Squamous Cell Carcinoma of the Hypopharynx

Squamous cell carcinoma of the hypopharynx is a rare and aggressive throat cancer that often goes unnoticed until it has spread, making early detection and specialized treatment essential for improving survival outcomes.

Table of contents

• What is squamous cell carcinoma of the hypopharynx?
• Where the hypopharynx is located
• How common is this cancer?
• Risk factors
• Signs and symptoms
• How the cancer spreads
• Diagnosis
• Prognosis and survival rates
• Treatment options

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hypopharyngeal squamous cell carcinoma, hypopharyngeal cancer, hypopharynx squamous cell carcinoma

• Hypopharynx (lower throat)
• Piriform sinus (pyriform sinus)
• Postcricoid area
• Posterior pharyngeal wall
• Larynx (voice box)
• Esophagus

What is squamous cell carcinoma of the hypopharynx?

Squamous cell carcinoma of the hypopharynx is a type of cancer that develops in the lower part of the throat. It forms when squamous cells—thin, flat cells that line the inside of the hypopharynx—begin to grow abnormally and form tumors^[1][3].

This cancer is particularly aggressive because it tends to spread quickly. The anatomy of the hypopharynx allows tumors to grow without causing obvious symptoms early on, and the area has extensive connections to the body’s lymphatic system^[2]. This means cancer cells can travel to lymph nodes and other parts of the body more easily than with some other cancers.

Squamous cell carcinoma accounts for approximately 95% of all hypopharyngeal cancers^[2][8]. The remaining cases include rarer types such as adenocarcinoma, sarcoma, and other non-squamous cell types^[2].

Where the hypopharynx is located

The hypopharynx is the bottom section of the pharynx (throat). The pharynx itself is a hollow tube about 5 inches long that starts behind the nose and runs down the neck^[4]. Air and food both pass through the pharynx on their way to either the windpipe or the esophagus.

The hypopharynx sits just below the middle part of the throat (oropharynx) and just behind the voice box (larynx)^[1]. It connects the throat to the esophagus, which is the tube that carries food to the stomach^[5].

The hypopharynx has three specific areas where cancer can develop^[2][4]:

• The piriform sinuses (also called pyriform sinuses), which are the most common location for tumors
• The postcricoid area, located behind the cricoid cartilage
• The posterior pharyngeal wall, which is the back wall of the throat

Cancer may be found in one or more of these areas^[4].

How common is this cancer?

Squamous cell carcinoma of the hypopharynx is rare. In the United States, an estimated 2,000 to 4,000 people receive a hypopharyngeal cancer diagnosis each year^[1]. For comparison, more than 238,000 people were diagnosed with lung cancer in 2023^[1].

Hypopharyngeal cancer accounts for approximately 15% of all head and neck cancers worldwide^[16]. It occurs most often in men in their 50s or 60s, although the number of younger people being diagnosed is increasing^[6].

Risk factors

Certain factors significantly increase the chance that someone will develop squamous cell carcinoma of the hypopharynx. Having risk factors does not mean you will definitely get cancer, and some people without any known risk factors still develop the disease^[4].

Tobacco use is the single largest risk factor for developing this cancer^[1]. This includes smoking cigarettes, cigars, pipes, and electronic cigarettes, as well as using chewing tobacco and snuff.

Heavy alcohol consumption is another major risk factor. When combined with tobacco use, the risk increases even more dramatically^[1][4]. Heavy drinking typically means having more than two drinks per day for men or one drink per day for women.

Other risk factors include^[2][4]:

• Infection with certain strains of human papillomavirus (HPV), which is a sexually transmitted infection
• Plummer-Vinson syndrome, a condition linked to poor nutrition and iron deficiency
• A diet lacking in essential nutrients
• Exposure to asbestos
• Chronic gastroesophageal reflux (severe, ongoing heartburn)
• Betel nut chewing
• Age over 65 years
• Being male (this cancer is up to five times more common in men)

Signs and symptoms

One of the most challenging aspects of hypopharyngeal cancer is that it often does not cause noticeable symptoms in its early stages^[1][2]. The location and anatomy of the hypopharynx allow tumors to grow without causing obvious problems right away.

When symptoms do appear, they may include^[1][4]:

• A sore throat that does not go away
• A feeling that something is caught in the throat
• Difficulty swallowing or painful swallowing (dysphagia or odynophagia)
• Ear pain
• Hoarseness or other voice changes
• A lump in the neck (from swollen lymph nodes)
• Difficulty breathing or noisy breathing (called stridor)
• Choking for no obvious reason
• Coughing up blood
• Unexplained weight loss
• Fatigue

These symptoms can also be caused by other, less serious conditions^[1]. However, you should talk to a healthcare provider if you have any of these symptoms that last for more than two weeks.

In more advanced cases, patients may experience malnutrition and breathing problems that require immediate medical attention^[2].

How the cancer spreads

Squamous cell carcinoma of the hypopharynx is known for spreading early and aggressively. The hypopharynx has rich lymphatic drainage, which means it has many pathways for cancer cells to travel through the lymphatic system^[2].

Approximately 70% of patients already have lymph node involvement (lymph node metastases) at the time of diagnosis^[2][8]. Early on, the cancer often spreads to lymph nodes in the neck, which is why a lump in the neck is an important warning sign^[1].

