- The majority of patients when diagnosed with hypopharyngeal cancer have:
- Advanced stage disease:
- With evidence of:
- Advanced local disease:
- T3 / T4
- Regional involvementof:
- Level II, III, IV
- Paratracheal and retropharyngeal lymph nodes:
- In greater than 80% of the cases
- Involvement of contralateral lymph nodes:
- In greater than 20% of the cases
- Advanced local disease:
- Distant metastases:
- In approximately 3% of the cases
- Thus restricting the options for curative treatment
- In approximately 3% of the cases
- With evidence of:
- Advanced stage disease:
- Those few patients who present with early primary site (T stage) disease:
- Should be considered for treatment by:
- Surgical excision (endoscopic (CO2) or open surgery) when possible:
- So that organ function:
- Voice and swallowing:
- Can be preserved
- Voice and swallowing:
- So that organ function:
- Surgical excision (endoscopic (CO2) or open surgery) when possible:
- Should be considered for treatment by:
- In the recent past:
- Treatment for operable patients:
- Was surgery with post-operative chemoradiotherapy:
- However:
- Because of the morbidity of the procedure and the likely risk of local recurrence and / or distant metastases:
- Manifesting within two years:
- The option of ‘organ preservation’ treatment has been explored
- Manifesting within two years:
- Because of the morbidity of the procedure and the likely risk of local recurrence and / or distant metastases:
- However:
- Was surgery with post-operative chemoradiotherapy:
- Treatment for operable patients:
- Patients with advanced inoperable disease:
- Should be treated by chemo ± biotherapy and radiotherapy regimens:
- With possible surgery for persisting neck disease:
- Aiming to maximize symptom relief:
- With minimal treatment toxicity:
- While maintaining good quality of life for the remainder of such patients’ life
- With minimal treatment toxicity:
- Aiming to maximize symptom relief:
- With possible surgery for persisting neck disease:
- There is a high risk of:
- Synchronous and metachronous:
- Second primary tumors
- Synchronous and metachronous:
- Should be treated by chemo ± biotherapy and radiotherapy regimens:
- Treat the neck in all cases:
- Approximately 80% are cN positive at the time of presentation
- Submucosal spread is common:
- Surgical margins should be:
- 3 cm inferiorly and
- 2 cm:
- Both superiorly and laterally
- Surgical margins should be:
- Prevent tracheal tears:
- By deflating the cuff of the endotracheal tube:
- When dissecting the trachea from the esophagus during gastric transposition
- By deflating the cuff of the endotracheal tube:
- Consider the addition of chemotherapy to organ-preservation treatment strategies and post-operative radiotherapy
#Arrangoiz #HeadandNeckSurgeon #HeadandNeckCancer #CancerSurgeon #SurgicalOncologist #Teacher
Rodrigo Arrangoiz MS, MD, FACS, FSSO 