Surgical Procedures: Surgery and Staging for Hypopharyngeal Cancer

What is the hypopharynx?

The hypopharynx is the lower part of your throat (pharynx). It lies behind your larynx (voice box) and leads into your esophagus (tube that connects your throat and your stomach). As what you swallow passes down your throat, your hypopharynx helps make sure it goes into your stomach and not into the larynx and lungs.

What is hypopharyngeal cancer?

When there are cancer cells in your hypopharynx, it is called hypopharyngeal cancer. Most hypopharyngeal cancers start in the thin cells (squamous cells) that line the inside of your hypopharynx. The most common type of hypopharyngeal cancer is squamous cell carcinoma. Less common types are:

• Basaloid squamoid carcinomas.
• Small-cell carcinomas.
• Spindle-cell carcinomas.
• Nasopharyngeal-type undifferentiated carcinomas (i.e., lymphoepitheliomas).
• Carcinomas of the minor salivary glands.

What is staging and how is it done?

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For hypopharyngeal cancers, these tests may include:

Physical Exam: This is a general exam to look at your body and to talk about past health issues.

Imaging: Radiology tests can look inside your body to look at the cancer and figure out if it has spread. These tests can include:

• X-ray.
• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).
• Bone scan.
• Barium swallow.

Procedures: These may include:

• Endoscopy: An endoscope, or a lighted tube, is used to look for any abnormal areas. If needed, the endoscope can obtain tissue for a biopsy.

Hypopharyngeal cancer can spread to other parts of the body through the tissue, lymph, and blood systems. The cancer stage describes how extensive the cancer is, how far it has spread, and helps guide what treatment should be used. Hypopharyngeal cancer is described as stages 0 through stage IV (four).

Surgical Procedures Used for Hypopharyngeal Cancer

Surgery is a common treatment for hypopharyngeal cancer. The goal of surgery is to remove as much of the cancer as possible while sparing healthy tissue or organs near the tumor. There are a few surgeries that may be used to treat cancer of the hypopharynx:

• Laryngectomy: Some or all of the larynx is removed.
• Pharyngectomy: Some or all of the pharynx is removed.
• Laryngopharyngectomy: The surgeon removes part or all of the pharynx and the larynx.
• Vocal Cord Stripping: The top layers of tissue on the vocal cords are stripped away using a long surgical instrument. This is used to biopsy or treat stage 0 cancer. After recovery, you usually can still speak normally.
• Cordectomy: Either part or all of your vocal cords are removed. How much this affects your ability to talk depends on how much of the vocal cord is removed. If only part of the vocal cord is removed, you may have hoarseness. If both cords are removed, you will not be able to speak normally.
• Laser Surgery: An endoscope is placed into your mouth and down into your throat to find the tumor. The tumor is then vaporized or cut out (excised) the tumor using the laser on the tip of the endoscope. If used to remove part of the vocal cord, it can cause a hoarse voice.
• Lymph Node Dissection: One or a few lymph nodes, nerves, and/or muscle is removed. Your surgeon will decide what needs to be removed based on the size and location of the tumor and if the nodes were larger than normal on imaging tests.

In some cases, chemotherapy and/or radiation therapy are given after surgery to kill any cancer that may be left. This is called adjuvant therapy.

What are the risks of surgery to treat hypopharyngeal cancer?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure).
• Bleeding.
• Blood clots.
• Infection.
• A change in how you look.
• Having a hard time speaking or swallowing.
• You may need a tracheostomy (tube/hole that lets you breathe through the neck). This can be temporary (short-term) or permanent (long-term).

Before surgery, your provider will talk to you about any other risks based on your health and the surgery you are having.

What is recovery like?

Recovery from surgery hypopharyngeal cancer depends on the procedure you have had. You may have to stay in the hospital. You may have a tracheostomy and/or feeding tube.

You will be told how to care for your surgical incisions (cuts) and will be given any other instructions before leaving the hospital. Instructions will include details about if you need to change your diet, feeding tube care, tracheostomy care, as well as the need for rehabilitative and/or speech therapy.

Your medical team will talk with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention, and/or other conditions.

Your provider will talk to you about any changes to activity level and nutritional needs you may have, depending on the surgery you had.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.