Tumours of Hypopharynx

DR.SHAFIULLAH
OTORHINOLARYNGOLOGY
AND HEAD AND NECK
SURGERY
DEPARTMENT
KUWAIT TEACHING HOSPITAL
 Surgical Anatomy
• The hypopharynx represents the lower
most part of the pharynx. It lies below and
posterior to the base of tongue, behind
and on each side of the larynx.
• It extends from the level of hyoid bone
superiorly down to the lower border of the
cricoid cartilage inferiorly and is divided
into three distinct sites.
 Sub-sites of Hypopharynx
1. Posterior pharyngeal wall:
Extends from superior level of the hyoid bone to the
level of the inferior border of the cricoid cartilage and
from the apex of one piriform sinus to the other.
2. Piriform sinus:
Extends from the pharyngoepiglottic fold to the upper
end of Oesophagous.
Bounded laterally by the thyroid cartilage and medially
by the hypopharyngeal surface of the aryepiglottic fold
and the arytenoid and cricoid cartilages.
3. Post cricoid space:
Extends from the level of the arytenoid
cartilage and connecting fold to the
inferior border of the cricoid cartilage.
 Tumour Types
A. Benign tumours:
Papilloma, adenoma, lipoma, fibroma,
and leiomyoma
Malignant tumours:
Squamous cell carcinoma,
leiomyosarcoma
 Risk factor for the development
of the hypopharyngeal tumour
• Alcohol
• Tobacco
• Iron deficiency
• Radiation
 TNM Classification
• T Primary tumour
• Tx Primary tumour cannot be assessed
• T0 No Evidence of primary tumour
• Tis Carcinoma in situ
Hypopharynx:
• T1 Tumour limited to one sub site of hypopharynx and 2 cm
or less in greatest dimensions.
• T2 Tumour invades more than one sub site of hypopharynx or
adjacent sites, or measured more than 2 cm but not more than 4 cm
in greatest dimension, without fixation of hemilarynx.
• T3 Tumour measured more than 4 cm in greatest dimension, or
with fixation of hemilarynx.
• T4 Tumour invades adjacent structures i.e thyroid/cricoid
cartilage, carotid artery, soft tissue of neck, pre-vertebral
fascia/muscle, thyroid or oesophagous.
 Prognostic factors in
hypopharyngeal squamous cell
carcinoma
• Tumour size (less or more than 5 cm).
• Tumour site
• Vocal cord paralysis
• Presence or absence of lymph node metastasis
• Size and number of lymph node involvement.
• Presence or absence of distant metastasis
• Presence of perineural spread.
Carcinoma of the piriform sinus
• Constitute 60% of hypopharyngeal cancer
• Male above 40 year are most commonly
affected.
• Growth is either exophytic or ulcerative
and deeply infiltrative.
• Growth of the piriform sinus remain
asymptomatic for a long time due to the
large size of the piriform sinus.
Piriform sinus tumour
 Spread

• Local spread:
The growth spread upward to the vallecula
base of tongue, downward to the post
cricoid region, medially to the aryepiglottic
fold in ventricle, it infiltrate into thyroid
cartilage, thyroid gland, or may present as
soft tissue mass in the neck.
• Lymphatic spread:
Piriform fossa has a rich lymphatic
network with 2/3rd of the patient have
cervical nodal metastasis when 1st seen.
• Distant metastasis:
Lungs , liver and bone.
 Clinical features
1. Sticking in the throat and pricking sensation on
swallowing may be the earliest symptom.
2. Referred otalgia
3. Pain on swallowing
4. Increased dysphagia
5. Hoarseness
6. Neck mass
7. Weight loss
 Carcinoma of the Postcricoid
Region
• It constitute about 30% of the
hypopharyngeal malignancies.
• Paterson-Brown-Kelly syndrome is an
important etiological factor in the
development of post-cricoid carcinoma.
 Spread:
• Local spread:
The tumour may invade the cervical
oesophagous, arytenoid, recurrent
laryngeal nerve at cricoarytenoid joint.
• Lymphatic spread:
Paratracheal lymph node.
 Clinical Features
1. Progressive dysphagia
2. Hoarseness
3. Weight loss
 Carcinoma of Posterior
Pharyngeal Wall
• This is least common hypopharyngeal malignancy and
constitute only 10% of them, and mostly seen in male
above 50 year of age.
• Spread:
Growth is usually exophytic or ulcerative and spread to
involve the pre-vertebral fascia, muscles and vertebra.
• Lymphatic spread:
Lymphatic spread is usually bilateral due to mid-line
nature of the lesion and 50% of the patient with posterior
pharyngeal wall cancer have nodal metastasis on their
1st examination.
 Clinical Features
1. Dysphagia
2. Neck mass
 Diagnosis
• All the patient with the throat complaint or
mass in the neck required full head and neck
and general examination.
• Laboratory investigation:
1. Full blood count
2. Iron stores
3. Urea and electrolytes
4. Liver function test
5. Thyroid function test
6. Serum calcium
• Radiological assessment:
1. Barium swallow
2. C.T scan
3. M.R.I
• Endoscopy:
• Biopsy:
Piriform sinus
 Treatment
• Stage-1(T1-N0)
• Piriform sinus=> Primary radiotherapy or
surgery (pp or pppl)
• Posterior pharyngeal wall=> Primary
radiotherapy or surgery (pp)
• Post cricoid=> Primary radiotherapy or
surgery (TLP)
 Treatment
• Stage-II(T2,NO)
• Piriform sinus=> Primary
radiotherapy or surgery (PPPL or TLP)
• Posterior pharyngeal wall=> Primary
radiotherapy or surgery (PP or TLP)
• Post cricoid=> ?Primary radiotherapy
or surgery (TLP) and post operative
radiotherapy
 Treatment
• Stage-III(T1-2,N+:T3,N0:N+)
• Piriform sinus=> Surgery (TLPP or
TLP) and post-operative radiotherapy
• Posterior pharyngeal wall=> Surgery
(PP or TLP) post-operative radiotherapy
• Post cricoid=> Surgery (TLP or TLPO)
and post-operative radiotherapy
 Treatment
• Stage-IV(T4:N0,N+)
• Piriform sinus=> Surgery (TLPP or
TLP) and post-operative radiotherapy
• Posterior pharyngeal wall=> Surgery
(TLP) and post-operative radiotherapy
• Post-cricoid=> Surgery (TLPO) and
post-operative radiotherapy
Follow Up and Rehabilitation