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Hypopharynx Cancer

Hypopharynx cancer is a type of head and neck cancer treated with a multidisciplinary approach. At IEO hypopharynx cancer is treated by the Head and Neck Division.

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IN SHORT

The hypopharynx is continued inferiorly with the cervical oesophagus and is situated post-laterally to the larynx with which it has a close relationship, enfolding almost 180° of it. Internally it is made up of mucosa, it does not have any cartilage or bone scaffold but only a muscular layer that forms the outer structure. Ninety-five percent of cancer cases in this region develop from the cells of the mucosal surface in the form of squamous cell carcinomas.

 

At the IEO hypopharynx cancer is treated by a multidisciplinary team consisting of specialists in:



RISKS OF HYPOPHARYNX CANCER

The risk factors of hypopharynx cancer are alcohol and tobacco abuse; the combination of these two factors increases the risk of hypopharyngeal cancer exponentially. Men, especially in the age range between 50 and 60, are more frequently affected. When present, throat cancer symptoms are the sense of an external body in the throat, pain on swallowing, bad breath, stabbing pain to the ear, the presence of spots of blood in the saliva. In more advanced stages, throat cancer symptoms may be associated with changes in the voice, difficulty breathing, or swelling in the neck due to a metastatic lymph node which can often be the first sign of throat cancer. Diagnosis is made via a clinical and instrumental evaluation (fibre-optic video) of the throat cancer in the clinic. It can be confirmed histologically by performing a biopsy of the throat cancer under general anaesthesia. Additional diagnostic tests such as CT, or magnetic resonance of the facial skeleton and neck, and PET complete staging to define in detail the spread of the throat cancer before proposing the treatment, which in general depends on the stage.

PREVENTION AND DIAGNOSIS

Good standards for prevention

  • Adopting a healthy lifestyle, not smoking and limiting alcohol intake.
  • Adopting a few precautions in eating habits: eating fruit, vegetables, and foods rich in carotenoids, such as tomatoes, carrots, sweet and spicy peppers, pumpkin, apricots, herbs (probable evidence).
  • Keeping a careful eye on oral hygiene.
  • Not underestimating any injury of the mouth although small or painless (nodules, small ulcers, white or red patches, growths).
  • After the age of 60 in subjects with risk factors, examination of the oral cavity and pharyngeal-laryngeal district is recommended.
  • Undergoing regular visits, if already affected in the past by a carcinoma of the head and neck region.

The most common symptoms and signs are small ulcers of the lip or mouth, a white or red spot in the oral mucosa, frequent epistaxis (nosebleeds), nasal respiratory obstruction, hoarseness, persistent sore throat, feeling of closed ears, pain radiating to the ear, blood in sputum, difficulty chewing, swallowing or breathing, numbness of the tongue, painless and persistent swelling in the neck. The durability of these disorders should be considered as an alarm bell; if they have not resolved spontaneously or with treatment within 3 weeks, a specialist should be consulted.

TREATMENTS AND CLINICAL TRIALS

The first approach to treatment is essential. Cure is the main goal, and is considered as important as the quality of life and functionality of the treated organs, such as the voice, language, swallowing, taste and breathing. IEO provides patients with a multidisciplinary team dedicated to diagnosis, treatment and rehabilitation

THE VALUE OF A MULTIDISCIPLINARY TEAM

Our multidisciplinary team is dedicated to the diagnosis, treatment and rehabilitation of patients with tumors of the head and neck, and to the study of these diseases. Our team includes over thirty oncology professionals with expertise in various specialties, such as ENT, maxillofacial surgery, emergency surgery, plastic-reconstructive surgery, radiotherapy, medical oncology, radiology, pathology, nuclear medicine, nutrition, physiotherapy, endocrinology, dentistry, voice therapy, speech therapy, psychology, and biology.

The integration of various skills can address complex clinical problems, from diagnosis and treatment planning, to the functional recovery (speech, breathing, swallowing) in order to achieve the best results with cancer and adequate quality of life. The team works in harmony and meets on a weekly basis to discuss cases of patients who trust in our structure. They develop comprehensive personalized care plans considering all aspects of treatment and rehabilitation, considering the different treatment options, taking into account the needs of individual patients in accordance with internal, national and international guidelines.

