causes, clinical features, staging and treatment options of tumors of the hypopharynx

1. Tumors of the hypopharynx
By
Lt Col Saeed Ullah, MBBS, FCPS
Classified ENT, Head and Neck Surgeon

2. Anatomy

3. Anatomy
• Pyriform sinus
• Post cricoid region
• Posterior pharyngeal wall

5. Aetiology
• Smoking tobacco.
• Chewing tobacco.
• Heavy alcohol use.
• Eating a diet without enough nutrients.
• Having Plummer-Vinson syndrome.
• There is a significant association with alcohol
and smoking, acting synergistically

6. Aetiology
• Role of genetic factors- association between
tobacco use and p53 mutations is found in a
much larger percentage of smokers and
drinkers
• The loss of heterozygosity at 9p and
abnormalities in chromosome 11 present.
• Mutations in the p21 gene have also been
identified.

7. Aetiology
• The role of human papilloma virus (HPV) as a
contributing factor to carcinogenesis in head
and neck squamous cell carcinomas.
• Occupational exposures mainly asbestos and
welding fumes.

8. Benign tumors
a) Papilloma
b) Adenoma
c) Lipoma
d) Fibroma
e) leiomyoma

9. Malignant tumors
Most of the tumours are squamous cell type
with various grades of differentiation
a) Pyriform sinus (60%)
b) Post cricoid region (30%)
c) Posterior pharyngeal wall (10%)

10. Carcinoma pyriform sinus
• Mostly affects male above 40 years of age
• Growth is either Exophytic, ulcerative and
deeply infiltrative
• Because of large size of pyriform sinus growth
of this region remain asymptomatic for long
time
• Metastatic neck nodes is the most common
presenting symptom

13. Spread
• Upwards: vallecula and base of tongue
• Downwards: post cricoid region
• Medially: AE fold and ventricle
• Laterally: thyroid cartilage, thyroid gland and may
present as soft tissue mass in neck
Lymphatic spread: upper and middle group of
jugular cervical nodes
Distant metastasis: occur late and may be seen in
lung, liver, bone

15. Clinical features
• Metastatic neck nodes may be the first sign
• Sticking/pricking sensation in throat
• Referred otalgia
• Odynophagia
• Dysphagia
• Hoarseness of voice
• Stridor

16. Diagnosis
• Indirect laryngoscopy
• Barium swallow
• Flexible nasopharyngoscopy
• CT scan: helpful to evaluate the extent of
growth and status of nodes
• Direct laryngoscopy and biopsy

17. Barium swallow

18. CT scan

19. Endoscopy

20. Treatment
• Early growth without nodes
– radiotherapy (preserves voice)
• Growth limited to pyriform fossa
– total laryngectomy and partial
pharyngectomy and pharyngeal
reconstruction often combined with neck
dissection

21. Treatment
• Growth extending to post cricoid region
– total laryngopharyngectomy with neck
dissection. Pharyngo-oesophageal segment
is reconstructed with myocutaneous flap or
gastric pull up
• Post operative radiotherapy

22. Carcinoma post cricoid region
• Constitutes 30% of hypopharyngeal tumours
• Plummer-Vinson syndrome is an important
etiological factor (seen in 1/3rd of patients)

23. Clinical features
• Females are usually affected in the age group
of 20-40
• Progressive dysphagia (predominant
presenting symptom)
• Voice change
• Weight loss

24. • Spread: local spread to cervical oesophagus,
arytenoids, RLN and cricoarytenoid joint
• Lymphatic spread to paratracheal nodes, may
be bilateral due to midline nature of lesion

25. Diagnosis
• laryngeal crepitus will be lost
• Indirect laryngoscopy
• lateral soft tissue neck x-ray
• Barium swallow
• CT scan
• Direct laryngoscopy and biopsy

26. Treatment
• Prognosis is poor with irradiation and surgical
treatment
• Radiotherapy: preserves laryngeal function
• Surgical: laryngo-pharyngo-oesophagectomy
with gastric pull up or colon transposition for
reconstruction

27. Carcinoma post pharyngeal wall
• Least common hypopharyngeal malignancy
• Mostly seen in males above 50 years of age

28. Clinical features
• Dysphagia
• Metastatic neck node

29. • Spread: prevertebral fascia, muscles and
vertebrae
• Lymphatic: usually bilateral, retropharyngeal
and deep cervical nodes involved

30. Diagnosis
• Indirect laryngoscopy
• lateral soft tissue neck x-ray
• CT scan
• Direct laryngoscopy and biopsy

31. Treatment
• Early lesions  radiotherapy
early small lesions surgery by
lateral pharyngotomy approach
advanced lesions
laryngopharyngectomy with block dissection

33. Questions

34. Thank you