Cancer in the Tissues at the Bottom Part of the Throat Behind the Voice Box

Hypopharyngeal cancer is a type of head and neck cancer that occurs when cancerous cells develop in the tissues of the hypopharynx, which is the bottom part of your throat (pharynx) at the entrance into the esophagus (the tube that connects the throat to the stomach). The cancer is called squamous cell carcinoma and usually originates from the surface of the lining of the throat.

The major risk factors for hypopharyngeal cancer include:

• Smoking or chewing tobacco
• Heavy alcohol use
• Rare genetic syndromes
• Nutritional deficiencies (vitamins B6 and B12)

More than 3,000 new cases of hypopharyngeal cancer occur every year. Symptoms tend to develop gradually and, therefore, most hypopharyngeal cancers are detected at an advanced stage.

Because hypopharyngeal cancer is relatively rare, guidelines do not recommend screening. However, you should visit your primary provider at least once a year for a well visit and see a doctor immediately if you have any concerns about your overall health. 

You can also take steps to lower your risk of developing hypopharyngeal cancer:

• Avoid tobacco products
• Limit alcohol consumption
• Eat a well-balanced diet rich in fruits and vegetables

Symptoms, Diagnosis & Outlook

Hypopharyngeal cancer symptoms can appear as hoarseness or other voice changes that do not go away within two weeks. This is often an early symptom. Other symptoms include:

• Airway obstruction, difficulty or noisy breathing
• An enlarged lymph node or lump in your neck
• Chronic bad breath
• Difficulty swallowing that does not go away
• Ear pain
• Persistent sore throat or a feeling that something is caught in your throat
• Fatigue
• Unexplained weight loss

Hypopharyngeal cancer can be diagnosed during a physical exam. If you experience any symptoms or are concerned about your health, schedule an appointment with your primary care provider. Your provider will conduct a complete physical exam and assess you for voice changes, breathing/swallowing difficulties and swollen neck lymph nodes. After your exam, your provider may refer you to a head and neck specialist, called an otolaryngologist.

At your appointment with the otolaryngologist, you will answer in-depth questions about your personal and family medical history and describe the severity of your symptoms, including how long you have been experiencing them. Your doctor may also perform a flexible endoscopic exam during your visit, under local anesthesia, to examine the upper airway and digestive tract.

In case of suspicious findings, your doctor may perform a biopsy, in which a small tissue sample is taken to evaluate for the presence and the extent of cancer, if confirmed. In some cases, biopsies can be performed in the office, but your specialist may want a more thorough evaluation by performing a biopsy in the operating room under general anesthesia.

Your doctor may also order imaging studies to assess for the presence and extent of hypopharyngeal cancer and whether it has spread to the lymph nodes or other organs. Imaging studies include:

• Computed tomography (CT or CAT) scan: takes detailed images of internal organs, bones, soft tissue and blood vessels. Your physician is able to use the cross-sectional images to confirm the presence, size and location of a tumor. 
• Magnetic resonance imaging (MRI) scan: provides the highest resolution of soft tissues, and less of the bony structures.
• Positron emission tomography (PET) scan: generally used in advanced-stage cancers to determine if cancer has spread to other organs. PET scans are sometimes combined with CT scans to provide a more precise and accurate location of the cancer.

A cancer’s stage is used to determine prognosis and treatment options. Stages describe the severity of cancer and help your doctor determine the best treatment plan for you. An early stage, such as stage 1, indicates a smaller cancer confined to one area. The advanced stage 4 indicates a severe cancer, such as a large tumor or cancer that has spread to the head, neck or other areas of the body.

In general, patients with an early stage of hypopharyngeal cancer have a more favorable prognosis compared to patients with advanced stage of disease.

Your Penn State Cancer Institute doctor will discuss the best way to treat your cancer, depending on its type and stage. Our multidisciplinary team of surgeons, radiation and medical oncologists, and pathologists reviews all treatment options before making a recommendation.

Treatment approaches for hypopharyngeal cancers include surgery, radiation therapy and chemotherapy in various combinations. Your surgeon and oncological team may recommend:

• Endoscopic surgery: performed through the mouth for small primary cancers. In many cases these surgery are robot assisted.
• Surgery with an open approach: this approach is indicated for more advanced cancers that cannot be removed with an endoscopic approach. Your surgeon may also remove lymph nodes from your neck with the hypopharyngeal cancer for therapeutic and staging purposes.
• Radiation therapy: uses high-energy X-rays or other types of radiation to kill cancer cells. Your doctor may recommend radiation, with or without chemotherapy, depending upon the extent of the cancer, as the primary treatment or as an addition to surgery.
• Chemotherapy: uses drugs to kill cancer cells and stop them from growing.
• Targeted therapy drugs: to attack specific cancer cells. This causes less harm to normal cells than radiation and chemotherapy.
• Epidermal growth factor receptor (EGFR) inhibitors: to slow down or stop cell growth.

Side effects of hypopharyngeal cancer treatment can include:

• Difficulty breathing
• Infection
• Bleeding
• Pain
• Swallowing problems
• Change in speech and articulation

Chemotherapy side effects depend upon the type of drugs used.

Our Experts in Care

The team of head and neck cancer experts at Penn State Health includes specially trained physicians, surgeons, physician assistants, nurses and specialists in related fields who work together to offer advanced care for a wide range of head and neck cancers.

Why Choose Penn State Health for Care

Comprehensive, Compassionate Care

Penn State Health provides specialized testing, treatment and management for hypopharyngeal cancers. Our medical team is consistently recognized nationally through Best Doctors in America and America’s Top Doctors awards. Our specialists also participate in worldwide conferences and speaking engagements in countries including India, Korea, Germany, Japan and others.

Leading-Edge Clinical Trials

The cancer experts at Penn State Health Milton S. Hershey Medical Center and Penn State Cancer Institute are committed to offering their patients the latest treatment options, including access to leading-edge clinical trials. Our superb clinical research team includes dedicated research nurses, clinical trial coordinators and data analysts and gives patients the opportunity to participate in the latest clinical trials. Learn more about new Penn State Health clinical trials at StudyFinder.

Support Groups

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