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• National Comprehensive Cancer Network Guidelines Cancer of the Hypopharynx Version 2.2013

• Quon, H; Meyers, A; Hypopharyngeal Cancer, emedicine.medscape, Maio 2013 • Wai Chan, J; Wei, W; Current management strategy of hypopharyngeal carcinoma, Auris

Nasus Larynx, 2013 • Uppaluri, R; Sunwoo, J; Neoplasms of the Hypopharynx and Cervical Esophagus,

Cummings Otolaryngology Head and Neck Surgery, 5th edition, 2010 • Chepeha, D; Reconstruction of the Hypopharynx and Esophagus, Cummings

Otolaryngology Head and Neck Surgery, 5th edition, 2011 • Mendenhall WM, Werning JW, Pfister DG: Treatment of head and neck cancer. In: DeVita

VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 729-80

• Uzcudun AE, Bravo Fernández P, Sánchez JJ, et al.: Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients. J Laryngol Otol 115 (2): 112-8, 2001

• Thabet HM, Sessions DG, Gado MH, et al.: Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx. Laryngoscope 106 (5 Pt 1): 589-94, 1996

• Pharynx. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 41-56 In our sample, as described in the literature, we found that inexpressive symptoms and the aggressive behavior of hypopharyngeal cancer may

contribute to a delay in diagnosis. The calculated survival rate is identical to the literature.

78,8%

61,0%

50,6%

29,9%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

100,0%

0 1 2 3 4 5

54,8%

32,4% 27,4%

16,4%

69,2%

39,6%

24,7%

16,5%

88,9%

76,9%

64,9%

40,9%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

100,0%

0 1 2 3 4 5

Neoplasms of the head and neck are the 6th most common type of cancer worldwide . Within this group the tumors of the hypopharynx account for only 7 % of cases. Hypopharyngeal cancers are often named for their location, including pyriform sinus (65-85%), posterior pharyngeal wall (10-20%), or postcricoid pharynx (5-15%). Smoking habits and alcohol consumption are the major risk factors. Hypopharyngeal tumors have an aggressive behavior due to their rapid invasion and distance spread, usually associated with indolent symptoms, which contribute to late diagnosis , with important implications for prognosis. Given this reality, the authors have reviewed the clinical records of patients with hypopharyngeal tumors diagnosed in IPOLFG between 2004 and 2008.

Hypopharyngeal carcinoma:

a 5-year review of 329 cases

Mafalda T. Soares, MD; Ricardo Santos, MD; Pedro Henriques, MD, Ana Hebe, MD ;Luís Oliveira, MD;

Pedro Montalvão, MD; Miguel Magalhães, MD

Department of ENT- Head and Neck surgery

Instituto Português de Oncologia de Lisboa Francisco Gentil

Mafalda Trindade Soares Email: mafaldamctsoares@gmail.com

ABSTRACT

OUTCOME OBJECTIVES

RESULTS/DISCUSSION

Chart 1. Sex

METHODS AND MATERIALS

CONCLUSION

• Between 2004 and 2008, 329 cases of hypopharyngeal cancer were diagnosed in our department. • Males constitute 96.7% of cases. (chart 1.)

• The most vulnerable age group was the age range between the 5th and the 7th decades. The mean age was 59 years. (chart 2.)

• Retrospective analysis of clinical records of patients diagnosed with hypopharyngeal cancer between 2004 and 2008.

• The authors analyzed variables of sex, age, location, initial symptom, staging, therapeutic approach, histological characterization, recurrence and survival rate, comparing between chemotherapy and surgery.

