Hypopharyngeal cancer: the decisions you may face
7 treatment settings, 5 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Diagnosis and staging
Panendoscopy with biopsy, CT of the neck and chest, PET-CT for stage III to IV, and assessment of swallowing and nutrition before treatment.
PET and CT in one machine, so hot spots on the PET are pinned to exact locations on the CT.
- Anatomy plus biology
- Standard for lymphoma, lung, melanoma, head and neck staging
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- CT radiation added to PET dose
- Is PET/CT the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?Why: A single standard does not mean a single choice; timing and trials are decisions too.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (diagnosis and staging), which of the standard options do you recommend and why?Why: Guideline options include: Panendoscopy with biopsy, CT of the neck and chest, PET-CT for stage III to IV, and assessment of swallowing and nutrition before treatment.
Add these to your appointment list, or take the full question set for this cancer.
Early disease (T1 to T2, node-negative)
Radiotherapy alone, or transoral or open partial pharyngectomy in selected small tumours, with treatment of both sides of the neck.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
Transoral robotic surgery removes early (T1 to T2) throat tumours through the mouth with a robot and 3D endoscope, avoiding splitting the jaw or a tracheostomy. In HPV-positive oropharyngeal cancer the pathology then guides how much radiation to add, but randomised trials found it no better than radiation for swallowing, and surgeon volume matters.
- Avoids mandibulotomy and tracheostomy
- Pathology-based selection of adjuvant therapy
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Low-dose bath to normal tissue
- Motion management
- Bleeding risk, swallowing morbidity
- Not superior to radiation in randomised comparison for function
- Between IMRT / IGRT (modern external beam) and Transoral robotic surgery (TORS), which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (early disease (t1 to t2, node-negative)), which of the standard options do you recommend and why?Why: Guideline options include: Radiotherapy alone, or transoral or open partial pharyngectomy in selected small tumours, with treatment of both sides of the neck.
Add these to your appointment list, or take the full question set for this cancer.
Locally advanced, larynx preservable
Concurrent cisplatin chemoradiation to 70 Gy; induction cisplatin-fluorouracil (EORTC 24891) or docetaxel-cisplatin-fluorouracil followed by radiotherapy in some centres.
Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.
The 1957 chemotherapy that remains the backbone of treatment for bowel, stomach, pancreatic, anal, head and neck and breast cancers, and as a cream for skin precancers.
The first chemotherapy to extend life in prostate cancer (2004), now part of triplet therapy at first metastatic diagnosis.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
- Advanced larynx cancer suitable for larynx preservation: concurrent cisplatin chemoradiation versus induction chemotherapy then radiotherapy versus radiotherapy alone
Larynx preservation at 2 years 88% (concurrent) vs 75% (induction) vs 70% (radiotherapy alone).
Laryngectomy-free survival driver: larynx preservation at 2 years (%): Concurrent cisplatin chemoradiation 88 (n=172) vs Induction chemotherapy then radiotherapy 75 (n=173) vs Radiotherapy alone 70 (n=173)
- Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
- Capecitabine: take within 30 minutes after a meal. DPD deficiency (DPYD variants) causes severe toxicity: pre-treatment genotyping is recommended in Europe.
- Capecitabine: reduce to 75% for CrCl 30-50; contraindicated below 30.
- Do not give if bilirubin above ULN, or AST/ALT above 1.5 x ULN with alkaline phosphatase above 2.5 x ULN (treatment-related deaths).
- Low-dose bath to normal tissue
- Motion management
- Between Cisplatin, Fluorouracil (5-FU), Docetaxel and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in RTOG 91-11, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (locally advanced, larynx preservable), which of the standard options do you recommend and why?Why: Guideline options include: Concurrent cisplatin chemoradiation to 70 Gy; induction cisplatin-fluorouracil (EORTC 24891) or docetaxel-cisplatin-fluorouracil followed by radiotherapy in some centres.
- Am I a candidate for Cisplatin, Fluorouracil (5-FU), Docetaxel, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of RTOG 91-11 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Cannot have cisplatin
Cetuximab with radiotherapy (Bonner), or carboplatin-based chemoradiation.
