AUTHOR AND EDITOR INFORMATION

Section 1 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

INTRODUCTION

Section 2 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

Cancer that arises in the hypopharynx represents approximately 7% of all cancers of the upper aerodigestive tract. An estimated 3000 new cases of hypopharyngeal cancer were diagnosed per year in the United States between 1987 and 1991 (Hoffman, 1997). The incidence of laryngeal cancer is 4-5 times that of hypopharyngeal cancer. The biological behavior of carcinoma of the hypopharynx differs greatly from that of carcinoma of the larynx. Carcinomas of the hypopharynx are usually poorly differentiated, and early presentations are unfortunately uncommon. In fact, T1 N0 cases (see Staging) represent only 1-2% of all patients seen.

The rate of metastases is high, with nodal involvement present in 50-70% of cases at presentation. The frequency of distant metastases is also among the highest of all head and neck cancers (Garden, 2001).

The prognosis of hypopharyngeal cancer is poor, with most series reporting a 5-year survival rate of less than a 25%.

Problem

Carcinomas of the hypopharynx are often poorly differentiated. Early presentations are uncommon.

Frequency

Approximately 2500 new cases of hypopharyngeal cancer are diagnosed in the United States each year (Arriagada, 1983).

Etiology

Patients diagnosed with hypopharyngeal cancer are typically men aged 55-70 years with a history of tobacco use and/or alcohol ingestion. The combined use of tobacco and alcohol has a synergistic effect on the incidence of hypopharyngeal cancer.

One exception is an increased incidence of postcricoid cancer in women aged 30-50 years with Plummer-Vinson or Paterson-Kelly syndrome. This syndrome includes dysphagia, hypopharyngeal and esophageal webs, weight loss, and iron deficiency anemia. Currently in the United States, because of the reduced incidence of Plummer-Vinson syndrome, postcricoid carcinoma is more common in men.

Asbestos may pose an independent risk for the development of hypopharyngeal cancer (Marchand, 2000).

Pathophysiology

In the United States and Canada, 65-85% of hypopharyngeal carcinomas involve the pyriform sinuses, 10-20% involve the posterior pharyngeal wall, and 5-15% involve the postcricoid area (Pignon, 2000).

Clinical

Symptoms of hypopharyngeal cancer include dysphagia, chronic sore throat, and foreign body sensation in the throat or referred otalgia. (Otalgia is pain referred to the ear via the Arnold nerve, a division of the 10th cranial nerve. It suggests an underlying malignancy.) For hypopharyngeal cancer, a metastatic node in the neck is often the presenting symptom. An asymptomatic mass in the neck, usually a jugulodigastric or jugulo-omohyoid lymph node, is present in 20% of patients. The average duration of symptoms before presentation is 2-4 months.

Other symptoms, which usually develop later, include weight loss, hemoptysis, and hoarseness when the vocal cord becomes affected by direct extension into the arytenoid cartilage or the recurrent laryngeal nerve. Of patients with hypopharyngeal cancers, 70% have stage III disease at presentation.

Physical examination

Assessment begins in the office with a thorough head and neck examination. Flexible fiberoptic endoscopic examination is important to attempt to localize and stage the primary tumor. Hypopharyngeal cancer is typically advanced at presentation, and an obvious abnormality is usually present in either the pharynx or the neck. Occasionally, only subtle signs such as submucosal fullness or unilateral pooling of saliva are present.

During the flexible laryngoscopy, the assessment of vocal cord mobility or fixation is important for staging purposes. The patient who puffs out his or her cheeks or performs a Valsalva maneuver may distend the pyriform fossae for inspection.

The neck should be examined in a systematic fashion. Any lymph nodes should be assessed with regard to size, location, and mobility. On neck examination, loss of the grating sensation (laryngeal crepitus) of the laryngeal cartilages over the prevertebral tissues may indicate deep pharyngeal wall involvement.

INDICATIONS

Section 3 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

Early hypopharyngeal cancer

Early carcinomas of the hypopharynx are not common. Small lesions, particularly of the lateral or posterior wall, may be amenable to partial pharyngectomy or partial laryngopharyngectomy (PLP). In these cases, radiation may be the therapy of choice, offering better functional outcome and the ability to address occult cervical nodal disease (Garden, 2001).

