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Hypopharyngeal cancer

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Faizan Sheraz, M.D. [3]

Synonyms and keywords: Squamous cell carcinoma of the hypopharynx, SCC of the hypopharynx, hypopharyngeal squamous cell carcinoma

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Faizan Sheraz, M.D. [3]

Overview

Hypopharyngeal cancer was discovered in 1970 by Dr.Harrison in London, U.K. Hypopharyngeal cancer is a disease in which malignant cells proliferate in the hypopharynx. Most hypopharyngeal cancers form in the squamous cells, which are thin, flat cells lining inside the hypopharynx. Hypopharyngeal cancer can be classified according to the anatomy regions and histopathological derivatives. The anatomic location of hypopharyngeal cancer is divided into 3 subtypes such as pyriform sinus cancer, postcricoid area cancer and posterior wall of the hypopharynx. There are no direct causes of hypopharyngeal cancer, however tobacco abuse, abuse of alcohol consumption, HPV infection, Plummer-Vinsom syndrome, and asbestos have been associated with hypopharyngeal cancer. Genes involved in the pathogenesis of hypopharyngeal cancer include p16, NOTCH1, cyclin D1, and TP53. Hypopharyngeal cancer is associated with sideropaenic dysphagia and Paterson Brown Kelly syndrome. On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are characteristic findings of hypopharyngeal cancer. On microscopic histopathological analysis, spindle cells, basaloid cells, and nuclear atypia are characteristic findings of hypopharyngeal cancer. The prevalence of hypopharyngeal cancer is estimated to be 2,500 new cases annually in U.S and hypopharyngeal cancer is a very rare type of cancer. Hypopharyngeal cancer commonly affects patients in 55 to 65 years of age. Males are mostly affected with a hypopharyngeal cancer compare to women. Hypopharyngeal cancer comprises about 7% of all cancers of the head and neck. According to the National Cancer Institute and American Cancer Society, screening test for hypopharyngeal cancer is not recommended.The majority of patients with hypopharyngeal cancer are initially asymptomatic. Most patients with hypopharyngeal cancer clinically manisfest symptoms at a late stage (III and IV) because of the tumor aggression which metastasizes to lymph nodes and submucosa. Once the tumor has expanded from its original site, it may obstruct the aerodigestive tract. Most common clinical presentations are neck mass, dysphagia with weight loss, non healing sore throat, odynophagia, and hoarseness. Common complications of hypopharyngeal cancer include upper airway obstruction and disfigurement of the neck or face. The prognosis varies with the type of hypopharyngeal cancer. The Squamous cell carcinoma of the hypopharynx has a poor prognosis and small survival rate.The medical therapy with the combination of the radiotherapy has been used compared to surgical therapy for the treatment of hypopharyngeal cancer. Swallowing, speech and laryngeal preservation are important to consider during the treatment. The feasibility of surgery depends on the stage of hypopharyngeal cancer at the time of the diagnosis.The main goal of the surgery is to clear any margin that contains the tumor cells. The available surgery options are transoral laser surgery, total laryngectomy with partial pharyngectomy surgery, total laryngectomy and circumferential pharyngectomy.

Historical Prospective

Hypopharyngeal Cancer is a rare type of malignant tumor. Hypopharyngeal cancer was discovered by Harrisson in 1970 with more than half in the postcricoid part.

Classification

Hypopharyngeal cancer may be classified according to the location into 4 subtypes: pyriform sinus cancer, postcricoid area cancer, and posterior wall of hypopharynx cancer. A pyriform sinus cancer subtype is found in 60 to 85 percent of patients who are diagnosed with hypopharyngeal cancer. Hypopharyngeal cancer may also be classified based on the histopathology.

