ENT (Otorhinolaryngology) · MU Sofia

45. Malignancies of the hypopharynx.

Covers hypopharyngeal cancer from its definition and anatomical limits through risk factors such as tobacco, alcohol, Plummer-Vinson syndrome and reflux, then the pathogenesis sequence. It classifies tumours by site and histology and sets out TNM criteria, noting that about 70% of patients have palpable neck nodes at presentation. Symptoms, signs, the diagnostic workup including panendoscopy and PET-CT, treatment by stage, complications and differential diagnosis close the note.

Inside: 1 section · 4 labelled pictures · 14 flashcards · 4 min

Topic 45 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 1 section, about 613 words (4 min of reading), with 14 flashcards.

In this note

  1. Malignancies of the hypopharynx.

Malignancies of the hypopharynx.

1. Definition: Hypopharyngeal cancer is a malignant neoplasm arising from the mucosal lining of the hypopharynx (the lower part of the throat). It extends from the level of the hyoid bone superiorly to the lower border of the cricoid cartilage inferiorly. Upper part of ei - cric

2. Etiopathogenesis

  • Tobacco and Alcohol: The primary risk factors, which act synergistically to damage DNA (field cancerization).
  • Plummer-Vinson Syndrome: iron-deficiency anemia, associated with post-cricoid carcinoma in non-smoking females.
  • Dietary Factors: Deficiencies in vitamins A and C.
  • Gastroesophageal Reflux (GERD): Chronic irritation from acid and bile may play a role in mucosal transformation.

Pathogenesis

  • Chronic mucosal irritation → epithelial dysplasia
  • Progression to carcinoma in situ → invasive SCC
  • Early submucosal spread
  • Early lymphatic spread to cervical lymph nodes
  • Advanced local invasion into larynx, esophagus, thyroid

3. Classification

A. According to Site

  • Pyriform Sinuses (65–85%): The recesses on either side of the larynx.- early nodal, often neck swelling
  • Posterior Pharyngeal Wall (10–20%): The back wall of the throat., often asym until large
  • Post-cricoid Region (5–15%): The area behind the cricoid cartilage, leading into the esophagus.. ass with iron def, most in female, dysphagia

B. Histological Classification

  • Squamous cell carcinoma (≈95%)
  • Verrucous carcinoma (rare)
  • Adenocarcinoma (very rare)

TNM Staging

  • T1: Tumor limited to one subsite and 2 cm.
  • T2: Invades more than one subsite or measures 2–4 cm without vocal cord fixation.
  • T3: Measures > 4 cm or causes vocal cord fixation.
  • T4: Invades thyroid/cricoid cartilage, carotid artery, or prevertebral fascia.
  • N (Nodes): High propensity for early nodal spread; 70% of patients have palpable neck nodes at presentation.

4. Clinical Picture - Symptoms are often insidious and "vague" in the early stages:

  • Odynophagia/Dysphagia: late symptom, Pain or difficulty swallowing, often starting with solids.
  • Referred Otalgia: Early symptom, ear pain is a classic "red flag" for pyriform sinus tumors.
  • Neck Mass: Often the only initial symptom.
  • Hoarseness: Indicates the tumor has spread to the larynx or involved the recurrent laryngeal nerve.
  • "Laryngeal Crepitus" Loss: On palpation, the normal "grating" sensation of the larynx moving against the spine is lost if a tumor occupies the post-cricoid space.
  • Signs:
  • Ulceroproliferative growth in pyriform sinus
  • Pooling of saliva
  • Fixation of larynx
  • Cervical lymphadenopathy (levels II–IV)

5. Paraclinical and Radiological Examinations

  • Flexible Laryngoscopy: The first step to visualize the tumor and check vocal cord mobility.

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