Pyriform fossa cancer

Lesions that do not extend into the apex of the pyriform fossa, the posterior wall, or the postcricoid may be resected while preserving the larynx, but extension to the apex or involvement of the postcricoid area indicates advanced (T3 or T4) disease and dictates laryngopharyngectomy. Tumors isolated to the lateral wall of the pyriform fossa may be treated with a partial pharyngectomy and resection of the upper thyroid ala. Extension to the medial wall of the pyriform fossa without vocal cord fixation may be managed with a PLP.

Postcricoid cancer

Most patients with postcricoid cancer develop symptoms at a later stage of their disease. Thus, tumors in this site are usually large and require a laryngopharyngectomy. Extension into the esophagus necessitates a pharyngoesophagectomy and reconstruction. Paraesophageal and paratracheal lymph node dissection with hemithyroidectomy is usually also indicated.

Posterior wall cancer

Tumors in this site can be localized and may present an opportunity for wide excision through a suprahyoid pharyngotomy. On the other hand, submucosal spread and fixation to prevertebral structures complicate resection. If the involvement of the prevertebral structures is extensive, the patient may not be a suitable surgical candidate.

RELEVANT ANATOMY

Section 4 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

The hypopharynx, or laryngopharynx, is the longest of the 3 segments of the pharynx. It is wide superiorly and progressively narrows toward the level of the cricopharyngeal muscle. The hypopharynx is a continuous area; the oropharynx is above it and the cervical esophagus through the cricopharyngeal sphincter is below it. This region is known as the pharyngoesophageal junction or postcricoid area. It is bounded anteriorly by the posterior face of the cricoid cartilage.

The parts of the hypopharynx that lie partly to each side of the larynx form the pyriform sinuses or fossae, so named for their pear shape. The pyriform sinuses are bound laterally by the thyroid cartilage and medially by the lateral surface of the aryepiglottic fold, arytenoids, and cricoid cartilages. The pyriform sinuses extend from the glossoepiglottic folds to the upper esophagus.

The superior laryngeal nerve lies deep to the mucosa of the lateral wall of the pyriform fossa. The constrictor muscles, covered with mucous membrane, form the posterior wall of the hypopharynx. It extends from the level of the floor of the vallecula to the level of the cricoarytenoid joint. The anterior wall of the hypopharynx is bounded by the larynx.

The pharyngeal plexus of nerves, which receives contributions from the glossopharyngeal and vagus nerves, supplies the innervation of the hypopharynx. The vagus nerve supplies motor innervation to the constrictors. Sensory information from the hypopharynx travels along the glossopharyngeal nerve and the internal laryngeal branch of the superior laryngeal nerve, which arises from the vagus nerve.

Lymphatic drainage of the hypopharynx is extensive. The pyriform sinuses are drained by a network of lymphatics, which drain primarily to the upper and middle jugular nodes, posterior cervical nodes, and retropharyngeal lymph nodes. Lymphatics of the posterior wall of the hypopharynx drain to the jugular nodes and retropharyngeal nodes. Postcricoid lymphatics drain to the middle and lower jugular nodes and to the paratracheal nodes (Million, 1994).

The intimate association between the hypopharynx and the larynx, oropharynx, and esophagus provide for certain dissemination routes of malignant disease. Pyriform sinus carcinomas may spread submucosally into the posterior wall of the hypopharynx, the postcricoid region, or the aryepiglottic fold. Large tumors also extend up into the paraglottic fat, the pre-epiglottic fat, and the base of the tongue. Tumors that arise from the lateral wall or apex of the pyriform sinus often have already invaded the thyroid cartilage. Lesions of the medial wall of the pyriform sinus may spread along the aryepiglottic fold into the false vocal cord and arytenoid cartilage. Medial wall lesions occasionally invade paraglottic and pre-epiglottic fat. They may also grow posteriorly into the postcricoid region and then cross the midline to involve the contralateral pyriform sinus.

CONTRAINDICATIONS

Section 5 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

See Surgical therapy.

WORKUP

Section 6 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

Lab Studies

• Blood count, urea, electrolyte, and liver function tests should be obtained to assess nutritional status.

