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Treatment of early (stage I and II) head and neck cancer: The hypopharynx

Joseph K Salama, MD
James W Rocco, MD, PhD, FACS
Section Editors
Bruce E Brockstein, MD
David M Brizel, MD
Marshall R Posner, MD
Marvin P Fried, MD, FACS
Deputy Editor
Michael E Ross, MD


The hypopharynx lies posterior and inferior to the oropharynx and extends to the esophageal inlet. Over 95 percent of hypopharyngeal cancers are squamous cell carcinomas. Other less common histologies include basaloid squamous carcinomas, spindle cell carcinomas, and minor salivary gland carcinomas.

At diagnosis, less than 15 percent of hypopharyngeal cancers are confined to the hypopharynx. Most have spread to the regional lymph nodes (65 percent) or distantly (20 percent). Presenting symptoms can include dysphagia, odynophagia, otalgia, hoarseness, dyspnea/stridor, and/or a painless neck mass. Diagnosis at an early stage is uncommon due to a lack of alarming symptoms until local progression or a neck metastasis is present. Countries that have introduced national diagnostic screening programs for early gastrointestinal malignancies are more likely to detect hypopharyngeal malignancy at an earlier stage.

The treatment of early hypopharyngeal cancer is presented here. The treatment of locally advanced hypopharyngeal cancer is discussed separately, as is the management of metastatic disease.

(See "Treatment of locoregionally advanced (stage III and IV) head and neck cancer: The larynx and hypopharynx".)

