Principles of selecting treatment for Hypopharyngeal Cancer

Should require a lot of thought
- Need to individualise treatment
- Cannot simply base on TNM staging
Need to balance cure with preservation of function
- Swallowing
- Voice
- Aspiration
- Airway
Consider patient’s values, beliefs, financial status, socioeconomic support
Consider available resources
Tumour factors
- Site
  - Lateral may not require laryngectomy
  - Small AE fold / medial may be amenable to transoral excision
- Stage
- Mobility
  - Cartilage invasion
  - Prevertebral fascia invasion
- Distal extent: May need flap reconstruction, oesophagectomy
Prior radiation therapy
Patient factors
- Age, fitness, nutritional status
- Pulmonary status (tolerate aspiration)
- Cognitive status
- Values and beliefs
- Socioeconomic status and social support
- Access to thyroid replacement therapy
- Reliability for follow-up
Institutional support
- Surgical expertise
- Availability of CO2 laser transoral microsurgery
- Radiotherapy package of care
- Speech and swallowing support
- Tracheoesophageal speaking valves/ electrolarynx