Imaging Studies

• Chest imaging: Pulmonary metastasis or a pulmonary second primary may be ruled out with a chest radiograph or computed tomography (CT) scan.
• Barium swallow
• • This may be helpful in patients with no obvious abnormality found on physical examination.
  • Negative swallow study findings with progressive or continuous symptoms should not preclude an endoscopic examination.
  • Superficial mucosal lesions in the pyriform sinus are seen on barium studies, although this is not the imaging modality of choice.
• Radiologic assessment of the larynx and hypopharynx
• • Hypopharyngeal malignancies are further assessed preoperatively with imaging studies such as CT scan or magnetic resonance imaging (MRI).
  • In patients with hypopharyngeal cancer, CT scan and MRI are used to visualize the primary tumor and regional lymph nodes prior to definitive treatment. These modalities provide information about the location and extent of tumor involvement and demonstrate the interface of tumor with bone, fat, muscles, soft tissues, blood vessels, dura, and brain.
  • The contrast-enhanced CT scan is typically used as the initial imaging modality to assess local tumor extent and evaluate lymph nodes.
• F-18 fluorodeoxyglucose–positron emission tomography (FDG-PET) may improve pretreatment staging, identification of an occult primary site, estimation of treatment response, and differentiation of early recurrence from scar tissue.
• • Integrated PET/CT: This modality overcomes poor anatomic localization of PET together with the morphologic data revealed by CT.
  • PET/CT is helpful in locating and localizing occult primary and regional disease and differentiating between malignant disease and posttreatment changes.
• Examination under anesthesia and triple endoscopy: Examination under anesthesia coupled with a triple endoscopy (laryngoscopy, esophagoscopy, and bronchoscopy) is often used to better asses the extent of the hypopharyngeal tumor and to evaluate the patient for synchronous second primary tumors. The necessity of triple endoscopy is being debated; an integrated PET/CT may obviate the need for triple endoscopy.

Diagnostic Procedures

• Flexible fiberoptic endoscopic examination is used to localize and stage the primary tumor.
• Pulmonary function: If a partial laryngeal surgery is being considered as part of the management plan, pulmonary function tests should be obtained.

Staging

The American Joint Committee on Cancer (AJCC) has designated staging by Tumor, Node, Metastases (TNM) classification (also see Image 2).

• Primary tumor
• • TX: Primary tumor cannot be assessed.
  • T0: Primary tumor is not evident.
  • Tis: Carcinoma is in situ.
  • T1: Tumor is limited to one subsite of the hypopharynx and is 2 cm or less in its greatest dimension.
  • T2: Tumor invades more than one subsite of the hypopharynx or an adjacent site, or the tumor measures more than 2 cm but not more than 4 cm in its greatest diameter without a fixation of hemilarynx.
  • T3: Tumor measures more than 4 cm in its greatest dimension or with fixation of hemilarynx.
  • T4a: Tumor invades the thyroid or cricoid cartilage, hyoid bone, thyroid gland, esophagus, or central compartment soft tissue (including prelaryngeal strap muscles and subcutaneous fat).
  • T4b: Tumor invades the prevertebral fascia, encases the carotid artery, or involves the mediastinal structures.
• Subsites of the hypopharynx are as follows:
  • Pharyngoesophageal junction (postcricoid area): This area extends from the level of the arytenoid cartilages and connecting folds to the inferior border of the cricoid cartilage.
  • Pyriform sinus: This sinus extends from the pharyngoepiglottic fold to the upper end of the esophagus and is bound laterally by the thyroid cartilage and medially by the surface of the aryepiglottic fold and the arytenoid and cricoid cartilages.
  • Posterior pharyngeal wall: This wall extends from the level of the floor of the vallecula to the level of the cricoarytenoid joints.

TREATMENT

Section 7 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

Medical therapy

No single therapeutic regimen offers a clear-cut superior survival advantage over other regimens. Although the literature highlights various therapeutic options, it contains few reports that present any valid comparative studies. Laryngopharyngectomy and neck dissection followed by radiation therapy have been the most frequently used surgical therapies for hypopharyngeal cancers. Combined chemotherapy and radiation therapy directed at the primary tumor are the most common nonsurgical approaches for advanced tumors, with radiation alone for early tumors without cervical nodal involvement.

Prior to treatment, the risks and benefits of treatment options should be frankly discussed with the patient. In cases of hypopharyngeal cancer, this should specifically address possible severe swallowing and speech dysfunction. A speech language pathologist should evaluate the patient before treatment. Before a treatment option is chosen, the patient's psychosocial factors should be considered.

