Hypopharyngeal carcinoma (cancer of the pharynx) is cancer of the lower throat, the closing portion. The hypopharynx is one of the three areas of the throat (pharynx). In hypopharyngeal cancer, the tumor usually originates from the pharyngeal mucosa. This lines this area of the body from the inside.
What is hypopharyngeal carcinoma?
Hypopharyngeal carcinoma is a malignant cancer that is one of the head and neck tumors and affects the lowest section of the human throat, called the pharynx. The hypopharynx (lowest part of the pharynx) begins where the air and food passages separate. It is located behind the entrance of the larynx as well as to the side of it. Hypopharyngeal carcinomas are almost always squamous cell carcinomas. These develop from the upper cell layer, the squamous epithelium. The malignant tumors originate from the mucous membranes and the epithelia of the skin. It has been observed that predominantly men at an older age are affected by the disease. However, this tumor is also increasing in women. This is due to changes in drinking and smoking habits. In 90 percent of cases, hypopharyngeal carcinoma is already in an advanced stage when it is first diagnosed.
Causes
The causes from which hypopharyngeal carcinoma results have not yet been fully elucidated. Hereditary factors, environmental factors, and malnutrition could be involved in its development. Among the factors that can be considered as triggers are excessive consumption of alcohol and nicotine, viral infections such as the Epstein-Barr virus or the human papillomavirus (HPV). A malfunctioning immune system, frequent exposure to harmful substances such as asbestos or paints containing chromium and nickel, and a genetic disposition are also possible causes of hypopharyngeal carcinoma.
Symptoms, complaints, and signs
In the early stages, hypopharyngeal carcinoma tends to cause uncharacteristic symptoms. As it progresses, swallowing difficulties and excessive salivation may occur as it grows in size. In addition, sore throat, a foreign body sensation in the pharynx, and stabbing pain during swallowing may occur. The latter often extend to the ear. In advanced stages, bloody sputum is also possible. Spread to neighboring structures is frequently observed. If the larynx is also affected, there may be restriction of vocal cord movement, hoarseness, and narrowed airways. The latter may lead to severe respiratory distress. Metastasis occurs very early, so one of the first symptoms is often enlarged lymph nodes below and behind the ear. These are usually unilateral and do not cause pain. The general symptoms of hypopharyngeal carcinoma also often lead to weight loss.
Diagnosis and course of the disease
To make a diagnosis of hypopharyngeal carcinoma, the physician has endoscopy at his or her disposal. This allows body cavities to be examined and visualized. Biopsies are taken from various regions. The disease can usually already be determined in this way. Imaging procedures also play a decisive role. Ultrasound, CT or MRI scans are used to assess the extent of the tumor in the neck and larynx as well as metastases. The patient may have to swallow a contrast medium for this. This improves the visualization of structures and functions. PET and bone scintigraphy help in the search for distant metastases. Viruses can also promote the tumor, so a blood test can also be helpful. The right contact person for hypopharyngeal carcinoma or corresponding complaints is an ear, nose and throat specialist. Timely diagnosis and initiation of therapy is of great importance. If the hypopharyngeal carcinoma is still small and has neither spread nor grown into neighboring structures, the prognosis is good. The more advanced the growth of the tumor, the worse the prognosis.
Complications
Due to the formation of the tumor, various restrictions and discomforts occur in the area of the pharynx and mouth. In this process, patients not infrequently suffer from disturbances in swallowing and increased salivation. Likewise, sore throat and a foreign body sensation in the throat occur.Furthermore, hemoptysis occurs and the affected person feels sick and hoarse. The voice also changes as a result of the hypopharyngeal carcinoma due to the narrowed airways. In the worst case, hypopharyngeal carcinoma can lead to breathing difficulties and shortness of breath. This can trigger a panic attack in the patient and further lead to death. As with other cancers, there is a loss of appetite and therefore weight loss. Diagnosis of hypopharyngeal carcinoma can be performed relatively easily, resulting in early treatment. The tumor can be surgically removed. Complications can arise if the tumor has spread to other regions, so that, for example, the patient’s larynx is also removed. This removal can lead to considerable restrictions in the daily life of the affected person. If the tumor is successfully removed, life expectancy is not reduced.
