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Hypopharyngeal cancer
Hypopharyngeal cancer is a "silent" squamous cell carcinoma found late — usually in the pyriform sinus — with a high rate of neck metastases already at diagnosis, submucosal spread and additional lesions in the oesophagus; its prognosis is the worst among head and neck cancers.
Why it matters in the exam
The three subsites are the pyriform sinus (commonest), the posterior pharyngeal wall and the postcricoid area (linked to Plummer-Vinson syndrome, in women). Symptoms come late: difficulty swallowing, painful swallowing, referred ear pain (through Arnold nerve, a branch of nerve X), a neck mass, and in advanced disease — hoarseness from laryngeal invasion. About 70% of patients present with neck metastases. Lymphatic drainage is to levels II to IV, the retropharyngeal nodes and the paratracheal nodes (VI); level I (submandibular and submental) is hardly ever involved.
Under AJCC 8: T1 — up to 2 cm and in one subsite; T2 — over 2 to 4 cm or more than one subsite, without fixation of the hemilarynx; T3 — over 4 cm, fixation of the hemilarynx or extension to the oesophageal mucosa; T4a — invasion of the thyroid or cricoid cartilage, the hyoid bone, the thyroid gland, oesophageal muscle or central soft tissue. The tumour spreads beneath the mucosa and has "skip lesions", so wide margins are needed. Because of the risk of a second primary in the oesophagus, panendoscopy or oesophagoscopy is performed.
Early disease is treated with radiotherapy or larynx-sparing surgery. In advanced disease there are two paths: larynx preservation with induction chemotherapy followed by radiotherapy (the EORTC 24891 trial), or concurrent chemoradiotherapy; or total laryngopharyngectomy with neck dissection and adjuvant radiotherapy. The pharynx is reconstructed with a free flap — radial forearm, ALT or jejunum — or with a gastric pull-up when the oesophagus is also removed. Complications after treatment: stricture, fistula and hypothyroidism.
Key points
- The pyriform sinus is commonest.
- Late detection, about 70% with metastases.
- Submucosal spread and skip lesions.
- Larynx preservation or laryngopharyngectomy.
- Examine the oesophagus for a second primary.
Summary table
| T stage | Size or extension | Note |
|---|---|---|
| T1 | Up to 2 cm, one subsite | Radiotherapy or larynx-sparing surgery |
| T2 | Over 2 to 4 cm or more than one subsite | No hemilarynx fixation |
| T3 | Over 4 cm, hemilarynx fixation or oesophageal mucosa | Larynx preservation or surgery |
| T4a | Cartilage, hyoid, thyroid, oesophageal muscle | Laryngopharyngectomy and reconstruction |
| Neck | About 70% with metastases at diagnosis | II to IV, retropharyngeal, VI |
A free exam question
באיזה אזורים בדרכי הנשימה העליונות שכיח יותר אמילואידוזיס? (the question as examined, in Hebrew)
- א. Subglottis
- ב. Ventricle
- ג. Epiglottis
- ד. Postcricoid area
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Sources
- AJCC Cancer Staging Manual, 8th edition (2017) — Hypopharynx
- NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers — Cancer of the Hypopharynx, 2025 — Larynx preservation and surgery
- Lefebvre JL et al. EORTC 24891 larynx preservation trial in hypopharyngeal cancer (JNCI), 1996 — Main results
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.