What do we mean by 'Hypopharyngeal Cancer'? It is a type of Throat Cancer that affects the hypopharynx, which is in the lower part of the neck. If it's not the cancer type you're looking for, please explore the information about other types of Throat Cancers or other types of Head and Neck Cancers.
1. Introduction to Hypopharyngeal Cancer 2. Symptoms, signs and tests of Hypopharyngeal Cancer 3. Treatment for Hypopharyngeal Cancer
Following a diagnosis of Hypopharyngeal Cancer, your cancer care team will discuss the treatment options including the possibility of participating in a clinical trial that is suitable for you. This is a good time to consider if you would like a second opinion. The most suitable treatment of Hypopharyngeal Cancer depends on many things including:
size and location of the cancer
whether the cancer has spread
personal factors (e.g. age, general health and treatment history)
types of treatment available (and whether any clinical trials are available)
your preferences for treatment
There are three treatment options for Hypopharyngeal Cancer:
Surgery — there are a number of operations that can be used to remove Hypopharyngeal Cancer. Some people with large or advanced Hypopharyngeal Cancer may require radiation therapy following surgery
Radiation therapy (with or without surgery) — This is usually given with chemotherapy (called chemoradiation)
Chemotherapy
The following sections will look at each of these treatment options.
There are a number of different types of operations that can be used to remove Hypopharyngeal Cancer. The type of operation used will depend on the size and the location of the cancer.
Your doctor will explain details of the surgery, general risks and side effects of surgery. Ask your doctor if you have questions. They may recommend:
stopping blood thinners (e.g. aspirin) before surgery to reduce the risk of bleeding
special stockings to reduce the risk of blood clots
early mobilisation (i.e. not staying in bed) to reduce the risk of blood clots and chest infection
antibiotics to lower the risk of wound infection.
If you smoke, it is important that you consider stopping smoking before starting treatment to help reduce the risk of infection and help you recover after your treatment.
The different surgical options for Hypopharyngeal Cancer include:
This is a minimally invasive approach to remove early hypopharyngeal cancers.
This is removal of part of the hypopharynx via an open neck approach.
This is the removal of all the larynx and pharynx. It is different to laryngectomy, where only the larynx (or part of it) is removed.
This involves removal of lymph nodes from your neck. This is important even when there is no sign of cancer in the lymph nodes on your scan, because there is a risk of microscopic cancer in the lymph glands of the neck.
This may be considered if a large area of tissue is removed. This may involve taking tissue from another part of the body called a free flap repair. This operation is carried out by a surgeon who specialises in reconstructive surgery, your head and neck surgeon or another surgeon.
A tracheostomy is used to create an opening in the trachea (windpipe) in the lower neck, where a tube is inserted to allow air to flow in and out, when you breathe. This is used as swelling after major head and neck surgery may affect your ability to breathe. The tracheostomy tube is usually removed within a week of surgery once normal breathing is possible.
A gastrostomy tube (called a PEG tube) goes through the skin and the muscles of your abdominal wall into the stomach. Gastrostomy is recommended if feeding is needed for a medium to longer time (months or years).
A nasogastric tube goes through the nose down into the stomach. Nasogastric feeding is used for short time (days or weeks).
The most common radiation therapy approach for Hypopharyngeal Cancer is called external beam radiation. This type of radiation therapy applies radiation from outside the body. Radiation therapy can be used in the following ways:
This is a curative treatment option for people with Hypopharyngeal Cancer. The aim of this treatment is to preserve the larynx and its function. It is an alternative to surgery, which may involve removal of the voice box (laryngectomy). Radiation therapy comprehensively treats the cancer of the hypopharynx, the surrounding region and the lymph nodes at both sides of the neck. Radiation therapy is delivered daily (no treatment on weekends) for 7 weeks and can be given as:
definitive radiation therapy alone; or
definitive radiation therapy with concurrent chemotherapy (adding chemotherapy to radiation therapy (chemoradiation) to make it more effective).
This is when radiation therapy is given after the surgical removal of the Hypopharyngeal Cancer. Adjuvant Radiation Therapy is used as an additional treatment to kill cancer cells that may not have been removed during surgery and may still be present in the hypopharynx and in the lymph nodes at both sides of the neck. It usually starts about 4 weeks after surgery to allow recovery from surgery. Radiation therapy treatment usually lasts for about 6 weeks. Sometimes chemotherapy is added to the adjuvant radiation therapy (chemoradiation) to make it more effective.
