Hypopharyngeal cancer
What is it?
It is a rare tumour affecting the structures of the pharynx behind the larynx that connect the pharynx to the oesophagus and are responsible for swallowing.
From a strictly anatomical point of view it can be divided into: perinasal sinuses, posterior wall of hypopharynx and retrocricoid region.
In Italy, it occurs in 0.4 cases per 100,000 inhabitants per year, while in Europe there are 0.9 cases/100000 per year.
The highest incidence in the world is in India. Men are nine times more likely to have the disease than women, with the highest incidence occurring between the ages of 50 and 70.
Known causes are smoking and alcohol abuse, as well as a diet low in iron, as in Plummer-Vinson syndrome.
Which are the symptoms?
An initial pharyngeal tumour most often manifests as a change in the voice (dysphonia), but if the tumour is more extensive, it can also manifest as difficulty and pain when swallowing, which can extend all the way to the ear. Breathlessness is less common: it can occur at night, during stressful situations or, in the case of a large tumour, difficulty in breathing even when resting.
- dysphonia
- difficulty or pain in swallowing
- shortness of breath
- coughing and hoarseness
- swollen lymph nodes in the neck
How is it diagnosed?
A rapid specialist otolaryngological evaluation is essential, supported by two endoscopic examinations: esophagogastroscopy and fibroscopy, linked, if suspected, to radiological investigations such as: computed axial tomography (CT) of the neck, chest and abdomen with and without MDT, followed by positron emission tomography (PET) and, when indicated, magnetic resonance imaging (MRI).
The diagnosis of cancer should be confirmed by a biopsy of the site of origin or, if not possible, by a lymph node biopsy.
Treatment of early stages consists only of radiation therapy or surgery.
In locally advanced disease (T3-4 and/or N 1-3), radiotherapy alone as well as surgery followed by radiotherapy have modest results, achieving a local-regional control of < 40%, while significant improvement has been achieved with surgery followed by radiotherapy.
When destructive surgery to remove the entire hypopharynx and larynx is necessary, organ-preserving treatment with concomitant chemotherapy and radiotherapy or, in selected cases, chemotherapy followed by radiotherapy to achieve cure and avoid complete laryngeal removal and subsequent permanent tracheostomy can be considered, with equal survival rates compared to surgery followed by radiotherapy.
Tracheostomy is a surgical procedure that involves the formation of an opening at the base of the neck excluding the larynx and to which the trachea is attached to provide breathing and, after adequate exercise, phonation. The opening is kept open by a cannula (small tube) that penetrates the trachea.
Tracheotomy, on the other hand, consists solely in creating a non-permanent opening in the trachea to facilitate breathing at certain critical moments, but without excluding the larynx and without changing phonation.
However, preservation of the organ is not advisable in cases of disease penetrating the cartilage, reduced life expectancy due to other diseases, poor general condition, advanced age, history of frequent pneumonia during the last year.
In advanced forms of the disease, the aim is to chronicise the disease by applying chemotherapy, possibly in combination with biological therapy, and secondarily, for patients in good general condition, immunotherapy, as recently approved, or further chemotherapy.
These treatments may be combined with radiotherapy for symptomatic or bleeding/fracture risk areas, and with surgical treatment of individual metastases.
How is it treated?
Treatment of early stages is either radiotherapy alone or surgery alone.
In locally advanced disease (T3-4 and/or N 1-3), radiotherapy alone as well as surgery followed by radiotherapy give modest results, reaching a local-regional control of < 40%, while significant improvement has been achieved with surgery followed by radiotherapy.
When destructive surgery to remove the entire hypopharynx and larynx is necessary, organ-preserving treatment with concomitant chemotherapy and radiotherapy or, in selected cases, chemotherapy followed by radiotherapy to achieve cure and avoid complete laryngeal removal and subsequent permanent tracheostomy can be considered, with equal survival rates compared to surgery followed by radiotherapy.
Tracheostomy is a surgical procedure that involves the formation of an opening at the base of the neck excluding the larynx and to which the trachea is attached to provide breathing and, after adequate exercise, phonation. The opening is kept open by a cannula (small tube) that penetrates the trachea.
Tracheotomy, on the other hand, consists solely in creating a non-permanent opening in the trachea to facilitate breathing at certain critical moments, but without excluding the larynx and without changing phonation.
However, preservation of the organ is not advisable in cases of disease penetrating the cartilage, reduced life expectancy due to other diseases, poor general condition, advanced age, history of frequent pneumonia during the last year.
In advanced forms of the disease, the aim is to chronicise the disease by applying chemotherapy, possibly in combination with biological therapy, and secondarily, for patients in good general condition, immunotherapy, as recently approved, or further chemotherapy.
These treatments may be combined with radiotherapy for symptomatic or bleeding/fracture risk areas, and with surgical treatment of individual metastases.
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