The incidence of hypopharyngeal malignant tumors has been rising in recent years. Based on the location of occurrence, these tumors can be classified into the piriform sinus type, postcricoid area type, and posterior hypopharyngeal wall type. Among these, the piriform sinus type is the most common, while the postcricoid area type is the least frequent. Etiological factors include excessive alcohol consumption, smoking, preference for hot foods, and gastroesophageal reflux.
Pathology
Approximately 95% of cases are squamous cell carcinomas, most of which demonstrate poor differentiation. Tumors may exhibit multifocal occurrence and skip lesions in growth. Between 20% and 40% of patients also have concurrent esophageal carcinoma. Cervical lymph node metastasis is common, while sarcomas and adenocarcinomas are rare.
Clinical Manifestations
Patients often present with a neck mass as the initial symptom. Early symptoms are nonspecific and may involve a sensation of a foreign body in the throat. As the tumor enlarges, symptoms may include difficulty in swallowing and a choking sensation. Ulceration of the tumor surface can lead to painful swallowing and ipsilateral referred ear pain. Progressive dysphagia, drooling, and blood-streaked sputum are frequently observed. In cases where the tumor involves the laryngeal cavity, symptoms such as hoarseness and dyspnea may arise.
Diagnosis
Early diagnosis can be challenging due to the subtlety of symptoms. The hypopharynx's deep anatomical location and close anatomical relationships make the detection of early lesions difficult. Flexible, electronic, or NBI laryngoscopy allows for the detailed observation of the mucosa in various hypopharyngeal regions, checking for edema, fullness in the piriform sinus, and secretion retention.
Suspicious lesions should undergo pathological examination for confirmation. During a neck examination, attention should be paid to laryngeal swelling, restricted mobility, and cervical lymph node enlargement. Imaging modalities such as CT, MRI, endoscopy, and PET-CT can provide additional details on the tumor's extent and metastasis.
Treatment
The primary treatment principle is to maximize survival rates while preserving laryngeal function whenever possible. A single treatment modality is associated with poor prognosis; therefore, a multidisciplinary team (MDT) approach combining surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy is recommended for comprehensive management.
In operable cases, preoperative and postoperative adjuvant therapies are often employed to improve the five-year survival rate and the likelihood of preserving laryngeal function. Surgical approaches, techniques, and the type of neck dissection depend on the tumor location and extent of invasion. For reconstruction, various techniques such as local tissue flaps, pedicled flaps, gastric pull-up, or colonic interposition may be used depending on the size of the postoperative defect.