After determining a diagnosis and completing a full pre-treatment evaluation, doctors will recommend a course of treatment for their patients. In general, there are three different options for the treatment of hypopharyngeal cancers that can be used alone or in combination.
For hypopharyngeal cancers there is no one, standard treatment plan. Instead, patients and their care teams should have extensive discussions to determine the best treatment course.
Surgery
Surgery may be an option for the treatment of hypopharyngeal cancers, depending on the type, grade, and stage of the cancer. Hypopharyngeal cancers may be treated with a pharyngectomy or a laryngectomy. Surgery will often involve a neck dissection, in which the surgeon will remove some of the lymph nodes from the neck to check if they contain cancer. For hypopharyngeal cancers, surgery is often followed by adjuvant radiation and/or chemotherapy.
Radiation
For the treatment of hypopharyngeal cancers, there are two types of radiation that may be used. Radiation therapy is a form of primary treatment, in which an external beam of radiation is directed at the tumor in order to destroy the rapidly dividing cancer cells. Radiation can also be given following surgical resection, termed adjuvant radiation, with the goal of decreasing the chances that the cancer will come back.
Chemotherapy
Chemotherapy is sometimes used in combination with radiation therapy as a primary treatment for hypopharyngeal cancers (generally those of a higher stage). Chemotherapy is also sometimes given prior to beginning either primary surgical or nonsurgical treatment, called induction chemotherapy.
General Treatment Options for Hypopharyngeal Cancer
These options depend on T, N, and M stages.
Most T1, N0 , Select T2, N0 (cancers not requiring total laryngectomy)
- For cancers in this category that do not require removal of the larynx (voice box) in order to completely remove the cancer, there are several options:
- Radiation alone, followed by surgery if any cancer remains.
- Partial hypopharyngectomy or laryngopharyngectomy with neck dissection.
- Enrollment in a clinical trial.
- Surgery can be performed open or in select cases can be performed through a transoral approach using Transoral Robotic Surgery (TORS) or Transoral Laser Microsurgery (TLM).
- If surgical removal is chosen as the initial treatment, then the cancer will be analyzed under a microscope to determine if additional treatment is needed. This decision will be made based on the presence of any adverse features such as:
- Positive margins (the presence of cancer cells at the edge of the tissue that was removed).
- Spread of the cancer beyond the capsule of the lymph nodes in the neck (extranodal extension).
- A more extensive cancer than was expected (T3 or T4 tumors and/or N2 or N3 disease in the neck lymph nodes).
- Cancerous lymph nodes in unusual parts of the neck.
- Tumor invasion into or around nerves (perineural invasion).
- Tumor invasion into blood vessels (lymphovascular invasion).
- If there are no adverse features, then no additional treatment is necessary.
- If the adverse features include extranodal extension with or without positive margins, then chemotherapy and radiation will be recommended.
- If there are positive surgical margins, then either additional surgical removal or radiation is recommended. Chemotherapy and radiation may also be considered, but only for T2 tumors.
- If there are other adverse features, then radiation with or without chemotherapy may be considered.
Advanced cancers requiring pharyngectomy with total laryngectomy T1, N+ T2-3, Any N
- For cases in which a total laryngectomy is required to completely remove the cancer, there are a few options for the initial treatment:
- Chemotherapy and radiation, followed by surgical removal if any cancer remains or comes back.
- Surgery to remove the larynx and pharynx (laryngopharyngectomy) with a neck dissection, followed by radiation with or without chemotherapy, depending on the pathology of the cancer (if there are no adverse features, then no additional treatment is necessary).
- Induction chemotherapy followed by either radiation alone, chemotherapy with radiation, or surgery, depending on the response to the initial chemotherapy.
- Enrollment in a clinical trial.
T4a, Any N
- For cases involving large primary tumors, there are a few treatment options:
- Surgical removal with a neck dissection, followed by radiation with or without chemotherapy, depending on the pathology of the cancer.
- Chemotherapy with radiation, followed by surgery if any cancer remains or comes back.
- Induction chemotherapy followed by radiation with or without chemotherapy or surgical removal, depending on the response to the initial chemotherapy.
- Enrollment in a clinical trial.
