Hypopharyngeal Carcinoma – Key Evidence

  • 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
      • Distant metastases:
        • In approximately 3% of the cases
          • Thus restricting the options for curative treatment
  • 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
  • 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
  • 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
    • There is a high risk of:
      • Synchronous and metachronous:
        • Second primary tumors
  • 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
  • Prevent tracheal tears:
    • By deflating the cuff of the endotracheal tube:
      • When dissecting the trachea from the esophagus during gastric transposition
  • Consider the addition of chemotherapy to organ-preservation treatment strategies and post-operative radiotherapy

#Arrangoiz #HeadandNeckSurgeon #HeadandNeckCancer #CancerSurgeon #SurgicalOncologist #Teacher

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