Do you have cancer in the lower part of your throat? Let's talk about Hypopharyngeal Cancer!

Have you ever wondered about throat cancer ? You probably have. Today we are going to talk about a type of cancer that occurs in the throat, but is a little less talked about. This is called Hypopharyngeal Cancer . Simply put, it develops in the lower part of our throat, that is, in the lower part of the throat (`(Pharynx)`), specifically behind the voice box (`(Larynx)`). Let's look at this in a little more detail, shall we?

How common is this cancer?

Actually, this hypopharyngeal cancer is not that common. Just think, even in a country like America, only 2000 to 4000 people are diagnosed with this disease per year. But if we compare it to something like lung cancer , that number is very low. For example, in 2023 alone, it is said that more than two hundred thousand people were diagnosed with lung cancer in America. So this means that this is a bit rare, which means that it is not seen often.

What are the symptoms of hypopharyngeal cancer?

One problem here is that this cancer may not show any symptoms in the early stages . Sometimes the cancer may have spread (metastasized) by the time symptoms appear. However, symptoms that do appear may include:

• A sore throat or a feeling of something stuck in the throat.
• Hoarseness .
• Difficulty swallowing food .
• Ear pain .
• Swollen lymph nodes in the neck .
• Shortness of breath or something stuck in the throat for no apparent reason.
• Feeling extremely tired (` Fatigue` ).
• Voice changes .
• Difficulty breathing or a noise when breathing (`(Stridor)`).
• Coughing up blood .
• Being thin for no reason.

The most important thing is not to be afraid that you have this cancer just because you have these symptoms. Because these symptoms can also be seen in other minor illnesses. However, if any of these symptoms persist for more than two weeks, it is wise to definitely see a doctor and seek advice.

Why does hypopharyngeal cancer develop?

Simply put, this cancer develops in the cells lining your hypopharynx (the part of your throat that lines your throat). These cells mutate and become cancerous, dividing uncontrollably and forming tumors. Experts can't really say exactly why this happens. However, there are some risk factors that significantly increase your chances of developing this cancer. They are:

• Smoking: This is the single biggest risk factor for throat cancer, including hypopharyngeal cancer. This includes cigarettes, cigars, pipe smoking, electronic cigarette (`(e-cigarettes)`) use, chewing tobacco, chewing gum, and chewing tobacco.
• Frequent and heavy drinking: Frequent and heavy drinking is defined as drinking more than two units of alcohol per day for men and more than one unit per day for women.
• HPV Infection: Human Papillomavirus (HPV) is a sexually transmitted infection (STI). It can be spread through oral sex with someone who has the virus.

What complications can arise from this condition?

Hypopharyngeal cancer can spread to the lymph nodes in the neck in its early stages. That's why it's important to talk to a doctor if you notice a lump in your neck. If left untreated, this cancer can spread to the following areas:

• Your esophagus (`(Esophagus)`).
• Other parts of the throat.
• Thyroid gland (`(Thyroid)`).
• Trachea (windpipe).
• Hyoid bone (`(Hyoid bone)`).
• The lining of the chest cavity.
• The tissue surrounding the upper part of the spine.
• Carotid artery (`(Carotid artery)`).

How is this cancer diagnosed?

When you see a doctor, he or she will ask you about your symptoms, how long you've had them, and whether you use tobacco or alcohol, as these things increase your risk of developing this cancer.

Then the doctor will examine you. He will feel your neck to see if your lymph nodes are swollen, and he will examine your throat.

Depending on your symptoms, your doctor may refer you to an ear, nose, and throat specialist (ENT specialist or Otolaryngologist). He or she specializes in diagnosing and treating diseases of the head and neck. He or she may order tests such as:

• Endoscopy: In this test, the doctor inserts a long, thin tube (endoscope) down your throat to examine the lower part of your throat. A test called a laryngoscopy may also be done to examine the voice box (larynx).
• Biopsy: The doctor may order a fine-needle aspiration (FNA) to take a sample of tissue. A pathologist will examine the sample under a microscope to see if there are any cancer cells.
• Imaging tests: If the biopsy confirms that you have hypopharyngeal cancer, your ENT specialist will refer you to an oncologist. He or she may order imaging tests to see if the cancer has spread from the lower part of the throat to other parts of the body. These may include a CT scan (Computed Tomography), MRI scan (Magnetic Resonance Imaging), or PET scan (Positron Emission Tomography).

Let's also learn about cancer staging and grade.

Cancer staging is a way for oncologists to talk about cancer in more detail. For example, where the tumor is, whether it has spread, and if so, where, or whether the cancer has spread to other parts of the body.

The stages of hypopharyngeal cancer range from Stage I – when the cancer is confined to the lower part of the throat and has not spread – to Stage IV. Stage IV is when the cancer has spread to other parts of the throat and mouth, the back of the nose (nasopharynx), the base of the skull, and the lining of the chest cavity.

Hypopharyngeal cancer is also classified by grade. The grade of a cancer allows oncologists to predict how quickly the cancer will spread. These grades range from GX (the cancer has a low chance of spreading) to G3 (the cancer is very likely to spread).

