This document provides an overview of hypopharyngeal carcinoma, including its anatomy, epidemiology, etiology, presentation, investigations, treatment options, and complications. Hypopharyngeal carcinoma most commonly arises in the piriform fossa and affects males over age 60, with risk factors including alcohol, smoking, and irradiation. Presenting symptoms include dysphagia, sore throat, and neck mass. Treatment depends on staging and may include surgical excision, chemoradiotherapy, or radiotherapy alone. Complications can include bleeding, tracheal damage, leakage, and swallowing difficulties.

1. HYPOPHARYNGEAL CARCINOMA
Dr. Tabeer Arif

2. LAYOUT
• Anatomy of hypopharynx
• Epidemiology
• etiology
• Presentation
• Investigations
• Treatment options
• complications

3. ANATOMY OF HYPOPHARYNX
• From epiglottis to cricoid cartilage
• 3 parts
1. Pyriform fossae
2. Posterior pharyngeal wall
3. Postcricoid area

5. • Arterial supply: sup. Thyroid, Ascending Pharyngeal and Lingual artery
• Nerve supply: Pharyngeal plexus
• Lymphatic drainage: level II, III, IV. Level Ib and level V less frequently.
Retropharyngeal nodes from PPW
Paratracheal nodes

6. • Mucosa: St. Squamous
• Fibrous layer
• Muscular layer: Middle and Inferior Constrictor
• Buccopharyngeal Fascia

7. EPIDEMIOLOGY
• Incidence 1/100000 in western world
• Piriform fossa (66-75%)
• Post pharyngeal wall (20-25%)
• Postcricoid (>10 %)
• Age of presentation 60 yr
• 5-20:1 male predominance
• Post cricoid lesion; 1.5:1 female predominance

8. ETIOLOGY
• Alcohol
• smoking
• Irradiation
• Sideropenic dysphagia
• Plummer-vinson syndrome

9. PATHOLOGY
Gross appearance
• Ulcerative lesions with Submucosal extensions
histopathology
• Squamous cell carcinoma (90%)
• Minor salivary gland tumors, Lymphomas and Sarcomas

10. PRESENTATION
• Dysphagia
• Sore throat
• Otalgia
• Hoarseness of voice
• Dyspnea
• Neck mass
• Weight loss

11. EXAMINATION
• Full head and neck examination
• Laryngeal crepitus
• Cervical lymph nodes
• IDL
• Direct laryngoscopy
• Ulcerative lesion
• Pooling of saliva
• Swollen arytenoids
• Tumor in hypopharynx

12. INVESTIGATIONS
• CBC
• Iron levels
• RFT’s
• LFT’s
• S/Ca
• TFT’s

13. • CXR
• USG abdomen
• Barium swallow
• CT scan
• Endoscopy
• Biopsy
• MRI
• PET scan

17. STAGING

22. TREATMENT OPTIONS

23. • Early hypopharyngeal tumor:
• Surgical Excision +/- neck dissection (endoscopic CO2 or Open)
• Conservation surgery +/- B/L selective neck dissection +/- post-op radiotherapy +/- chemotherapy
• Concurrent chemoradiotherapy to primary site and B/L neck dissection
• Radiotherapy alone (in case of significant comorbidity)

24. • Locally advanced hypopharyngeal carcinoma
• Concurrent chemo +/- Radiotherapy to primary site and neck
• Radical surgery; pharyngolaryngectomy +/- reconstruction +/- B/L selective or modified neck dissection , with post-op chemoradiotherapy

25. • Partial Pharyngectomy +/- partial Laryngectomy; PPW, small tumor of pyriform sinus not involving apex with vocal cords mobile
• Partial Pharyngectomy and total Laryngectomy; involvement of apex, mucosa of postcricoid region, thyroid cartilage invasion, paralyzed
hemilarynx
• Total Pharyngectomy; tumor involves postcricoid or upper esophagus
• Repair of the defect primarily or with flap

26. • No neck nodes palpable: selective neck dissection level II, III, IV
• Palpable cervical lymph nodes: modified Radical neck dissection

27. • Hemithyroidectomy: early disease confined to one side
• Total thyroidectomy: subglottic extension of more than 2 cm, cricoid cartilage involvement, perithyroidal soft tissue involvement
• Parathyroid reimplantation

28. • Internal excision; Transoral Partial Hypopharyngectomy
• Pyriform fossa: tumor limited to one half, not involving apex
• Postcricoid: limited to one half, only involving arytenoid
• Complications:
pharyngocutaneous fistula
post-op bleeding
surgical emphysema
swallowing difficulty (including aspiration)
dyspnea (due to edema or stenosis)

29. • Supportive treatment
• Tracheostomy
• Gastrostomy

30. COMPLICATIONS
• Bleeding
• Tracheal damage
• Tension at anastomosis
• Leakage
• Mucositis
• Swallowing difficulties

31. • post op care
• Follow up
• PET scan at 12 weeks
• Salvage :
surgery after initial radiotherapy/chemoradiotherapy
radiotherapy after initial primary surgical resection

32. Thank You.