Pathophysiology

Hypopharyngeal cancer arises from squamous cells, which are cells that are normally involved in protection of aerodigestive tract. Hypopharyngeal cancer is a rare type of malignant cancer which has a delayed onset of clinical manifestations. Hypopharyngeal cancer is usually diagnosed at an advanced stage and it spreads to other organs such as lungs, mediastinum, bones, brain, liver, esophagus, and thyroid gland. The metastatic invasion depends on the anatomic location of the hypopharyngeal cancer. Hypopharyngeal cancer is mostly differentiated as squamous cell carcinoma, but the undifferentiated type can be found in the pyriform sinus region. The exact pathogenesis of the hypopharyngeal cancer is not exactly understood, but the p16, cyclin D1, NOTCH1, and TP53 gene mutations have been associated with the development of the hypopharyngeal cancer. Hypopharyngeal cancer is associated with sideropenic dysphagia and Paterson Brown Kelly syndrome. On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are the characteristic findings of hypopharyngeal cancer. On microscopic histopathological analysis, spindle cells, basaloid cells, and nuclear atypia are the characteristic findings of hypopharyngeal cancer.

Causes

There are no direct causes for hypopharngeal cancer however, there are some common risk factors that may lead to gene mutations and cause the hypopharyngeal cancer. Common risk factors for hypopharyngeal cancer can be found here.

Differentiating Hypopharyngeal Cancer from other Diseases

Hypopharyngeal carcinoma must be differentiated from accessory salivary gland tumor, lymphoma, and retropharyngeal abscess.

Epidemiology and Demographics

The prevalence of hypopharyngeal cancer is estimated to be 2,500 new cases annually in U.S and hypopharyngeal cancer is a very rare type of cancer. Hypopharyngeal cancer commonly affects patients in 55 to 65 years of age. Males are mostly affected with a hypopharyngeal cancer compare to women. Hypopharyngeal cancer comprises about 7% of all cancers of the head and neck.

Risk Factors

Common risk factors in the development of hypopharyngeal cancer are tobacco use, and abuse of alcohol consumption.

Screening

According to the National Cancer Institute and American Cancer Society, screening test for hypopharyngeal cancer is not recommended.

Natural History, Complications and Prognosis

The majority of patients with hypopharyngeal cancer are initially asymptomatic. Most patients with hypopharyngeal cancer clinically manisfest symptoms at late stage (III and IV) because of the tumor aggression which metastasizes to lymph nodes and submucosa. Once the tumor has expanded from its site of origin, it may obstruct the aerodigestive tract. Most common clinical presentations are neck mass, dysphagia with weight loss, non healing sore throat, odynophagia, and hoarseness. Common complications of hypopharyngeal cancer include upper airway obstruction and disfigurement of the neck or face. The prognosis varies with the type of hypopharyngeal cancer. Squamous cell carcinoma of hypopharynx has poor prognosis and small survival rate.

Diagnostic Study of Choice and Staging

The diagnostic study of choice for hypopharyngeal cancer is CT scan with contrast of head and neck. The definitive diagnosis of hypopharyngeal cancer is biopsy of the tumor. According to the American Joint Committee of Cancer (AJCC) TNM staging system, there are 5 stages of hypopharyngeal cancer based on the tumor size, lymph node involvement, and distant metastasis.

History and Symptoms

The hallmark of hypopharyngeal cancer is dysphagia. A positive history of odynophagia and hoarseness is suggestive of hypopharyngeal cancer. Common symptoms include a lump in the neck, dysphagia, chronic sore throat and hoarseness.

Physical Examination

Patients with hypopharyngeal carcinoma are usually well appearing. Physical examination of the patients with hypopharyngeal carcinoma is usually remarkable for the neck swelling.

Laboratory Findings

There are no diagnostic laboratory findings associated with hypopharyngeal cancer.

Electrocardiogram

There are no ECG findings associated with hypopharyngeal cancer.

Chest X Ray

Chest X rays may be performed to detect metastasis of hypopharyngeal cancer to the lungs.

CT

Head and neck CT scan may be helpful in the diagnosis of hypopharyngeal cancer. Findings on CT scan suggestive of hypopharyngeal cancer include soft tissue mass, irregular thickening of the mucosa, and necrotic region which is a sign of metastasis.

MRI

MRI may be helpful in the diagnosis of hypopharyngeal cancer. Findings on the MRI suggestive of hypopharyneal cancer include tumors are hypointense on T1 and hyperintense on T2 for soft tissues.

Other Imaging Findings

Ultrasound may be helpful to assess hypopharyngeal cancer along with endoscopy. Ultrasound may be use to detect, and localize primary tumors that invade neighboring organs such as esophagus, thyroid gland, and postcricoid area.

