3 |
N1 None |
M0 M0 |
| Stage 4 (A) | T1-T3 Or T4 |
N2 N1-N2 |
M0 M0 |
| Stage 4 (B) | T4 | N1, N2 or N3 | M0 |
| Stage 4 (C) | T1-T4 | N1-N2 | M1 |
Stage 0
This implies that a tumor was found in the epithelium
Epithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
, the layer of tissue closest to the top, but not in the connective tissue. A patient would not have swollen lymph nodes and the cancer has not metastasized to other tissues or organs. This is almost never diagnosed in the case of Hypopharyngeal Cancer.
Stage I (1)
T1: the tumor is less than 2 cm across and is limited to one area in the hypopharynx. There is still no lymph node involvement and no metastasis.
Stage I Hypopharyngeal Cancer has a five-year survival rate of 41%, but this type of cancer is rarely caught in Stage I because the first signs and symptoms are often unnoticed or patients remain asymptomatic.
Stage II (2)
T2: the tumor has grown to affect more than one area of the hypopharynx and is between 2 and 4 centimeters with no lymph node involvement and no metastasis.
Late stage
Stage III (3)T1 or T2 or T3: the tumor’s growth is between less than 2 cm and more than 4cm and may be affecting the vocal cords.
AND N1: cancer has spread to 1 lymph node (same side of the neck as tumor), which has swollen to 3 cm or less.
OR
T3: the tumor is more than 4cm and is affecting the vocal cords.
BUT there is no lymph node involvement.
Note: The distinction between the two is made by the oncologist.
Stage II and III have a five-year survival rate of 36%.
Stage IV (4)
The final stage has three subsets depending on the severity of the cancer.
Stage IVA
T1 or T2 or T3: the tumor is between less than 2 cm or more than 4cm.
AND N2: cancer has spread to 1 or more lymph nodes, less than 6 cm, on 1 or both sides of the neck.
OR
T4: the tumor is affecting different areas outside of the hypopharynx, starting with the throat and moving towards the spine and chest cavity.
AND N1 or N2: cancer is affecting 1 or more lymph nodes that are between less than 3 and less than 6 cm on one or both sides of the
throat.
Stage IVB
T4: Tumor is affecting areas outside of the hypopharynx.
N1 or N2 or N3: Lymph nodes are between less than 3 or up to 6 cm on one or both sides of the neck.
Stage IVC (End Stage)
The cancer could be anything from T1 to T4, N1 to N4, but the major difference is the fact that the cancer has metastasized (M1) to other organs away from the hypopharynx.
Stage IV Hypopharyneal Cancer only has a 10% five-year survival.
Most cases of Hypopharyneal Cancer are found in the End Stage because the cancer is in close proximity to several large lymphatic vessels easily spreading to other regions of the body.
Tests to diagnose hypopharyngeal cancer
There are several ways to diagnose Hypopharyngeal Cancer.- Physical Examination:
The doctor checks for swollen lymph nodes and may look down the patient’s throat with a long handled mirror.
- EndoscopyEndoscopyEndoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
, Esophagoscopy, or BronchoscopyBronchoscopyBronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for...
:
Inserted into the nose or mouth of the patient, this a thin, lighted tube that allows the doctor to see farther down the throat, into the esophagus or into the trachea.
- BiopsyBiopsyA biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
:
This is a small tissue sample that can be acquired during an endosopy, esophagoscopy, or bronchoscopy. The tissue is analyzed for the presences of cancer cells.
- CT scan or MRI:
These tests will give doctors a detailed picture of any abnormalities in the body. For a CT scan, the patient often swallows a dye that coats the throat and provides a better image. An MRI is a better tool if the patient is pregnant because the test uses no radiation.
Treatments
Treatment of hypopharyngeal cancer depends on the prognosis (chance of recovery), age, stage, and general health of the patient. Because hypopharyngeal cancer is often advanced at the time of diagnosis, treatment also depends on the overall goal. The goal may simply be to keep the patient talking, eating, and breathing normally.Treatment usually begins with surgery and then a course of radiation for cancer that has progressed passed Stage I. For cancer that is advanced, which is typical of hypopharyngeal cancer, neoadjuvant chemotherapy
Neoadjuvant chemotherapy
Neoadjuvant therapy is the administration of therapeutic agents before a main treatment. One example is neoadjuvant hormone therapy prior to radical radiotherapy for adenocarcinoma of the prostate...
may be used. This is performed by administering chemotherapy before surgery. Neoadjuvant chemotherapy in conjunction with radiation and surgery has yielded the best results in patients with Stage III and Stage IV cancers.