When should you see a doctor?
A physician must always be consulted if hypopharyngeal carcinoma is suspected. Individuals who notice difficulty swallowing, excessive salivation, and other typical signs are best to speak with their primary care physician and arrange for further evaluation. If symptoms such as bloody sputum or shortness of breath occur, the disease may already be in an advanced stage. A doctor must then be consulted immediately. At the latest, if weight loss or a feeling of illness occurs and does not subside on its own after a week at the latest, the symptoms must be taken to a doctor. The tumor disease can cause serious complications if it progresses untreated. Therefore, hypopharyngeal carcinoma should be promptly medically evaluated and treated. People who have suffered from viral infections or a weakened immune system for a long time are particularly susceptible to developing hypopharyngeal carcinoma. So are people who regularly consume alcohol or nicotine. Anyone who belongs to these risk groups should seek medical advice or inform the relevant doctor as soon as possible if they show any of the signs mentioned above.
Treatment and therapy
Smaller hypopharyngeal carcinoma can be removed by laser surgery. But it is possible that areas of the closely adjacent larynx may need to be removed as well. The primary goals of treatment are to remove the tumor and preserve speech function. The same generally applies to the quality of life of the affected person. Thus, it should be made possible for the affected person to drink, eat and breathe normally. In the case of more advanced tumors, however, it is often necessary to remove the entire larynx as well. If the tumor has already grown into neighboring structures, such as the thyroid gland or esophagus, parts of these must also be removed. In many cases, however, it is then difficult to remove the tumor completely. Radiation therapy and chemotherapy are often additionally used after the operation. In the case of inoperability, an attempt is made to reduce the size of the hypopharyngeal carcinoma using a carbon dioxide laser. Accordingly, this is performed when no surgical intervention is possible. In the terminal stage, gastrostomy and tracheostomy are often required. The former allows artificial feeding if the patient is unable to swallow due to hypopharyngeal carcinoma. Tracheotomy is an access to the trachea, which is used to ensure ventilation. Hypopharyngeal carcinoma does not cause any symptoms for a long time. As a result, the disease is often detected only in advanced stages. In more than half of patients, it is only noticed when the first metastases are already visible as a swelling of the lymph nodes in the neck.
Prevention
Prevention for hypopharyngeal carcinoma is a healthy lifestyle that includes a balanced diet rich in vitamins. In particular, smoking and excessive alcohol consumption (especially high-proof) should be avoided. In smokers, the risk of developing pharyngeal carcinoma is generally very high. Alcohol increases it additionally. Especially in combination, the development of the disease can often be observed. Alcohol ensures that the pharyngeal mucosa is damaged, which is then vulnerable to the carcinogenic substances supplied by smoking. Optimal oral hygiene is also mentioned by doctors as useful.Furthermore, occupational exposure to metal and wood dust, coal, tar products and asbestos cement is considered to have a carcinogenic effect. In addition, because reflux disease or heartburn can promote hypopharyngeal carcinoma, these conditions should be treated appropriately, for example, with acid blockers.
Follow-up
In most cases, the measures of an aftercare for a hypopharyngeal carcinoma are very limited or not available to the affected person at all. In this case, the patient must see a physician at a very early stage to prevent further complications or further worsening of symptoms. Self-healing is not possible with hypopharyngeal carcinoma. If the disease is detected late, it can lead to premature death of the affected person. Most of the affected persons are dependent on a surgical intervention in case of this disease. After such an operation, the affected person should in any case rest and take care of his body. Efforts or physical activities should be avoided in order not to put unnecessary strain on the body. Stress should also be avoided. Support and help from friends and family also have a positive effect on the course of hypopharyngeal carcinoma and can also prevent psychological upsets or depression. In many cases, however, the disease significantly limits the life expectancy of the affected person. A complete cure is also not possible in many cases.