Other Diagnostic Studies

Biopsy may be diagnostic of hypopharyngeal cancer. Findings on biopsy diagnostic of hypopharyngeal cancer include spindle cells, basaloid cells, and nuclear atypia.

Medical Therapy

The medical therapy with the combination of the radiotherapy has been used compared to surgical therapy for the treatment of hypopharyngeal cancer.The optimal therapy for hypopharyngeal cancer depends on the stage at the time of the diagnosis. The combined treatment helps with organ preservation. Swallowing, speech and laryngeal preservation are important to consider during the treatment.

Surgery

The feasibility of surgery depends on the stage of hypopharyngeal cancer at the time of diagnosis. The main goal of the surgery is to clear any margin that contains tumor cells. The available surgery options are transoral laser surgery, total laryngectomy with partial pharyngectomy surgery, total laryngectomy and circumferential pharyngectomy.

Primary Prevention

Effective measures for the primary prevention of hypopharyngeal cancer include smoking cessation, decrease alcohol consumption, increase vegetables and fruits consumption, and vaccination for HPV.

Secondary Prevention

Secondary prevention measures of hypopharyngeal cancer include routine physical examination of head and neck and thyroid Screening are recommended among the patients who had received radiation therapy to the head and neck regions.

References

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Historical Perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2]

Overview

Hypopharyngeal Cancer is a rare type of malignant tumor. Hypopharyngeal cancer was discovered by Harrisson in 1970 with more than half in the postcricoid part.

Historical Perspective

Discovery

  • Hypopharyngeal cancer is a rare type of malignant tumor.
  • Hypopharyngeal cancer was first discovered by Harrisson in 1970 in London, UK at his clinic. He also described that about 60 percent of hypopharyngeal cancer were derived from the postcricoid area.[1][2]

References

  1. Helliwell TR (February 2003). “acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx”. J. Clin. Pathol. 56 (2): 81–5. PMC 1769882. PMID 12560383.
  2. International Journal of Recent Scientific Research. doi:10.24327/IJRSR. ISSN 0976-3031. Missing or empty |title= (help)
Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Faizan Sheraz, M.D. [3]

Overview

Hypopharyngeal cancer may be classified according to the location into 4 subtypes: pyriform sinus cancer, postcricoid area cancer, and posterior wall of hypopharynx cancer. A pyriform sinus cancer subtype is found in 60 to 85 percent of patients who are diagnosed with hypopharyngeal cancer. Hypopharyngeal cancer may also be classified based on the histopathology.

Classification

Anatomic classification of hypoharyngeal cancer includes:[1][2][3]

Histopathologic classification of hypopharyngeal cancer includes:[4]

References

  1. Toland, Amanda Ewart; Joo, Young-Hoon; Lee, Youn-Soo; Cho, Kwang-Jae; Park, Jun-Ook; Nam, In-Chul; Kim, Chung-Soo; Kim, Sang-Yeon; Kim, Min-Sik (2013). “Characteristics and Prognostic Implications of High-Risk HPV-Associated Hypopharyngeal Cancers”. PLoS ONE. 8 (11): e78718. doi:10.1371/journal.pone.0078718. ISSN 1932-6203.
  2. Pracy P, Loughran S, Good J, Parmar S, Goranova R (May 2016). “Hypopharyngeal cancer: United Kingdom National Multidisciplinary Guidelines”. J Laryngol Otol. 130 (S2): S104–S110. doi:10.1017/S0022215116000529. PMC 4873926. PMID 27841124.
  3. “Hypopharyngeal Cancer Treatment (Adult) (PDQ(R)): Health Professional Version”. 2002. PMID 26389199.
  4. Rosai, Juan (1996). Ackerman’s surgical pathology. St. Louis: Mosby. ISBN 9780801670046.
Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Faizan Sheraz, M.D. [3]