• Radiation therapy
  • Radiation therapy as a curative treatment is feasible only for T1 lesions. Small lesions can be treated with definitive radiotherapy.
  • If a standard fractionation scheme is used, 65-74 Gy is given. If the tumor involves the postcricoid region or the pyriform sinus, the posterior pharyngeal wall usually receives 50-55 Gy in order to treat the retropharyngeal nodes prophylactically. The nodes in the supraclavicular region usually receive prophylactic radiation to approximately 50 Gy.
  • Concomitant chemotherapy and radiotherapy offer the potential of increased tumor control compared with those treatments being used sequentially in an organ preservation protocol.
• Concurrent chemoradiation
  • Primarily based on the concepts of spatial cooperation and toxicity independence, combining radiation with chemotherapy to improve outcome has generated great interest. Cisplatin is considered the best agent to use with radiation in the treatment of hypopharyngeal cancer, either as a single agent or similar to induction therapy with fluorouracil (5-FU).
  • However, bleomycin (with and without methotrexate), hydroxyurea, mitomycin C, and 5-FU have been used (Garden, 2001). Many randomized trials with cisplatin alone or cisplatin and 5-FU have demonstrated that chemoradiation is superior to radiation alone with respect to disease control or impacting overall survival.
  • The European Organization for Research and Treatment of Cancer (EORTC) conducted a trial of voice preservation in patients with advanced hypopharyngeal cancer.
    • The trial consisted of 3 cycles of induction cisplatin/5-FU followed by radiation. This trial randomized 194 patients, of which 37% had stage IV disease. Only 3% of patients randomized to induction chemotherapy had stage T4 disease, whereas 23% had stage T2 cancers. Most patients were stage T3.
    • The incidence of nodal metastases was high. A complete response was achieved in the primary tumor in more than 50% of the patients randomized to chemotherapy, and 43% had no evidence of disease above the clavicles after chemotherapy.
    • In 1996, the EORTC published the preliminary results of their trial. Three-year survival rates were significantly better among patients randomized to chemotherapy (57%) compared with immediate surgery (43%). At 5 years, however, the differences were no longer significant. The 5-year survival rate with a functional larynx was 35%. The trial demonstrated a reduction of distant metastases with neoadjuvant chemotherapy (Lefebvre, 1996).
• Chemotherapy following surgery
  • Several studies have demonstrated that concurrent treatment with radiotherapy and chemotherapy is a promising approach for locally advanced squamous-cell carcinoma that is not amenable to surgery.
  • In a recent study, Bernier et al determined that the addition of cisplatin to high-dose radiotherapy after radical surgery increases progression-free survival in patients at high risk for recurrent cancer. They concluded that, after surgery with curative intent, adjuvant treatment with high-dose cisplatin plus radiotherapy is more efficacious than radiotherapy alone (Bernier, 2004).

