The pharynx is a muscular tube that connects the nose and mouth to the esophagus; it is commonly known as the throat. The hypopharynx is the lowest part of this that surrounds the larynx (voicebox) and opens into the esophagus. Its purpose is to guide food and saliva past the voicebox, and into the esophagus where they travel to the stomach. The growth and division of cells are normally regulated by the body. When cells divide in an uncontrolled manner they form a mass or tumor. Cancers, or malignant tumors, are masses that have the ability to spread to other parts of the body, and often invade or destroy tissues near to where they arise. Benign tumors do not have the ability to spread to other parts of the body and are not considered cancers. Hypopharyngeal cancer is a malignant tumor arising in the hypopharynx. The most common type of hypopharyngeal cancer is squamous cell carcinoma, which develops from the cells that line the pharynx.
The stage (based on the size and spread of the cancer) and location of the tumor help the cancer team determine what type of treatment is most appropriate. The neck is often treated even if no neck mass is present, because spread of microscopic cancer cells is common. The larynx is surrounded by the hypopharynx and treatment will often involve or affect the larynx.
The type of surgery performed to resect a hypopharyngeal cancer is determined by the size and location of the tumor. Partial pharyngectomy involves removing the part of the throat where the tumor is located. Pharyngectomy with partial laryngectomy involves removing parts of the throat and voice box, but typically preserves the voice. Total laryngopharyngectomy involves removing the hypopharynx and larynx (voice box). This requires creation of a permanent hole in the neck for breathing and the normal voice is lost. The lymph nodes of the neck are usually removed at the time of surgery. This is called a neck dissection. Often, lymph node removal will be performed on both sides of the neck. All normal structures that are uninvolved by tumor will be preserved at the time of neck dissection. Many procedures that remove a hypopharyngeal cancer, but save part or all of the larynx require tracheotomy. This is a temporary opening from the windpipe to the neck that is kept open with a plastic tube. This allows the airway to be safe, even if there is significant swelling in the throat and larynx in the days after the surgery.
Radiation therapy uses radiation to kill cancer cells. Radiation may be used as the primary therapy for a cancer, with chemotherapy, or after surgery. The normal cells surrounding the tumor and lymph nodes are also affected by radiation therapy. The radiation is most commonly delivered from the outside with beams focused on the tumor, and the lymph nodes of the neck. This is performed in multiple treatments; usually daily for several weeks. Occasionally, radioactive materials are placed near the tumor at the time of surgery, and these radiation sources may later be removed.
Chemotherapy is the use of medications to kill cancer cells. There are many types of chemotherapy medications, that may be given orally, or by injection. Chemotherapy can affect cancer cells throughout the body, but some of the body's normal cells are also affected by these medications. Chemotherapy may be given before radiation, during radiation, or both.
The rehabilitation after surgery, radiation, and chemotherapy is focused on preserving speech and swallowing function. Surgery has an immediate impact on function, while nonsurgical treatments may affect function during treatment, or at some point after treatment. At the time of surgery, reconstruction of the throat is often performed to allow for continued swallowing and speech function. This may involve transfer of tissue from near the surgical site (such as skin and muscle from the chest), or a free tissue transfer. Free tissue transfer involves transplanting tissue and the blood vessels that supply that tissue, from some other part of the body (the forearm is used most often). These reconstructive tissues help keep the throat open, but do not have the same sensation and muscle function as the normal throat that is removed. Speech and swallowing therapists work with patients who have undergone surgical or nonsurgical treatment of hypopharyngeal cancer to improve speech and swallowing function. If a patient is unable to swallow, or cannot keep food from entering the airway, a temporary or permanent gastrostomy tube may be placed. This is an artificial tube inserted through the skin of the abdomen into the stomach, allowing food and medicine to be passed directly into the stomach for as long as swallowing difficulty is present. If the voice box is removed (total laryngectomy) there are several option for providing voice. The electrolarynx is an electronic device that provides sound through the neck, or through a tube inserted into the mouth. The mouth and tongue are then used normally to form words from this sound. Tracheo-esophageal puncture involves creating an opening between the windpipe (trachea) and the esophagus. A one way valve allows air to flow into the esophagus and pharynx that creates vibrations which produce sound. The type of tissue used to reconstruct the throat may affect how well this technique works. Rarely, some patients are able to speak by swallowing air, then releasing it (like burping) to produce sound that can be formed into words. This is the hardest technique to learn. All three techniques require therapy with a speech pathologist.
Learn more about the patient-centered, high-quality approach to cancer care provided to patients diagnosed and treated at Lahey Clinic's Sophia Gordon Cancer Center.