Hypopharyngeal Cancer

21.03.2024

DIAGNOSIS AND TREATMENT OF HYPOPHARYNX CANCER

Hypopharynx Cancer is a type of cancer that occurs in the lower part of the throat called the hypopharynx. The hypopharynx is located between the larynx and the esophagus and is involved in the swallowing function as well as the respiratory tract. This type of cancer usually presents with symptoms such as difficulty swallowing, sore throat, earache, voice changes and swelling in the neck area. Hypopharyngeal cancer is often diagnosed in advanced stages and can cause treatment difficulties. Treatment options include methods such as surgery, radiotherapy, chemotherapy and immunotherapy. The treatability of hypopharyngeal cancer can be increased with early diagnosis and appropriate treatment. Therefore, it is important for individuals experiencing throat and swallowing problems to pay attention to these symptoms and consult a healthcare professional when necessary. Hypopharyngeal cancer is a type of cancer that can achieve more positive results with early diagnosis and effective treatment.

WHAT ARE THE RISK FACTORS?

Hypopharynx Risk factors that are effective in the development of cancer may be:

Smoking: People who smoke have a higher risk of hypopharyngeal cancer. For smokers, quitting tobacco products may reduce the risk of cancer.

Alcohol Consumption: Excessive alcohol consumption may increase the risk of hypopharyngeal cancer. Limiting or stopping alcohol use can be a preventive measure.

HPV (Human Papillomavirus) Infection: Some hypopharyngeal cancers have been associated with HPV infection. Vaccines are available against sexually transmitted HPV and may reduce the risk of cancer.

Age: Hypopharyngeal cancer is generally more common in individuals over the age of 40.

Gender: The risk of hypopharyngeal cancer is higher in men than in women.

Nutrition habits: Inadequate fruit and vegetable consumption, poor eating habits and nutritional deficiencies may increase the risk of hypopharyngeal cancer.

Exposure to Environmental Toxins: Exposure to asbestos industrial chemicals and other harmful substances may increase the risk of hypopharyngeal cancer.

Family History: Family history can affect individuals' susceptibility to cancer. The risk may increase in people with a previous family history of hypopharyngeal cancer.

To reduce the risk factors for hypopharynx cancer, smoking and alcohol consumption should be avoided, a healthy lifestyle should be adopted and precautions should be taken to protect against sexually transmitted infections. Additionally, regular health checks and screenings can increase the chances of early diagnosis and treatment.

Image 1: Hypopharyngeal tumor is a type of cancer that occurs in the lower part of the throat.

HOW IT OCCURS ?

Hypopharyngeal cancer development mechanisms are complex and occur as a result of the interaction of multiple factors. The most commonly accepted mechanisms may be: Smoking and excessive alcohol consumption can irritate the hypopharynx area, causing mutations in cellular DNA and initiating cancer formation. HPV (Human Papillomavirus) infection, especially some subtypes, can lead to hypopharyngeal cancer. HPV can disrupt cellular control mechanisms and lead to overgrowth of cancer cells as a result of the DNA of the virus integrating into the cell DNA. Genetic predisposition and family history may also increase the risk of hypopharyngeal cancer. The combination of these factors can lead to uncontrolled growth of cells and the development of cancer. Understanding the mechanisms of hypopharyngeal cancer is important for developing preventive strategies and more effective treatment methods.

WHAT ARE THE SYMPTOMS?

Symptoms and signs of hypopharyngeal cancer may include:

Difficulty Swallowing: One of the most common symptoms is difficulty swallowing. Hypopharyngeal cancer can affect swallowing function, making feeding and fluid intake difficult.

Sore throat: A sore throat or feeling of discomfort is a common symptom.

Earache: Hypopharynx cancer can cause ear pain because this area is located adjacent to nearby ear canals.

Voice Changes: Changes in voice quality, especially the voice becoming hoarse can be another common symptom.

Neck Swelling: Swelling of lymph nodes in the neck area may be a sign of the spread of cancer.

Intraoral Lesions: Sores, ulcers or lesions may occur in the mouth or throat.

Shortness of breath: Since hypopharyngeal cancer is close to the respiratory tract, shortness of breath may also occur.

Bloody Saliva: Bloody saliva or bloody sputum may be a result of bleeding in the mouth or throat area.

Symptoms of hypopharyngeal cancer can be similar to other throat problems, so it is important for people experiencing such symptoms to be evaluated by a healthcare professional. Early diagnosis can increase the chances of treatment and prevent cancer from being diagnosed in advanced stages.

HOW IS IT DIAGNOSED?

Diagnosis of hypopharynx cancer is usually made by combining a number of clinical and diagnostic methods. The diagnostic process may include: First, the patient's symptoms and medical history are evaluated. At this stage, symptoms such as difficulty swallowing, sore throat, earache, and voice changes are taken into consideration. During the physical examination, the throat and neck area are examined and the size of the lymph nodes is checked. Imaging tests are then used, which may include methods such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Biopsy is important to confirm the diagnosis and a tissue sample is taken from the hypopharynx area and sent for pathological examination. This tissue sample is used to determine the type and stage of cancer. Based on the diagnostic results, an appropriate treatment plan is created and the patient is planned to begin treatment. Diagnosis and treatment of hypopharyngeal cancer is usually managed by a multidisciplinary healthcare team, which involves collaboration of specialists such as an oncologist, surgeon, radiation oncologist, and pathologist.

WHAT ARE THE PATHOLOGICAL TYPES?