1. Analyze the incidence, risk factors, clinical manifestations and treatment related-outcomes of patients with hypopharyngeal cancer diagnosed in an Oncology Referral Center (Instituto Português de Oncologia de Lisboa, Francisco Gentil – IPOLFG) 2. Recognize the importance of an early diagnosis in hypopharyngeal cancer

n=329

11

0

20

40

60

80

100

120

140

Nº patients

30%

23% 13%

12%

6%

2%

2% 12%

odynophagia

cervical mass

dysphonia

dysphagia

foreign body sensation

dyspnea

otalgia

unknown

INTRODUCTION

The outcome objectives of this study were to analyze the incidence, risk factors, clinical manifestations and treatment related-outcomes of patients with hypopharyngeal cancer diagnosed in an Oncology Referral Center and also recognize the importance of an early diagnosis in hypopharyngeal cancer. Methods: Retrospective analysis of clinical records of patients diagnosed with hypopharyngeal cancer between 2004 and 2008. Results: 329 cases of hypopharyngeal cancer were diagnosed in our department. Males constitute 96.7% of cases. The most vulnerable age group was the age range between the 5th and the 7th decades. The mean age was 59 years. Odynophagia was the main symptom referred as first manifestation. Risk factors such as alcohol consumption and smoking habits were present in most patients. Invasive squamous cell carcinoma moderately differentiated was the most common histopathological type. As for location, pyriform sinus tumors are the most prevalent. Regarding the stage and according to the TNM classification, 76,5% of tumors were classified as T3 or T4a/b. Almost 80% of patients presented with cervical lymphadenopathy at the time of diagnosis. 145 patients underwent surgical treatment, many of whom with complementary radiotherapy and chemotherapy. The overall survival rate at 5 years. Conclusion: In our sample, as described in the literature, we found that inexpressive symptoms and the aggressive behavior of hypopharyngeal cancer may contribute to a delay in diagnosis. The calculated survival rate is identical to the literature.

318

Pyriform sinus (65-85%)

Posterior pharyngeal wall (10-20%)

Postcricoid pharynx (5-15%)

Figure 1. Location of hypopharyngeal tumors .

30-39y 40-49Yy 50-59Yy 60-69y 70-79y 80-89y >90y

n=329 Chart 2. Age

• Odynophagia was the main symptom referred as first manifestation. (chart.3)

Chart 3. Symptoms n=329

• 145 patients underwent surgical treatment, many of whom with complementary radiotherapy and chemotherapy. • The overall survival rate at 5 years was 27.1%. (chart 4.) Patients treated with surgery had a better survival rate. (charts 5&6)

Tis Tumor in situ

T1 T<2cm and/or limited to 1 subsite

T2 T 2-4 cm or extension > 1 subsite

T3 T >4 cm or hemilarynx fixation or esophagus extension

T4a) Moderately advanced local disease (invades thyroid cartilage, gland)

T4b) Very advanced local disease (invades carotid artery, mediastinal structures)

N0 No regional lymph node metastasis

N1 Metastasis in a single ipsilateral lymph node, ≤ 3cm

N2a) Metastasis in a single ipsilateral lymph node, <6cm

N2b) Metastasis in a multiple ipsilateral lymph nodes, <6cm

N2c) Metastasis in a bilateral or contralateral lymph nodes, <6cm

N3 Metastasis in a lymph node>6 cm

M0 No distant metastasis

M1 Distant metastasis

• Regarding the stage and according to the TNM classification, 76,5% of tumors were classified as T3 or T4a/b. (fig.2)

• Almost 80% of patients presented with cervical lymphadenopathy at the time of diagnosis. (fig.2)

• 92% of patients were diagnosed in stages III or IV

1

16

60

143

96

12

n=328

76,5% 43

27

80

64

49

65

n=328

75,6%

19,8%

316

12

3.7% n=328

47,0%

27,0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

6meses

1 2 3 4 5 6 7 8 9 Time (years)

Survival rate

• Risk factors such as alcohol consumption and smoking habits were present in most patients. • Invasive squamous cell carcinoma moderately differentiated was the most common histopathological type. • As for location, pyriform sinus tumors are the most prevalent with 85%.

Survival rate

Time (years)

Surgery

CTx/RT

STAGE III Survival rate

Time (years)

Surgery

CTx/RT

STAGE IVa

n=81 n=142 n=329

Chart 4. Global survival rate Chart 5. & 6. Survival rate, stage III and IVa, chemotherapy/radiotherapy vs surgery

REFERENCES

Figure 2. TNM classidication.