(See "Treatment of metastatic and recurrent head and neck cancer".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 06, 2017.
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  1. Carvalho AL, Nishimoto IN, Califano JA, Kowalski LP. Trends in incidence and prognosis for head and neck cancer in the United States: a site-specific analysis of the SEER database. Int J Cancer 2005; 114:806.
  2. Curado MP, Hashibe M. Recent changes in the epidemiology of head and neck cancer. Curr Opin Oncol 2009; 21:194.
  3. Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988; 48:3282.
  4. Gandini S, Botteri E, Iodice S, et al. Tobacco smoking and cancer: a meta-analysis. Int J Cancer 2008; 122:155.
  5. Hashibe M, Brennan P, Benhamou S, et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst 2007; 99:777.
  6. Sapkota A, Gajalakshmi V, Jetly DH, et al. Smokeless tobacco and increased risk of hypopharyngeal and laryngeal cancers: a multicentric case-control study from India. Int J Cancer 2007; 121:1793.
  7. Sapkota A, Gajalakshmi V, Jetly DH, et al. Indoor air pollution from solid fuels and risk of hypopharyngeal/laryngeal and lung cancers: a multicentric case-control study from India. Int J Epidemiol 2008; 37:321.
  8. Marchand JL, Luce D, Leclerc A, et al. Laryngeal and hypopharyngeal cancer and occupational exposure to asbestos and man-made vitreous fibers: results of a case-control study. Am J Ind Med 2000; 37:581.
  9. Shangina O, Brennan P, Szeszenia-Dabrowska N, et al. Occupational exposure and laryngeal and hypopharyngeal cancer risk in central and eastern Europe. Am J Epidemiol 2006; 164:367.
  10. Laforest L, Luce D, Goldberg P, et al. Laryngeal and hypopharyngeal cancers and occupational exposure to formaldehyde and various dusts: a case-control study in France. Occup Environ Med 2000; 57:767.
  11. Wahlberg PC, Andersson KE, Biörklund AT, Möller TR. Carcinoma of the hypopharynx: analysis of incidence and survival in Sweden over a 30-year period. Head Neck 1998; 20:714.
  12. Galli J, Cammarota G, Calò L, et al. The role of acid and alkaline reflux in laryngeal squamous cell carcinoma. Laryngoscope 2002; 112:1861.
  13. Lydiatt WM, Ridge JA, Patel SG, et al. Oropharynx (p16-) and Hypopharynx. In: AJCC Cancer Staging Manual, 8th, Amin MB (Ed), Springer, New York 2017. p.123.
  14. Helliwell TR. acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx. J Clin Pathol 2003; 56:81.
  15. Becker M, Burkhardt K, Dulguerov P, Allal A. Imaging of the larynx and hypopharynx. Eur J Radiol 2008; 66:460.
  16. Zbären P, Becker M, Läng H. Pretherapeutic staging of hypopharyngeal carcinoma. Clinical findings, computed tomography, and magnetic resonance imaging compared with histopathologic evaluation. Arch Otolaryngol Head Neck Surg 1997; 123:908.
  17. Rumboldt Z, Gordon L, Gordon L, et al. Imaging in head and neck cancer. Curr Treat Options Oncol 2006; 7:23.
  18. Ng SH, Chan SC, Liao CT, et al. Distant metastases and synchronous second primary tumors in patients with newly diagnosed oropharyngeal and hypopharyngeal carcinomas: evaluation of (18)F-FDG PET and extended-field multi-detector row CT. Neuroradiology 2008; 50:969.
  19. Roh JL, Yeo NK, Kim JS, et al. Utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography and positron emission tomography/computed tomography imaging in the preoperative staging of head and neck squamous cell carcinoma. Oral Oncol 2007; 43:887.
  20. Branstetter BF 4th, Blodgett TM, Zimmer LA, et al. Head and neck malignancy: is PET/CT more accurate than PET or CT alone? Radiology 2005; 235:580.
  21. de Bondt RB, Nelemans PJ, Hofman PA, et al. Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol 2007; 64:266.
  22. Castelijns JA, van den Brekel MW. Imaging of lymphadenopathy in the neck. Eur Radiol 2002; 12:727.
  23. Adams S, Baum RP, Stuckensen T, et al. Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 1998; 25:1255.
  24. Ng SH, Yen TC, Chang JT, et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol 2006; 24:4371.
  25. Dulala R, Campian JL, Dubner S, et al. Evaluation of PET imaging in treatment decision making for early stage head and neck squamous cell cancer. J Clin Oncol 2009; 27:r17017.
  26. Richard C, Prevot N, Timoshenko AP, et al. Preoperative combined 18-fluorodeoxyglucose positron emission tomography and computed tomography imaging in head and neck cancer: does it really improve initial N staging? Acta Otolaryngol 2010; 130:1421.
  27. Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck 2012; 34:270.
  28. Martin A, Jäckel MC, Christiansen H, et al. Organ preserving transoral laser microsurgery for cancer of the hypopharynx. Laryngoscope 2008; 118:398.
  29. Steiner W, Ambrosch P, Hess CF, Kron M. Organ preservation by transoral laser microsurgery in piriform sinus carcinoma. Otolaryngol Head Neck Surg 2001; 124:58.
  30. Eckel HE, Staar S, Volling P, et al. Surgical treatment for hypopharynx carcinoma: feasibility, mortality, and results. Otolaryngol Head Neck Surg 2001; 124:561.
  31. Karatzanis AD, Psychogios G, Waldfahrer F, et al. T1 and T2 hypopharyngeal cancer treatment with laser microsurgery. J Surg Oncol 2010; 102:27.
  32. Suárez C, Rodrigo JP, Silver CE, et al. Laser surgery for early to moderately advanced glottic, supraglottic, and hypopharyngeal cancers. Head Neck 2012; 34:1028.
  33. Hall SF, Groome PA, Irish J, O'Sullivan B. Radiotherapy or surgery for head and neck squamous cell cancer: establishing the baseline for hypopharyngeal carcinoma? Cancer 2009; 115:5711.