What are the treatments for this?

The most common treatment is surgery to remove the tumor and radiation therapy to kill any remaining cancer cells. Your oncologist may also combine surgery with chemotherapy or immunotherapy.

Here are some surgical options for hypopharyngeal cancer:

• Partial or total pharyngectomy: This surgery removes all or part of your throat. This may also include a surgery called a laryngectomy, which removes the voice box (larynx). Because your throat helps you breathe, a stoma, or opening, is created after surgery so that a laryngectomy tube can be inserted. You will breathe through this tube after surgery.
• Laryngectomy: If you have a laryngectomy, your surgeon may make a small hole (tracheoesophageal puncture – TEP) between your windpipe (trachea) and your esophagus (oesophagus). This TEP is where a voice prosthesis (laryngectomy speaking device) is inserted.
• Neck dissection: A surgeon may perform this to remove affected lymph nodes in the neck.
• Transoral robotic surgery (TORS): This surgery allows surgeons to remove cancerous tumors in hard-to-reach areas, such as the lower part of the throat.
• Reconstructive surgery: After surgery to remove all or part of the throat or voice box, reconstructive surgery may be needed to restore functions such as eating, breathing, and the ability to use a voice device.

Surgery for throat cancer can affect your ability to speak, eat, and breathe. Before surgery, ask your surgeon how the treatment will affect you. For example, you may work with a speech-language pathologist (Speech-language pathologist) to learn ways to manage any speech or swallowing difficulties that may arise from surgery.

Is there a way to prevent this cancer?

Although it cannot be completely prevented, there are things you can do to reduce your risk of developing hypopharyngeal cancer:

• Quitting tobacco use completely and avoiding secondhand smoke.
• Stopping alcohol use or limiting the amount you drink.
• Protect yourself from HPV infection by getting vaccinated against the HPV virus and practicing safe sex.

What should I expect if I have this condition?

Hypopharyngeal cancer can come back (recur) after treatment. This also increases the risk of developing a new type of cancer elsewhere in the body. Doctors call this a ``second cancer.''

Therefore, you will need to have regular follow-up appointments to help your cancer care team monitor your overall health and check for signs of recurrence, spread (metastatic) hypopharyngeal cancer, or a second cancer. This follow-up may include imaging tests and physical exams. These appointments may be scheduled as follows:

• Every two months for the first year after treatment.
• Every four months in the second year .
• Every six months in the third year .
• Once a year in the fourth and fifth years .
• In some cases, your cancer treatment team may recommend lifelong follow-up .

What are the survival rates?

When thinking about survival rates, it's important to remember that these are just estimates based on the experiences of others who have had hypopharyngeal cancer. These rates vary greatly depending on whether the cancer is in the same place where it first started, has spread to nearby tissues and lymph nodes ('regional'), or has spread to other parts of the body ('distant').

Also, these rates may vary depending on your overall health and other factors. Ask your oncologist to explain how these survival rates apply to your situation. He or she knows you and your overall health, so he or she is the best source of information.

Can this be cured completely?

In some cases, hypopharyngeal cancer can be cured with surgery and other treatments. This is most likely to happen if the tumor is smaller than 2 centimeters and has not spread. However, sadly, many people with this cancer are diagnosed when the disease is in the advanced stages.

How do I take care of myself?

If you have had throat surgery, you will have to learn new ways to breathe and speak. It can be a big change to manage. So, never hesitate to ask your speech-language pathologist for help. They may have suggestions for support groups for people recovering from throat surgery.

Here are some other ways you can take care of yourself:

• Think about cancer survivorship. Hypopharyngeal cancer can come back, or a second cancer can develop. You may feel anxious about the future. Many cancer recovery programs include mental health support.
• Continue to avoid tobacco use and limit your alcohol intake.
• Eat well. Throat surgery can affect your ability to eat and drink. Consult a nutritionist (nutrition expert) for meal plans and recommendations. Ask your speech and language therapist about ways to manage any problems that may interfere with eating well.

When should I see the doctor?

It really depends on your condition and treatment. Ask your cancer care team what symptoms or problems you can expect, and when you should contact them.

What questions should I ask the oncologist?

When you see your doctor, it's very important to ask questions like these:

• What is the stage of my cancer?
• What treatment options do you recommend?
• If I have surgery, what support programs are available to help me deal with the changes it may cause?
• How will treatment affect my quality of life?
• Are there any clinical trials I am eligible for?

Things to remember in summary

Hypopharyngeal cancer is a life-threatening disease. Unfortunately, it is often diagnosed after the cancer has spread. In this case, you may have to undergo major surgery and then undergo major lifestyle changes and be under medical supervision for the rest of your life.

If you have this cancer, you will be relieved to know that everyone on your cancer care team is dedicated to helping you. They will help you understand your diagnosis and treatment options. They will also support you as you learn to live with the changes that cancer treatment can bring. Never hesitate to ask for their help. It is always best to seek medical advice if you have a sore throat, difficulty swallowing, or a change in your voice that lasts more than two weeks.