Cetuximab is a chimeric antibody that blocks the EGFR growth receptor. It is used with FOLFIRI or FOLFOX in RAS wild-type, left-sided bowel cancer, with encorafenib in BRAF V600E disease, with KRAS G12C inhibitors, and with radiation or chemotherapy in head and neck cancer; RAS-mutant tumours gain nothing and may be harmed, so RAS testing comes first.
Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.
- Tests CetuximabLocoregionally advanced head and neck squamous cell carcinoma: radiotherapy with or without cetuximab
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Median overall survival 49.0 vs 29.3 months (hazard ratio 0.74).
Locoregional control (primary) and overall survival (months): Radiotherapy plus cetuximab 49 (n=211) vs Radiotherapy alone 29.3 (n=213)
- Dose by Calvert formula using GFR (see the calculators).
- Between Cetuximab and Carboplatin, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in Bonner trial (cetuximab plus radiotherapy), and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (cannot have cisplatin), which of the standard options do you recommend and why?Why: Guideline options include: Cetuximab with radiotherapy (Bonner), or carboplatin-based chemoradiation.
- Am I a candidate for Cetuximab, Carboplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of Bonner trial (cetuximab plus radiotherapy) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy
Total laryngopharyngectomy with neck dissection and free-flap or gastric pull-up reconstruction, then postoperative radiotherapy or cisplatin chemoradiation by pathology.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Low-dose bath to normal tissue
- Motion management
- Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
- Between IMRT / IGRT (modern external beam) and Cisplatin, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy), which of the standard options do you recommend and why?Why: Guideline options include: Total laryngopharyngectomy with neck dissection and free-flap or gastric pull-up reconstruction, then postoperative radiotherapy or cisplatin chemoradiation by pathology.
- Am I a candidate for Cisplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.
Recurrent or metastatic
Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048).
Pembrolizumab is a PD-1 blocking antibody approved in more than 40 settings, from melanoma and lung cancer to the first tumour-agnostic approval for mismatch-repair-deficient tumours in 2017, and before and after surgery in triple-negative breast cancer. A subcutaneous form arrived in 2025, and it is the backbone partner for ADCs and personalised neoantigen vaccines.
- Tests PembrolizumabUntreated recurrent or metastatic HNSCC: pembrolizumab alone, pembrolizumab + platinum/5-FU, or cetuximab + platinum/5-FU (EXTREME)
OS 14.9 vs 10.7 months (CPS ≥20, monotherapy); 13.0 vs 10.7 (all, with chemotherapy).
Overall survival, CPS ≥20, pembrolizumab monotherapy (months): Pembrolizumab 14.9 vs Cetuximab + chemotherapy 10.7 · HR 0.61 · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Hypothyroidism (immune-mediated) · Pooled monotherapy data, >2,800 patients | 8% | - |
| Pneumonitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 3.4% | - |
| Colitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 1.7% | - |
| Hepatitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 0.7% | - |
- No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Is Pembrolizumab the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?Why: A single standard does not mean a single choice; timing and trials are decisions too.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in KEYNOTE-048, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Pembrolizumab are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (recurrent or metastatic), which of the standard options do you recommend and why?Why: Guideline options include: Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048).
- Am I a candidate for Pembrolizumab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-048 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Prevention
Smoking cessation and alcohol reduction; no screening programme exists.
Stopping smoking after a cancer diagnosis improves survival, reduces treatment complications and second cancers, and is the single most effective supportive intervention that oncology services still routinely fail to deliver.
- Large survival effect in lung and head and neck cancer
- Cheap, effective drugs available
- Opt-out models are proven to raise uptake
Alcohol causes at least seven cancers and there is no safe threshold. Price, availability and cancer warning labels are the tools that work; most people still do not know alcohol causes cancer.
- Causal evidence is settled
- Pricing and taxation have robust quasi-experimental evidence
- Labelling is cheap and reaches everyone
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Under-delivered: most patients never offered treatment
- Stigma and fatalism among patients and clinicians
- Reimbursement gaps for cessation pharmacotherapy
- Industry lobbying and trade-law challenges
- Low public awareness
- Little trial evidence for reduction after diagnosis
- Between Smoking cessation in cancer patients and Alcohol reduction, pricing and cancer warning labels, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (prevention), which of the standard options do you recommend and why?Why: Guideline options include: Smoking cessation and alcohol reduction; no screening programme exists.
Add these to your appointment list, or take the full question set for this cancer.