Without treatment, the cancer can spread to^[1][4]:

• The esophagus (food tube)
• Other parts of the throat
• The thyroid gland
• The trachea (windpipe)
• The larynx (voice box)
• The hyoid bone (a bone under the tongue)
• The cartilage around the thyroid or trachea
• The lining of the chest cavity
• Tissues around the upper part of the spine
• The carotid artery
• Distant organs such as the lungs, liver, and bones

Distant spread (metastasis) to organs like the lungs often occurs within the first year after diagnosis^[10].

Diagnosis

If you have symptoms that might suggest hypopharyngeal cancer, your healthcare provider will start by asking about your symptoms, how long you’ve had them, and your history of tobacco and alcohol use^[1].

During a physical examination, the provider will feel your neck for swollen lymph nodes and examine your throat^[1]. Depending on your symptoms, you may be referred to an ear, nose, and throat (ENT) specialist or otolaryngologist, who specializes in diagnosing and treating head and neck conditions.

Several tests and procedures may be used to diagnose this cancer^[4]:

Physical examination: The doctor checks for signs of disease, including lumps or anything unusual in the throat and neck.

Endoscopy and laryngoscopy: These procedures use a thin, flexible tube with a camera to view the inside of the throat and hypopharynx^[1].

Biopsy: A tissue sample is taken from the suspicious area and sent to a laboratory for analysis. This is the definitive way to confirm whether cancer is present^[1].

Imaging tests: These help determine the extent of the cancer and whether it has spread. They may include^[1]:

• CT scan (computed tomography)
• MRI (magnetic resonance imaging)
• Ultrasound

Prognosis and survival rates

The prognosis for squamous cell carcinoma of the hypopharynx is generally poor, primarily because most cases are diagnosed at an advanced stage^[2]. By the time symptoms appear, the cancer has often already spread.

Five-year survival rates vary significantly depending on when the cancer is found^[2]:

• For early-stage disease: approximately 60%
• For advanced-stage disease: less than 25%

Overall, about half of people diagnosed with hypopharyngeal cancer survive more than five years after diagnosis^[6]. However, the disease has a high risk of recurrence. More than 40% of patients experience a return of their cancer, and an additional 20% develop distant metastases, usually within the first year^[10].

Certain factors affect a person’s chance of recovery and treatment options, including the stage of the cancer, the exact location of the tumor, the person’s overall health, and whether this is a new diagnosis or a recurrence^[4].

Treatment options

Treatment for squamous cell carcinoma of the hypopharynx depends on the stage of the cancer, its location, whether it has spread, and the patient’s overall health^[1]. The main treatment approaches include surgery, radiation therapy, chemotherapy, and immunotherapy, often used in combination.

For early-stage cancer (Stage I and II)

Early-stage hypopharyngeal cancers are uncommon because most are found at a later stage^[13]. When they are diagnosed early, treatment options include^[13]:

Chemoradiation: This is a main treatment for stages 1 and 2. Chemotherapy (usually with a drug called cisplatin) is given at the same time as radiation therapy. The chemotherapy makes the radiation more effective. Radiation is directed at the tumor and lymph nodes on both sides of the neck.

Surgery: Surgery may be used to remove the tumor along with a margin of healthy tissue around it. Depending on the size and location, this may involve removing part or all of the hypopharynx and larynx. Most people also have a neck dissection, which removes the lymph nodes in the neck. Surgery is usually followed by radiation therapy^[13].

Radiation therapy alone: External radiation therapy may be given for certain small tumors. If radiation is used as the main treatment and the cancer comes back, surgery (called salvage surgery) will be needed^[13].

For advanced-stage cancer (Stage III and IV)

Most hypopharyngeal cancers are diagnosed at an advanced stage. Treatment becomes more complex and often involves multiple approaches. A critical decision is whether the patient is eligible for a larynx preservation treatment program or whether more extensive surgery is needed^[16].

Advanced-stage treatment may include:

Chemoradiation: A combination of chemotherapy and radiation therapy remains a common approach for locally advanced disease^[14].

Surgery with total laryngectomy: For some patients, particularly those with T4 tumors or contraindications to larynx preservation therapies, surgery that removes the entire larynx (total laryngectomy) may be necessary as the primary treatment^[16]. This is also commonly used as salvage treatment when other treatments have failed.

Immunotherapy: This newer treatment approach helps the body’s immune system fight the cancer^[1].

Supportive procedures and reconstructive surgery

Because treatment can affect breathing, eating, and speaking, additional procedures may be needed^[13]:

• Placement of a feeding tube (usually a gastrostomy tube) to ensure adequate nutrition
• Placement of a breathing tube (tracheostomy) to help with breathing
• Reconstructive surgery to improve the appearance and function of the mouth and neck, usually done at the same time as tumor removal surgery

Surgery for hypopharyngeal cancer can affect your ability to speak and swallow, as well as your appearance^[13]. Therapists who specialize in speech and swallowing can help preserve or restore these abilities^[19].

For recurrent or metastatic cancer

When cancer comes back after initial treatment or has spread to distant parts of the body, treatment focuses on controlling the disease and relieving symptoms. Options may include additional surgery, radiation therapy, chemotherapy, immunotherapy, or clinical trials of new treatments^[4].

Clinical trials

Clinical trials study new ways to prevent, find, and treat cancer. Your doctor may discuss whether you are eligible for any clinical trials^[13].