Hypopharyngeal Cancer in Singapore

Squamous cell carcinoma represents the vast majority of hypopharyngeal cancers. This type develops from the flat, thin cells lining the hypopharynx. These cancers vary in their growth patterns and characteristics, with some growing slowly while others may spread to nearby tissues.

Adenocarcinoma of the hypopharynx is rare, originating from the glandular cells in the throat. This type has different treatment considerations and may respond differently to certain therapies compared to squamous cell carcinoma.

Primary lymphomas of the hypopharynx are uncommon. When they occur, they arise from the lymphoid tissue in the throat area. These cancers require different treatment approaches from carcinomas.

Sarcomas developing in the hypopharynx are rare. These cancers originate from the connective tissues, muscles, or blood vessels in the throat region. Their rarity often requires specialised treatment protocols.

• Persistent sore throat lasting more than 2-3 weeks
• Difficulty swallowing (dysphagia) that gradually worsens
• Sensation of something stuck in the throat
• Voice changes or hoarseness
• Ear pain on one side without infection
• Small lump in the neck

• Severe difficulty swallowing solids and liquids
• Significant weight loss and malnutrition
• Persistent cough, sometimes with blood
• Breathing difficulties or noisy breathing
• Large or multiple neck lumps
• Bad breath (halitosis) not resolved with oral hygiene
• Frequent choking on food

• Complete inability to swallow (requiring feeding tube)
• Severe breathing obstruction
• Bleeding from the throat
• Extreme fatigue and weakness
• Spread to distant organs, causing specific symptoms

Symptoms of hypopharyngeal cancer often appear late because the hypopharynx is spacious, allowing tumours to grow before causing noticeable problems. Patients may experience symptoms before seeking medical attention.

Radiation therapy uses high-energy beams to target cancer cells in the hypopharynx. Modern techniques like intensity-modulated radiation therapy (IMRT) allow targeting of tumours while aiming to minimise impact on surrounding healthy tissues. Treatment may involve daily sessions. Radiation may be used as a treatment for early-stage cancers or combined with chemotherapy for more advanced cases.

Chemotherapy involves using anti-cancer medications to target cancer cells throughout the body. For hypopharyngeal cancer, chemotherapy is often combined with radiation therapy (chemoradiation). Common chemotherapy agents include cisplatin, carboplatin, and 5-fluorouracil. Treatment cycles may be administered periodically, with the number of cycles depending on the treatment protocol and response.

Targeted therapy drugs attack cancer cells with certain genetic features while aiming to spare normal cells. Cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor (EGFR), may be used in combination with radiation or for recurrent disease. These treatments are administered intravenously and may offer treatment options for patients who cannot tolerate traditional chemotherapy.

Immunotherapy medications help the body’s immune system recognise and attack cancer cells. Pembrolizumab and nivolumab are checkpoint inhibitors that may be considered for certain hypopharyngeal cancers. These treatments may be considered for recurrent or metastatic disease and are administered intravenously. Response to immunotherapy varies, with some patients experiencing responses.

Partial pharyngectomy involves surgical removal of the affected portion of the hypopharynx while aiming to preserve normal tissue where possible. This procedure may be performed through the mouth (transoral) using instruments or through an external neck incision. The goal is to remove the cancer while aiming to maintain swallowing function. Recovery may require hospitalisation with gradual resumption of oral feeding.

For extensive cancers, removal of the larynx and pharynx may be necessary. This surgery requires the creation of a permanent breathing stoma in the neck and the reconstruction of the food passage using tissue from elsewhere in the body. Patients require rehabilitation, including speech therapy, to learn alternative communication methods. This procedure may be considered for advanced cancers where organ preservation is not feasible.

Early-stage, small tumours may be removed using endoscopic techniques through the mouth. This approach uses instruments and lasers to remove cancerous tissue. Recovery may be faster with preservation of swallowing and speech function compared to open surgery. Suitable candidates are selected based on tumour size and location.

Removal of lymph nodes in the neck may be necessary when cancer has spread or when there’s a risk of spread. The extent of neck dissection varies from selective removal of specific lymph node groups to comprehensive clearance. This procedure is often combined with primary tumour treatment and requires preservation of important structures like nerves and blood vessels.