Cancer of the hypopharynx

Hypopharyngeal cancer presents major problems for the patient and the clinician regarding how best to treat both the disabling symptoms and to offer patients the likelihood of cure. The majority of patients present with squamous cell carcinoma at a clinically advanced disease stage, with cervical nodal disease, and frequently have multiple comorbidities. Options for treatment include surgery, radiotherapy, chemoradiotherapy, or a combination. Many surgical options have been described and range from partial pharyngeal surgery with or without partial laryngectomy in localized early disease, to a more radical approach in advanced disease, including total laryngectomy with partial pharyngectomy or extended pharyngolaryngectomy. The physical consequences of a radical surgical approach are a significant alteration or loss of voice and swallowing function. Rehabilitation of the swallowing function is difficult, and, currently, there is no satisfactory pharyngeal replacement when a circumferential hypopharyngeal segment is resected. Complications, such as fistula and stenosis, are common, and patients may require further surgery if they survive.