Evaluation of Hypopharyngeal Cancer: Key points

Histological diagnosis is essential
- Squamous cell carcinoma (SCC) is most common (rarely adenoid cystic carcinoma, liposarcoma)
- Exclude inflammatory causes e.g. TB
Principal treatment options are surgery +/- adjuvant radiation therapy; or (chemo)radiation
Objectives of preoperative evaluation
- Confirm diagnosis
- Describe the precise location of the cancer
- Stage the primary cancer and the neck and exclude distant metastases
- Decide whether to offer curative or palliative treatment
Patient evaluation
- Unlike cancers of the larynx, patients are often malnourished due to dysphagia and odynophagia
- Fitness for surgery / chemoradiation
- Ability to cope with aspiration if partial laryngectomy, chemoradiation considered
- Ability to complete surgery and postoperative radiation therapy, or chemoradiation
- Ability to deal with the long-term consequences of treatment e.g. dysphagia, aspiration, tracheostomy, hypothyroidism, voice disturbance/aphonia
Surgery
- Plan appropriate surgery
- Avoid inappropriate surgery
- Avoid surgery beyond the scope of the surgeon e.g. complex salvage surgery