The first 60 days: Hypopharyngeal cancer
Cancer of the hypopharynx, the funnel behind the voice box, is the head and neck cancer with the worst outlook because it grows silently and spreads to the neck early. Treatment is chemoradiation to keep the larynx where possible, or removal of the larynx and pharynx with reconstruction for the most extensive tumours. Below, week by week, is what OnCo's record of Hypopharyngeal cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Panendoscopy with biopsy, CT of the neck and chest, PET-CT for stage III to IV, and assessment of swallowing and nutrition before treatment.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Diagnosis and staging, Extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy.
- RadiologistNamed in the standard of care for: Diagnosis and staging.
- SurgeonNamed in the standard of care for: Early disease (T1 to T2, node-negative), Extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy.
- Medical oncologistNamed in the standard of care for: Early disease (T1 to T2, node-negative), Locally advanced, larynx preservable, Cannot have cisplatin, Extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy and 1 more.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Early disease (T1 to T2, node-negative), Locally advanced, larynx preservable, Cannot have cisplatin, Extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy.
- Palliative and supportive care teamNamed in the standard of care for: Prevention.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Smoking cessation and alcohol reduction; no screening programme exists.
- 2.Early disease (T1 to T2, node-negative)NCCN category Category 2A, NCCN Guidelines: Head and Neck Cancers
Radiotherapy alone, or transoral or open partial pharyngectomy in selected small tumours, with treatment of both sides of the neck.
- 3.Locally advanced, larynx preservableNCCN category Category 1 (concurrent chemoradiation), NCCN Guidelines: Head and Neck Cancers
Concurrent cisplatin chemoradiation to 70 Gy; induction cisplatin-fluorouracil (EORTC 24891) or docetaxel-cisplatin-fluorouracil followed by radiotherapy in some centres.
Cetuximab with radiotherapy (Bonner), or carboplatin-based chemoradiation.
- 5.Extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapyNCCN category Category 2A, NCCN Guidelines: Head and Neck Cancers
Total laryngopharyngectomy with neck dissection and free-flap or gastric pull-up reconstruction, then postoperative radiotherapy or cisplatin chemoradiation by pathology.
Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048).
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Stage, cartilage invasion and oesophageal extension on CT or MRI, Vocal cord fixation, Second primary in the oesophagus or lung at panendoscopy, Nutritional status, PD-L1 combined positive score), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Pyriformsinus cancer, the commonest hypopharyngeal site, Posterior pharyngeal wall cancer, Postcricoid cancer.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Diagnosis and staging
- For my situation (diagnosis and staging), which of the standard options do you recommend and 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.
Early disease (T1 to T2, node-negative)
- For my situation (early disease (t1 to t2, node-negative)), which of the standard options do you recommend and why?Guideline options include: Radiotherapy alone, or transoral or open partial pharyngectomy in selected small tumours, with treatment of both sides of the neck.
Locally advanced, larynx preservable
- For my situation (locally advanced, larynx preservable), which of the standard options do you recommend and 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?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?Trial populations differ from individual patients; ask how closely you match.
Cannot have cisplatin
- For my situation (cannot have cisplatin), which of the standard options do you recommend and 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?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?Trial populations differ from individual patients; ask how closely you match.
Extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy
- For my situation (extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy), which of the standard options do you recommend and 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?Knowing the expected toxicities helps you plan work, family, and supportive care.
Recurrent or metastatic
- For my situation (recurrent or metastatic), which of the standard options do you recommend and 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?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-048 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Prevention
- For my situation (prevention), which of the standard options do you recommend and why?Guideline options include: Smoking cessation and alcohol reduction; no screening programme exists.
Any stage
- Are there clinical trials I could join, for example of NIVOPOSTOP (GORTEC 2018-01), KEYNOTE-689, Adaptive radiotherapy (online replanning), Pembrolizumab?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Survival has barely improved in thirty years”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Choosing between preservation and laryngopharyngectomy in the most extensive tumours”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Hypopharyngeal cancer: the full pageCancer of the hypopharynx, the funnel behind the voice box, is the head and neck cancer with the worst outlook because it grows silently and spreads to the neck early. Treatment is chemoradiation to keep the larynx where possible, or removal of the larynx and pharynx with reconstruction for the most extensive tumours.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.
Every term links to the glossary.