The team, in close collaboration with the Scientific and Health Management Board, monitors the results of treatment and the quality of the performances in real time in order to point out critical issues and identify areas for improvement and development. The multidisciplinary meetings are an opportunity for professional development based on the exchanges in the group, the evidence in the literature, and the critical review and update of guidelines as well as diagnostic and therapeutic approaches. The information obtained from the critical review of the clinical activities, from technological innovations, from the study of the evolution of the cancers treated, and from continuous updating are used to identify open issues and propose research activities. Thanks to this approach, clinical research activities and institutional research projects in collaboration with national and international institutions have been put in place.

Cancers of the hypopharynx

The therapeutic treatment choice depends on various factors such as stage, site of the tumour and general health conditions of the patient. In cases diagnosed at the initial stage, it is possible to intervene with conservative methods such as radiotherapy or - in selected cases - minimally invasive surgical procedures using transoral laser microsurgery. On the contrary, in case of intermediate or advanced stage tumours, treatments combining chemotherapy and radiotherapy or more extensive surgery (total laryngopharyngectomy) need to be used, sometimes followed by post-operative radiotherapy or chemo-radiotherapy. 

Distant metastases of head and neck carcinoma

Distant metastases are defined as tumor spread to other organs. Lung, liver, and bone are the most common sites for hematogenous metastases of head and neck squamous cell carcinoma. The incidence of distant metastasis in head and neck squamous cell carcinoma is low for the general head and neck squamous cell carcinoma population: generally below 5% at presentation. Head and neck squamous cell carcinoma patients with distant metastases are generally candidates for palliative treatment scenarios only, because currently no systemic therapy has curative potential in head and neck squamous cell carcinoma patients with distant disease. Consequently, extensive locoregional treatment is usually considered futile in these patients. Particular attention is paid to our collaboration with CNAO, National Centre of Oncology Hadrontherapy) for Phase II, the clinical trial on radiotherapy boost, using protons (hadron therapy) for locally advanced tumours of the cervical-cephalic region.

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Clinical nutrition

Stage and location of the disease, anatomical changes resulting from any surgical procedure, and the acute and late toxicity of chemo-radiotherapy are all factors that may contribute to the impairment of swallowing and create deficiency in the oral protein-calorie intake.

Artificial Nutrition (AN) is indicated with cancers that cause a stenosis (narrowing), severe dysphagia (difficulty in eating that contraindicate oral feeding), or where there is evident malnutrition or in the patient who, although feeding through the mouth, takes on a calorie-protein amount <50% of nutritional needs. AN must also be started when you expect a period of severe dysphagia longer than 7 days or inadequate intake (<60% of the nutritional requirements) for at least 10 days.

In patients with cancer of the cervical-facial district, Enteral Nutrition (EN) represents the primary route of choice when the gastrointestinal tract is accessible and functioning. It can be performed via nasogastric tube or via Percutaneous Endoscopic Gastrostomy (PEG) or Jejunostomy Nutrition, in case of expected duration of nutritional support greater than 3-4 weeks. EN is effective in containing the decline in body weight, preventing dehydration and interruptions of the radio-chemotherapy treatment, reducing the frequency and duration of hospitalisations, and improving the quality of life.

 Adequate nutritional support during radiotherapy treatment can reduce the impact and degree of morbidity (mucositis, odynophagia, dysphagia, xerostomia, dysgeusia, nausea, vomiting, and anorexia), minimise weight loss, preserve the nutritional status, improve the quality of life and optimize the situation by speeding up the recovery of the patient at the end of treatment.

The use of early and intensive nutritional counseling and oral caloric supplementation have been shown to increase the protein-calorie oral intake, reduce the extent of body weight loss, and reduce the interruptions of the cancer treatment.

In the presence of a sufficiently safe swallowing, oral feeding (using a diet modified in consistency) is the first choice.

 

PARTNERSHIP

Università degli Studi di Milano Ecancer Medical Science IFOM-IEO Campus

CREDITS

Ministero della Salute Joint Commission International Breastcertification bollinirosa

© 2013 Istituto Europeo di Oncologia - via Ripamonti 435 Milano - P.I. 08691440153

IRCCS - ISTITUTO DI RICOVERO E CURA A CARATTERE SCIENTIFICO

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