Radiation therapy is also used to relieve symptoms of advanced Hypopharyngeal Cancer. Symptoms that may require palliative radiation therapy include pain, bleeding, breathing and swallowing difficulties.
You will meet with many members of the cancer care team, who will help you learn how to look after yourself through radiation therapy, recovery and long term follow-up. They will also talk to you about side effects and how to manage them. It may be helpful to write down questions as they come up, so you can ask anyone in your cancer care team when you see them.
Dental extraction may be needed to remove any broken or infected teeth before radiation therapy. It is important to take out any broken or infected teeth before radiation therapy. Taking out unhealthy teeth after radiation therapy can cause problems with the jaw bone.
Your cancer and its treatment can make it hard to eat and drink. Your doctor will recommend you see a dietitian to maximise your nutrition during treatment as well as while you are recovering. Sometime feeding tubes may be recommended depending on the area being treated and the dose of radiation therapy. There are two common types of feeding tubes:
Gastrostomy tube (sometimes called a PEG tube): this type of tube is inserted through your abdominal wall into your stomach, with part of the tube staying outside the stomach. A syringe can be attached to the tube to give you food this way if needed. The tube is inserted using a camera through the mouth into the stomach (gastroscopy) or using a CT scanner to guide insertion directly through the skin. If a PEG tube is needed, your doctor will organise this before starting your radiation therapy.
Nasogastric tube: this type of tube goes through the nose down into the stomach and is usually used for short periods (days or weeks). A nasogastric tube can be inserted at any time (before, during or after treatment).
The side effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week or just after treatment ends. The side effects start to improve 2-3 weeks after the end of treatment.
the dose of radiation therapy
the area being treated
whether or not chemotherapy is added to the radiation.
tiredness
hoarse voice
skin irritation in the treated area e.g. redness, dryness and itching, weeping skin, scaling or sometimes skin breakdown (sores)
pain on swallowing or difficulty with swallowing
irritation in the throat progressing to sore throat requiring pain killers
dry moth and throat (with advanced stage hypopharyngeal cancer treatment).
Most side effects are short lived and may go away within 4–6 weeks of finishing radiation therapy. Some side effects may last for months after you finish radiation therapy and some may be permanent.
Chemotherapy works by destroying or damaging cancer cells. For Hypopharyngeal Cancer, it is usually given into a vein through a needle with a cannula (tube) attached. There are a number of ways that chemotherapy may be used to treat Hypopharyngeal Cancer including:
Sometimes chemotherapy is added to definitive radiation therapy (chemoradiation). It is usually used for advanced stage hypopharyngeal cancers. This may be given once every 3 weeks or once a week throughout the duration of radiation therapy. The addition of chemotherapy makes the radiation more effective at killing cancer cells but also leads to increased side effects in most patients.
This is when chemotherapy is given after surgery, in combination with radiation therapy (chemoradiation). This may be given once every 3 weeks or once a week or every day that radiation therapy is given. The addition of chemotherapy makes the radiation more effective at killing cancer cells but also leads to increased side effects in most patients.
This is when chemotherapy is given before surgery or radiation therapy to help shrink large cancers and make them easier to remove during surgery or target with radiation therapy.
This is used when the cancer is incurable. The cancer may be too large or has spread too much to be removed by surgery. Palliative chemotherapy helps to slow the growth of cancer and reduce symptoms. It is important to remember that palliative chemotherapy is not as intense as other types and is much less likely to have significant side effects.
Before you start treatment, your medical oncologist will choose one or more chemotherapy medications that will be best to treat the type of cancer you have. The chemotherapy medications your doctor chooses may depend on:
a feeling of wanting to vomit (nausea) or vomiting
more side effects of radiation, if you have chemotherapy at the same time as radiation
Most of these side effects are short lived and may go away once you finish chemotherapy. Some side effects can take months or years to improve or may be permanent.
loss of feeling in the fingers and toes
kidney damage (caused by some medications)
hearing loss/thinning
ringing in the ears
rash
higher risk of infection (if the chemotherapy reduces the number of white cells in the blood)
1. Introduction to Hypopharyngeal Cancer
2. Symptoms, signs and tests of Hypopharyngeal Cancer
3. Treatment for Hypopharyngeal Cancer
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