Surgical therapy

• Partial laryngopharyngectomy (PLP) for tumors of the medial pyriform sinus
  • Selected patients without pyriform sinus apex involvement may be treated with PLP. Involvement of the apex of the pyriform sinus, extensive submucosal spread, and deep invasion of the lateral pyriform sinus wall are contraindications for this procedure.
  • The operation is an extension of the supraglottic laryngectomy and involves the combination of suprahyoid and lateral pharyngotomy approaches. Interarytenoid and aryepiglottic cuts allow excision of the ipsilateral arytenoid and pyriform sinus, with cuts similar to those of a supraglottic laryngectomy on the contralateral side.
• Near-total laryngopharyngectomy
  • Near-total laryngopharyngectomy preserves one uninvolved arytenoid with a portion of the thyroid cartilage, recurrent laryngeal nerve, and a thyroarytenoid muscle to allow creation of a mucosa-lined tracheoesophageal shunt for voice. Breathing is facilitated with a tracheostomy.
  • Near-total laryngopharyngectomy can be considered in patients with T2 and T3 lesions of the pyriform sinus in whom total laryngectomy is contemplated.
  • Near-total laryngopharyngectomy involves an en bloc resection of the paralaryngeal space, including the ipsilateral cricoid. Conservation procedures preserve the cricoid ring, but, in the case of pyriform apex involvement, resection would require stripping the mucosa off the cricoid, which prevents an en bloc resection. Similarly, pyriform sinus cancers cause early vocal cord fixation due to paralaryngeal space invasion. Thus, vocal cord fixation is not a contraindication to a near-total laryngopharyngectomy.
  • The resected specimen from a near-total laryngopharyngectomy includes the entire hemilarynx from the base of the tongue to the trachea, the pyriform sinus, and part of the posterior pharyngeal wall, if indicated. If the resulting defect requires reconstruction with a flap, near-total laryngectomy can still be performed. The remaining contralateral posterior glottic tissues are reconstructed to form a semirigid glottic shunt to allow phonation and effective swallowing.
  • Reconstruction of the pharyngeal defect with a skin graft or myocutaneous flap is usually necessary to prevent pharyngeal stenosis.
  • Near-total laryngopharyngectomy is not recommended for patients in whom radiation treatment has failed or those with postcricoid or interarytenoid tumors, bilateral cord fixation, tumors approaching the midline posteriorly, and bilateral palpable nodes.
• Total laryngopharyngectomy (see Image 3)
  • A total laryngopharyngectomy involves surgical ablation of the larynx, hypopharynx, and upper cervical esophagus.
  • The commonly accepted indications for this procedure include hypopharyngeal carcinoma or laryngeal carcinoma that involves the hypopharynx.
• Total laryngopharyngectomy with esophagectomy
  • Another procedure for more advanced-stage hypopharyngeal or laryngeal tumors is total laryngopharyngectomy with esophagectomy. This procedure involves the removal of the larynx, circumferential hypopharynx, and varying lengths of the esophagus.
  • Lesions that involve the cervical esophagus, postcricoid area, large areas of the pyriform sinus, and posterior pharyngeal wall with larynx are resected, which leaves a circumferential defect.
• Extended total laryngectomy for tumors of the pyriform sinus
  • For hypopharyngeal tumors that are too large for conservation procedures, extended total laryngectomy allows resection of the larynx and pharynx, often with preservation of 3 cm of residual mucosa. This residual mucosa allows primary closure of the pharynx without the need for tissue transposition. If insufficient mucosa remains, pedicled or free tissue transfer patch flaps may be inset into the defect site for reconstruction.
  • The tendency for submucosal spread of hypopharyngeal tumors mandates wide margins, and primary closure is often not possible. These procedures often require free tissue transfer for closure (see Image 4).

Hypopharyngeal tumors metastasize to the neck early. This is most likely in pyriform fossa tumors and least likely in postcricoid tumors. Bilateral neck metastasis may develop because of rich submucosal lymphatics, which cross the midline. In addition, many patients who have no clinical findings for the neck are found to harbor occult metastasis. Because of the high incidence of clinically positive nodes with hypopharyngeal carcinoma, treating both neck nodes at the time of treatment of the primary tumor is prudent. The site and stage of the patient's tumor and the method of treatment of the primary disease dictate the mode of treatment for the neck.

Preoperative details

Some surgeons consider prevertebral musculature or c-spine involvement, massive mediastinal nodal enlargement, and carotid artery involvement to be contraindications to surgery. These cases usually represent advanced and aggressive disease.

COMPLICATIONS

Section 8 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

Certain factors, such as prior radiation therapy, poor general health, chronic malnutrition, alcoholism, diabetes mellitus, advanced age, and systemic illness, all increase the chance of surgical complications.

Intraoperative complications may include hemorrhage, carotid sinus reflux, and damage to cranial nerves. Unilateral resection of the hypoglossal nerve is usually well tolerated without serious sequelae; however, bilateral hypoglossal nerve resection causes severe disability with serious difficulties in feeding, swallowing, and speaking. Resection of the vagus nerve, which carries motor and sensory branches to the larynx and pharynx, causes vocal cord paralysis.

Damage to the accessory nerve causes denervation of the trapezius muscle, which is one of the most important shoulder abductors. Damage to the accessory nerve also causes destabilization of the scapula, with progressive flaring of this bone at the vertebral border. Injury to the brachial plexus and phrenic nerve are complications that should be avoided with proper identification of anatomic planes.

Postoperative complications are not uncommon after extensive head and neck surgery. In the immediate postoperative period, the patient is at greatest risk for pulmonary embolism, gastric ulceration, hemorrhage, and aspiration pneumonia. Other more specific early complications include infection, fistula formation, and subsequent mediastinitis.

When a fistula or infection in the neck is detected, the wound should be opened widely and packed. The tract should be diverted away from the carotids and microvascular pedicle.