Overview

Hypopharyngeal cancer arises from squamous cells, which are cells that are normally involved in protection of aerodigestive tract. Hypopharyngeal cancer is a rare type of malignant cancer which has a delayed onset of clinical manifestations. Hypopharyngeal cancer is usually diagnosed at an advanced stage and it spreads to other organs such as lungs, mediastinum, bones, brain, liver, esophagus, and thyroid gland. The metastatic invasion depends on the anatomic location of the hypopharyngeal cancer. Hypopharyngeal cancer is mostly differentiated as squamous cell carcinoma, however, the undifferentiated type may be found in the pyriform sinus region. The exact pathogenesis of the hypopharyngeal cancer is not exactly understood, but the p16, cyclin D1, NOTCH1, and TP53 gene mutations have been associated with the development of the hypopharyngeal cancer. Hypopharyngeal cancer is associated with sideropenic dysphagia and Paterson Brown Kelly syndrome. On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are the characteristic findings of hypopharyngeal cancer. On microscopic histopathological analysis, spindle cells, basaloid cells, and nuclear atypia are the characteristic findings of hypopharyngeal cancer.

Pathophysiology

Genetics

Associated Diseases

Gross Pathology

Gross pathology of hypopharyngeal cancerfrom Wikimedia Commons

Microscopic Pathology

Immunohistochemistry

    • Beta catenin positive
    • C-erbB2 negative
    • mRNA translation initial factor positive

References

  1. 1.0 1.1 Kohmura, Takahide; Hasegawa, Yasuhisa; Ogawa, Tetsuya; Matsuura, Hidehiro; Takahashi, Masakatsu; Yanagita, Noriyuki; Nakashima, Tsutomu (1999). “Cyclin D1 and p53 Overexpression Predicts Multiple Primary Malignant Neoplasms of the Hypopharynx and Esophagus”. Archives of Otolaryngology–Head & Neck Surgery. 125 (12): 1351. doi:10.1001/archotol.125.12.1351. ISSN 0886-4470.
  2. 2.0 2.1 2.2 2.3 2.4 Helliwell TR (February 2003). “acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx”. J. Clin. Pathol. 56 (2): 81–5. PMC 1769882. PMID 12560383.
Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Faizan Sheraz, M.D. [3]

Overview

There are no direct causes for hypopharngeal cancer. However, there are some common risk factors that may lead to gene mutations and cause the hypopharyngeal cancer.

Causes

There are no established direct causes for hypopharngeal cancer. Common risk factors for hypopharyngeal cancer can be found here.[1]

References

  1. What are the risk factors for laryngeal and hypopharyngeal cancers?. Cancer.org. Accessed on October 13, 2015. http://www.cancer.org/cancer/laryngealandhypopharyngealcancer/overviewguide/laryngeal-and-hypopharyngeal-cancer-overview-what-causes
Differentiating Hypopharyngeal Cancer from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2], Gertrude Djouka, M.D.[3], Qurrat-ul-ain Abid, M.D.[4]

Overview

Hypopharyngeal carcinoma must be differentiated from other diseases that present as a neck mass.

Differentiating Hypopharyngeal Cancer From other Diseases

Hypopharyngeal cancer should be differentiated from other diseases causing a neck mass such as congenital abnormalities, inflammatory, and malignant lesions.