  34. Hall SF, Groome PA, Irish J, O'Sullivan B. The natural history of patients with squamous cell carcinoma of the hypopharynx. Laryngoscope 2008; 118:1362.
  35. Garden AS, Morrison WH, Clayman GL, et al. Early squamous cell carcinoma of the hypopharynx: outcomes of treatment with radiation alone to the primary disease. Head Neck 1996; 18:317.
  36. Holsinger FC, Motamed M, Garcia D, et al. Resection of selected invasive squamous cell carcinoma of the pyriform sinus by means of the lateral pharyngotomy approach: the partial lateral pharyngectomy. Head Neck 2006; 28:705.
  37. Lydiatt WM, Kraus DH, Cordeiro PG, et al. Posterior pharyngeal carcinoma resection with larynx preservation and radial forearm free flap reconstruction: a preliminary report. Head Neck 1996; 18:501.
  38. Chevalier D, Watelet JB, Darras JA, Piquet JJ. Supraglottic hemilaryngopharyngectomy plus radiation for the treatment of early lateral margin and pyriform sinus carcinoma. Head Neck 1997; 19:1.
  39. Plouin-Gaudon I, Lengelé B, Desuter G, et al. Conservation laryngeal surgery for selected pyriform sinus cancer. Eur J Surg Oncol 2004; 30:1123.
  40. Makeieff M, Mercante G, Jouzdani E, et al. Supraglottic hemipharyngolaryngectomy for the treatment of T1 and T2 carcinomas of laryngeal margin and piriform sinus. Head Neck 2004; 26:701.
  41. Kania R, Hans S, Garcia D, et al. Supracricoid hemilaryngopharyngectomy in patients with invasive squamous cell carcinoma of the pyriform sinus. Part II: Incidence and consequences of local recurrence. Ann Otol Rhinol Laryngol 2005; 114:95.
  42. Laccourreye O, Ishoo E, de Mones E, et al. Supracricoid hemilaryngopharyngectomy in patients with invasive squamous cell carcinoma of the pyriform sinus. Part I: Technique, complications, and long-term functional outcome. Ann Otol Rhinol Laryngol 2005; 114:25.
  43. Shimizu Y, Yoshida T, Kato M, et al. Long-term outcome after endoscopic resection in patients with hypopharyngeal carcinoma invading the subepithelium: a case series. Endoscopy 2009; 41:374.
  44. Park YM, Kim WS, De Virgilio A, et al. Transoral robotic surgery for hypopharyngeal squamous cell carcinoma: 3-year oncologic and functional analysis. Oral Oncol 2012; 48:560.
  45. Park YM, Kim WS, Byeon HK, et al. Feasiblity of transoral robotic hypopharyngectomy for early-stage hypopharyngeal carcinoma. Oral Oncol 2010; 46:597.
  46. Wang CC, Liu SA, Wu SH, et al. Transoral robotic surgery for early T classification hypopharyngeal cancer. Head Neck 2016; 38:857.
  47. Weiss BG, Ihler F, Wolff HA, et al. Transoral laser microsurgery for treatment for hypopharyngeal cancer in 211 patients. Head Neck 2017; 39:1631.
  48. Rabbani A, Amdur RJ, Mancuso AA, et al. Definitive radiotherapy for T1-T2 squamous cell carcinoma of pyriform sinus. Int J Radiat Oncol Biol Phys 2008; 72:351.
  49. Gupta T, Chopra S, Agarwal JP, et al. Squamous cell carcinoma of the hypopharynx: single-institution outcome analysis of a large cohort of patients treated with primary non-surgical approaches. Acta Oncol 2009; 48:541.
  50. Taki S, Homma A, Oridate N, et al. Salvage surgery for local recurrence after chemoradiotherapy or radiotherapy in hypopharyngeal cancer patients. Eur Arch Otorhinolaryngol 2010; 267:1765.
  51. Yoshimura R, Kagami Y, Ito Y, et al. Outcomes in patients with early-stage hypopharyngeal cancer treated with radiotherapy. Int J Radiat Oncol Biol Phys 2010; 77:1017.
  52. Byers RM, Wolf PF, Ballantyne AJ. Rationale for elective modified neck dissection. Head Neck Surg 1988; 10:160.
  53. Shah JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 1990; 160:405.
  54. Candela FC, Kothari K, Shah JP. Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx. Head Neck 1990; 12:197.
  55. McLaughlin MP, Mendenhall WM, Mancuso AA, et al. Retropharyngeal adenopathy as a predictor of outcome in squamous cell carcinoma of the head and neck. Head Neck 1995; 17:190.
  56. Yoshimoto S, Kawabata K. Retropharyngeal node dissection during total pharyngolaryngectomy for hypopharyngeal cancer. Auris Nasus Larynx 2005; 32:163.
  57. Amatsu M, Mohri M, Kinishi M. Significance of retropharyngeal node dissection at radical surgery for carcinoma of the hypopharynx and cervical esophagus. Laryngoscope 2001; 111:1099.
  58. Nakamura K, Shioyama Y, Kawashima M, et al. Multi-institutional analysis of early squamous cell carcinoma of the hypopharynx treated with radical radiotherapy. Int J Radiat Oncol Biol Phys 2006; 65:1045.
  59. http://seer.cancer.gov/publications/survival/surv_head_neck.pdf (Accessed on March 30, 2012).
  60. Farrington WT, Weighill JS, Jones PH. Post-cricoid carcinoma (a ten-year retrospective study). J Laryngol Otol 1986; 100:79.
  61. Chao KS. Practical essentials of intensity modulated radiation therapy, 2nd ed, Lippincott Williams and Wilkins, Philadelphia 2005.
  62. Molina MA, Cheung MC, Perez EA, et al. African American and poor patients have a dramatically worse prognosis for head and neck cancer: an examination of 20,915 patients. Cancer 2008; 113:2797.
  63. Homma A, Sakashita T, Oridate N, et al. Importance of comorbidity in hypopharyngeal cancer. Head Neck 2010; 32:148.
  64. Rose BS, Jeong JH, Nath SK, et al. Population-based study of competing mortality in head and neck cancer. J Clin Oncol 2011; 29:3503.
  65. Raghavan U, Quraishi S, Bradley PJ. Multiple primary tumors in patients diagnosed with hypopharyngeal cancer. Otolaryngol Head Neck Surg 2003; 128:419.
  66. Dikshit RP, Boffetta P, Bouchardy C, et al. Risk factors for the development of second primary tumors among men after laryngeal and hypopharyngeal carcinoma. Cancer 2005; 103:2326.