Cancers of Hypopharynx

Hypopharyngeal cancer is another HNSCC which are biologically very aggressive and generally runs a rapid downward course . Unfortunately it forms nearly a 1/3rd to a 1/4rth of of the HNSCC. It occurs in nutritionally impoverished population who indulge in tobacco and alcohol . Being in close anatomic proximity to the larynx ,it not only leads to a state of nutritional insufficiency but can be associated with trachea bronchial aspiration which can complicate management of these cancers. Majority of them 70-80% present in stages 3&4 and have co morbid conditions owing to their destructive lifestyles with over indulgence of tobacco and alcohol. These co morbid condition often render these individuals beyond the realms of curative cancer treatment . Often these patients are associated with very poor survival rates which depends on the spread of disease and the poor general condition of most of these patients.

Early stage node negative patients which comprise less than 20 % of total hypopharyngeal cancer can be treated successfully with EBRT if they are in good general condition . The advanced stage hypopharyngeal cancers are often unfit for most curative modalities . If they are fit and have no other co morbid condition than they generally are advised concurrent chemoradiation . Such robust individuals with hypopharyngeal cancers are an exception rather than the rule . Majority are not fit for these “ toxic “ chemoradiation regimes and if amenable to ablative surgery then this is perhaps the best modality for them along with adjuvant therapy . Primary ablative surgery certainly achieve cessation of any further trachea bronchial aspiration which later becomes life threatening problem surgery and may lead to successful locoregional control in as high as 50%-60 % of the cases . Today with availability of voice prostheses and electronic larynges successful speech rehabilitation is far from a challenge for those case who undergo total laryngectomy for disease control . What mars the initial satisfactory loco-regional control conferred by surgery and adjuvant RT in the hypopharyngeal group are the deaths due to intercurrent disesaes , 2nd primary cancers and distant metastasis such bthat initial local control of 60-70 % at 2 -3 years become 30-40% at 5years .