Category Diseases Benign/

Malignant

Clinical manifestation Paraclinical findings Gold standard diagnosis Associated findings
Demography History Symptoms Signs Lab findings Histopathology Imaging
Pain Dysphagia Mass exam Others
Congenital Branchial cleft cyst[1]
  • Age: 1-15 years old
  • Familial occurrence
  • Lateral neck mass
±
  • Solitary
  • Smooth
  • Mobile
  • Well-defined
  • Non-pulsatile
  • Fluctuant
  • A pit at the opening of the cyst
Thyroglossal duct cyst[2][3]
  • Age: 1-10 years old
  • Midline neck mass
Hemangioma[4]
  • Presents with a flat red or purple patch
  • Regress gradually with age
  • Firm
  • Rubbery
  • Well-demarcated
Vascular malformation[5][6]
  • Incidence: 1 in 2000 to 5000 births
  • Gender: No predilection
±
  • Grow proportionally with age
  • MRI
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Congenital Lymphatic malformation[7][8]
  • Age: Birth-5 years old
  • Gender: No predilection
+
Laryngocele[9][10][11] +
  • Soft
  • Reducible
  • Increase in size on valsalva
  • Common in glass blowers and trumpet players
Ranula[12][13]
  • Well circumscribed
  • Fluctuant
  • Soft
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Congenital Teratoma[14][15]
  • Incidence: 1:4000 births
  • Gender: No predilection
  • Presents as a firm lateral neck mass
  • Firm
  • Non-tender
  • High ALP levels
Dermoid cyst[16][17]
  • Freely mobile
  • Solitary
  • Rubbery
  • Nonpulsatile
  • Noncompressible
  • Ultrasound: Thin walled, unilocular
  • CT with contrast: Well circumscribed, unilocular, sac-of-marbles appearance due to fatty tissue
Thymic cyst[18]
  • Presents as a soft mass, gradually enlarging, on left side of the neck (usual)
  • Soft
  • Compressible
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Acute sialadenitis[19]
  • Age: Occurs in all age groups
  • Gender: No predilection
+
Chronic sialadenitis[20]
  • Age: Occurs in all age groups
  • Gender: No predilection
  • Presents with an unilateral swelling
  • Recurrent episodes common
+
  • Non-tender
  • Firm
  • Smooth
Reactive viral lymphadenopathy CMV[21]
  • Age: 10-35 years old
  • Gender: No predilection
  • Flu-like illness
  • Non-tender
  • Soft
  • Usually not necessary
EBV[22][23]
  • Age: Mainly adolescents
  • Gender: No predilection
  • Non-tender
  • Firm
  • Usually not necessary
HIV[24]
  • Non-tender mass
  • Usually not necessary
Viral URI[25]
  • Incidence: More in fall & winter
  • Age: Common in elderly and infants
  • Non-tender
  • No specific findings
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Bacterial lymphadenopathy Tularemia[26][27]
  • Age: Affects all age groups
  • Gender: No predilection
+
  • No specific findings
Brucellosis[28]
  • Flu-like illness
+
  • No specific findings
Cat-scratch disease[29][30]
  • More common in the Southern of U.S among children and young adults
+
Actinomycosis[31][32]
  • No predilection in race, age
  • [[Male] to female ratio : 1.5 to 3:1
  • Tender at the beginning
  • Painless
  • Fluctuant
  • Non-tender at late stage
Mycobacterial infections[22][33][34]
Streptococcal infection[21][35] + +
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Parasitic lymphadenopathy Toxoplasma gondii[36][37]
  • 6 years old and older adults are more affected in U.S.
  • Seen in hot climates
+
  • Bilateral
  • Non-tender
  • Symmetrical
  • Non-fluctuant
Sarcoidosis[38][19]
  • More common in African American women aged 20-40 years
Sjögren syndrome[39]
  • Female to male ratio: 9 to 1
  • May happen at any age
  • Mean age: 40-50
+
Castleman disease (angiofollicular lymphoproliferative disease)[40][41]
  • Mean age: 30-40 years
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Kikuchi disease (histiocytic necrotizing lymphadenitis)[42]
  • High prevalence in Japan
  • More common in young adults < 30 years old
+
Kimura disease[43]
  • More common in Asian males
Rosai-Dorfman disease[44][45]
Kawasaki disease[46][47]
  • More common in children < 5 years old
  • Highest incidence in Japan
  • Most leading cause of acquired heart disease in U.S
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Salivary gland neoplasm Pleomorphic adenoma[48][49] +
  • MRI: Homogenous on T1
  • Abundant myxochondroid stroma on T2
Warthin’s tumor[50][51]
  • Male to female ratio: 4:1
  • More common in people aged 60-70 years old
+
Oncocytoma

[52]

  • Race: Caucasian patients predilection
  • Gender: No gender preference
  • Age: 50–70 years
± ±
  • CT:
    • Isodense expansive mass
    • Enhancement after intravenous contrast
    • Hypodense areas
  • MRI:
    • Isodensties on T1
    • Mass is hyperintense on T2
    • Enhancement on contrast
Monomorphic adenoma [53][54][55]
  • Age: 26-76 years
  • Rare in children
  • Gender: No predilection
± ±
  • Normal
Mucoepidermoid carcinoma

[56]

  • Age: Mean age of 59
  • Female predilection
± ±
  • Cystic and solid component with variable appearance on CT and MRI
  • Association with CMV
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Salivary gland neoplasm Adenoid cystic carcinoma [57]
  • Age: 40s-60s
  • Gender: Female predominance
± ±
Adenocarcinoma