Hypopharyngeal cancer is often associated with a pathological type called squamous cell carcinoma. However, various pathological types originating from different cell types can also be seen in the hypopharynx region. These pathological types can be:

Squamous Cell Carcinoma: The most common type, squamous cell carcinoma, arises from the surface tissues of the hypopharynx and consists of squamous epithelial cells.

Adenocarcinoma: Adenocarcinoma arises from gland cells and begins in the glands of the hypopharynx.

Lymphoma: Lymphoma types originating from lymphoid tissues in the hypopharynx region can also be seen.

The diagnosis of hypopharynx cancer is confirmed by pathological examination of the tissue sample obtained during biopsy and the pathological type of cancer is determined. The pathological type can have an impact on how the cancer is treated and its prognosis. Therefore, accurate pathological diagnosis is important and treatment options are planned according to this diagnosis. Identifying molecularly targeted therapies in the treatment of hypopharyngeal cancer may improve treatment outcomes by targeting critical receptors that control the growth and spread of cancer cells. Receptors such as EGFR, HER2, VEGFR, PD-1, and PD-L1 are the hotspots of cancer cells and can help personalize treatment options. Identification of these receptors and other molecular targets allows the treatment plan to be made in accordance with the characteristics and stage of the tumor. Therefore, evaluating receptors and using targeted therapies in the treatment of hypopharyngeal cancer can help patients achieve better results and is an important step in the fight against cancer.

Image 2: Hypopharyngeal cancer can spread to the lymph nodes in the neck and cause swelling.

HOW IS TUMOR STAGING DONE?

Hypopharynx Staging of cancer is used to determine how far the cancer has spread and what the treatment plan should be. The staging process usually includes the following elements:

Tumor Size (T): The size of the cancer and the tissues it has spread to are evaluated. This can refer to a grade between T1 (small) and T4 (large).

Lymph Nodes (N): It is examined whether the cancer has spread to the lymph nodes. It may range from N0 (no spread to lymph nodes) to N3 (spread to large and/or multiple lymph nodes).

Distant Metastasis (M): It is evaluated whether the cancer has spread to other parts of the body. It is classified as M0 (no distant metastasis) or M1 (distant metastasis present).

Staging of hypopharyngeal cancer is done using a stage classification that includes a combination of these T, N, and M factors. The staging result is used to define the stage of the cancer. For example, a staging result might read "T2N1M0," indicating that the cancer is a certain size, has spread to several lymph nodes, but has no distant metastasis. Staging of hypopharyngeal cancer is important to determine treatment options and the patient's prognosis.

HOW IS TREATMENT DONE ACCORDING TO STAGES?

Hypopharynx Cancer treatment may vary depending on the stage and type of cancer and the patient's general health condition. Generally, hypopharyngeal cancer treatment is planned according to the stages as follows:

Stage I and Stage II: Hypopharyngeal cancer in these stages is usually localized (local). Treatment options may include surgery (for example, removal of the tumor) or radiotherapy (using high-energy rays). In some cases, radiotherapy and surgery may be used together.

Stage III and Stage IV: Cancer in these stages can be found in more advanced stages and spread to surrounding tissues or lymph nodes. Treatment may usually consist of a combination of surgery, radiotherapy and chemotherapy. At these stages, treatment may be more aggressive and procedures such as neck dissection may also be required to target cancer cells that have spread to the lymph nodes.

The treatment plan is determined by an oncologist based on the patient's specific condition. Treatment options may also vary depending on the patient's age, general health and personal preferences. Treatment of hypopharyngeal cancer is a complex process that requires a multidisciplinary approach and the collaboration of many specialists is required for patient care.

Image 3: In hypopharyngeal cancer, complaints such as neck swelling, difficulty swallowing and pain may be observed.

WHAT ARE THE DRUGS USED IN TREATMENT?

There are different treatment methods used in the treatment of hypopharynx cancer.

Chemotherapy: Platinum-based chemotherapy drugs (for example, Cisplatin or Carboplatin) are often used to treat hypopharyngeal cancer. These drugs work by stopping the growth of cancer cells or killing them.

Smart Drug Therapies: Smart drugs are less commonly used in the treatment of hypopharyngeal cancer. But molecular targeted therapies can help treat cancer cells by targeting their specific receptors or signaling pathways.

Immunotherapy: Immunotherapy helps treatment by stimulating the immune system against cancer cells. Drugs known as checkpoint inhibitors (for example, Pembrolizumab or Nivolumab) may be used to treat hypopharyngeal cancer and may encourage the immune system to recognize and destroy cancer cells.

The treatment plan is personalized based on the patient's stage, type of cancer, and general health condition. The most appropriate treatment options for each patient are determined by an oncologist and may vary depending on the patient's condition.

HOW SHOULD FOLLOW-UP BE CARRIED OUT AFTER RECOVERY?

Follow-up after hypopharyngeal cancer treatment is critical for monitoring the patient's health and early detection of recurrences or post-treatment complications. The follow-up program is designed to evaluate the patient's post-treatment recovery process and intervene when necessary. This follow-up usually includes the following elements: regular doctor exams, imaging tests (for example, CT or MRI), blood tests, and invasive procedures such as biopsies when necessary. Additionally, post-treatment health and lifestyle recommendations are also part of the patients' follow-up plan. Regular follow-up is recommended to maintain the long-term health and quality of life of hypopharyngeal cancer patients and is vital for early detection of recurrences and re-initiation of treatment if necessary.