The hypopharynx is situated behind the voice box (Fig.1. Coloured green). The upper part communicates with the oropharynx and the lower part forms the entrance of the food pipe (oesophagus). Because the hypopharynx is behind the voice box, the front wall of the hypopharynx is actually the back wall for the voice box covered by mucosa (known as post cricoid area). On either side of the front wall, are the funnel shaped pyriform si-nuses directing food down towards the oesophagus.
At least 70% of hypopharyngeal cancer cases arise in the pyriform sinus. Diffused local spread is common and is caused by tumour extension underneath the mucosal lining. Abundant lymphatic drainage results in a higher incidence of spread to the lymphnode compared to other head and neck tumours. At presentation, 70-80% of the patients with hypopharyngeal cancers have a lump in the neck; in half of these patients lymphnode metastases is the presenting complaint. Bilateral metastases are seen in only 10% of the patients with pyriform sinus cancers but in 60% of those with postcricoid tumours.
If something suspicious is seen, then the next step is performing an endoscopy under general anaesthesia. If some area looks abnormal, then a biopsy is taken from that area. If the neck nodes are enlarged, fine needle aspiration is done for cytological examination (FNAC) by the pathologist to rule out metastatic carcinoma. If cancer is found, the doctor will need to know the extent of the disease. This is called staging. In most cases, the most important factor in considering treatment options is the stage of the disease. The stage is based on the size of the tumour, as well as whether or not the cancer has spread (metas-tasized) and where it has spread. To obtain more information about the location and ex-tent of the cancer, the doctor may perform the following investigations.
The three main types of treatment for these cancers are surgery, radiation and chemo-therapy. Most of these cancers will need surgery and /or radiotherapy. Chemotherapy is usually given when the cancer has spread too far to be treated with surgery and radio-therapy. It is also given before or along with radiation with the goal of preserving the voice box.
Since surgical treatment for hypopharyngeal cancer involves removal of the voice box, radiotherapy has been the ideal treatment for small tumours. Radiotherapy is most com-monly used after surgery in large tumours to kill cancer cells that are not visible during surgery. In some cases when the tumour is extensive and cure is not possible, radiother-apy is given for easing symptoms like pain, bleeding and swallowing.
In this situation, the continuity between the pharynx and oesophagus is lost. This is re-constructed in a number of ways. The latest technique is to use a small portion of the small intestine (Jejunum) (Fig.2). The blood supply to this segment of the transposed intestine is reestablished in the neck by connecting its blood vessels to the blood vessels in the neck using microsurgical techniques.
When the voice box is removed, the patient will no longer have normal speech. This doesn’t mean that speech is lost and there are ways to talk without a larynx. Further in-formation about Alaryngeal Speech can be obtained in the section about cancer of the larynx.