Later complications include pharyngoesophageal stenosis and stricture. A stricture that causes dysphagia may develop some weeks or months after surgery or after radiotherapy is complete. Other late complications include chronic pharyngocutaneous fistula and functional deficits in swallowing.

OUTCOME AND PROGNOSIS

Section 9 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

Patients in whom lesions are detected early and who have negative nodes have 5-year survival rates higher than 70% (Martin, 1980). Most cases are, however, advanced, and the overall survival rate rarely exceeds 25% in any series. Postcricoid carcinomas and pyriform apex lesions fare more poorly than superiorly based pyriform sinus lesions.

Postoperative irradiation improves the results of surgery. Despite a good local control rate, the 5-year survival rate does not exceed 35%; most patients succumb to distant metastases, intercurrent diseases, or second primaries.

In the past, chemotherapy was used for palliative purposes because of poor outcomes in the treatment of cancer of the head and neck. With the introduction of platinum-based chemotherapeutics, either as a single agent or in combination with other drugs, partial response rates and complete response rates have improved. Of late, concomitant chemoradiotherapy has been show to result in a significant increase in survival.

Altered fractionation radiation has been explored in advanced head and neck cancers. The largest randomized trial was a 4-arm trial carried out by the RTOG (RTOG 90-03) evaluated the effectiveness of conventional irradiation, a split course accelerated fractionation, delayed concomitant boost and hyperfractionated irradiation.

In this study, only 13% of patients had hypopharyngeal cancers. Both hyperfractionated irradiation and concomitant boost showed significantly better locoregional control, disease-free survival, disease-specific survival, and overall survival.

Importantly, these trials and studies do not specifically address hypopharynx cancers. Thus, this site is rarely studied separately; in case of mixed sites, the hypopharynx represents just a few cases. Little is known about the selection of patients with cancer of the hypopharynx (detailed locoregional extension, performance status), and no information is provided about the possibilities of surgical salvage.

MULTIMEDIA

Section 10 of 11  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

Media file 1:  The hypopharynx is the longest of the 3 segments of the pharynx. It is wide superiorly and progressively narrows toward the level of the cricopharyngeal muscle. It is bounded anteriorly by the posterior face of the cricoid cartilage. The parts of the hypopharynx that lie partly to each side of the larynx form the pyriform sinuses or fossae.
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Media type:  Image

Media file 2:  Staging of cancer of the hypopharynx.
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Media type:  Image

Media file 3:  Lateral view of tumor cuts for laryngopharyngectomy.
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Media type:  Illustration

Media file 4:  The tendency for submucosal spread of advanced hypopharyngeal tumors mandates wide margins, and primary closure is often not possible. These procedures often require free tissue transfer for closure.
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Media type:  Illustration

REFERENCES

Section 11 of 11

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Contraindications
• Workup
• Treatment
• Complications
• Outcome And Prognosis
• Multimedia
• References

• Bernier J, Domenge C, Ozsahin M. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. May 16 2004;350(19):1945-52.
• Garden AS. Organ preservation for carcinoma of the larynx and hypopharynx. Hematol Oncol Clin North Am. Apr 2001;15(2):243-60, v. [Medline].
• Hoffman H, Karnell, L, Shah J. Hypopharyngeal Cancer Patient Care Evaluation. Laryngoscope. August 1997;107 (8):1005-1017. [Medline].
• Jones AS. The management of early hypopharyngeal cancer: primary radiotherapy and salvage surgery. Clin Otolaryngol. Dec 1992;17(6):545-9. [Medline].
• Lefebvre JL, Chevalier D, Luboinski B, et al. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst. Jul 3 1996;88(13):890-9. [Medline].
• 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. Jun 2000;37(6):581-9. [Medline].
• Martin SA, Marks JE, Lee JY, et al. Carcinoma of the pyriform sinus: predictors of TNM relapse and survival. Cancer. Nov 1 1980;46(9):1974-81. [Medline].
• Million RR, Mancuso AA. Pharyngeal walls, pyriform sinus, postcricoid pharynx. In: Million R, Cassissi NJ, eds. Management of Head and Neck Cancer: A Multidisciplinary Approach. Philadelphia: JB Lippincott;1994: 505-32.
• Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet. Mar 18 2000;355(9208):949-55. [Medline].

Article Last Updated: Feb 7, 2007