[58]

  • Age: young age predilection
Salivary duct cancer[59][60][61]

(Highly aggressive)

  • Incidence: 1-3%
  • Gender: Male predilection
  • Mean age: 55-61 years old
  • Rapidly growing mass with jaw involvement
± ±
  • Painless
  • Hard
  • Non-compressible mass
Squamous cell carcinoma[62][63]
  • Incidence: rare
  • Age: Old age , 61-68 years
  • Male predilection
  • Present as painful growing mass on jaw
+
  • Tumor dimension can be delineated using both CT and MRI
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Hypopharyngeal cancer[64][65][66]
  • More common in males
  • Age: 55-65 years old
  • Incidence: < 1/100,000 in U.S.
  • More common in Japan, India, Iran
+
Parathyroid cancer[67][68][69]
  • Incidence: Rare
  • Mean age : 44-54 years old
  • Gender: Female predilection
+ +
Carotid body tumors[70][71][72][73]
  • Age: 26-55 years
  • Male predominance
+
Paraganglioma[74][75][76]
  • Age 50-70 years
  • More in females
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Schwannoma[77][78][79]
  • Rare tumor
  • Incidence: 1-10%
+ ±
  • Multiple
  • Slow growing nodules on the skin
  • May be normal
  • Encapsulated neural tissue growth
Lymphoma [80][81][82][83][84][85]
  • Age: Predilection for older age
  • Mean age: 55
±
  • On complete node analysis four patterns are described:
    • Nodular/follicular
    • Diffuse pattern
    • Transition from a nodular to a diffuse pattern in adjacent nodes
    • Transition from a lower to a higher grade of involvement within a single node
Liposarcoma [86][87][88][89]
  • Rare tumor
  • Age: Relatively in older age
  • Gender: No gender predilection
  • Mobile mass
  • Few symptoms until they grow enough to compress the surrounding structures
  • Symptoms of neural deficit, pain, tingling, or skin changes
±
  • Intact skin and normal color
  • Normal
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Lipoma [90][91][92]
  • One or multiple soft, painless skin nodules
  • May causes pain or compressive symptoms
±
  • Normal
  • Normal
  • Diagnoses is usually clinical
  • Tissue biopsy may show:
    • Bundle of well-demarcated lipocytes
    • Single nuclei aligned to the side
    • Intra-cytoplasimic fat granules
Glomus vagale, glomus jugulare tumors[93][94][95][96][97][98]
  • Rare tumor
  • Painless slowly enlarging mass in the neck
±
  • Normal
Metastatic head and neck cancer[99][100] ±
  • Vary depending on the underlying cancer
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Other Laryngeal cancer[101][102] Benign/Malignant
  • Older males
  • Younger patients with HPV infection or smoking history
± ±

human papillomavirus (HPV) infection

Arteriovenous fistula

[103][104]

  • Depends on the risk factors
  • Varies depending on the etiology
Thyroid nodule/ Goiter

[105][106][107][108]

  • Female predominance
  • Young age (benign causes)
  • Old age (malignant etiology)
± ±
  • Painless
  • Non-tender
  • Asymmetrical neck mass in front of neck
  • With smooth overlying skin
  • Nodular surface
  • Depending on the type:
  • Normal to low TSH levels in case of malignancy
  • High TSH levels in case of goiter
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings

References

  1. Nahata, Vaishali (2016). “Branchial cleft cyst”. Indian Journal of Dermatology. 61 (6): 701. doi:10.4103/0019-5154.193718. ISSN 0019-5154.
  2. Amos J, Shermetaro C. PMID 30085599. Missing or empty |title= (help)
  3. Deaver MJ, Silman EF, Lotfipour S (August 2009). “Infected thyroglossal duct cyst”. West J Emerg Med. 10 (3): 205. PMC 2729228. PMID 19718389.
  4. Léauté-Labrèze, C.; Prey, S.; Ezzedine, K. (2011). “Infantile haemangioma: Part I. Pathophysiology, epidemiology, clinical features, life cycle and associated structural abnormalities”. Journal of the European Academy of Dermatology and Venereology. 25 (11): 1245–1253. doi:10.1111/j.1468-3083.2011.04102.x. ISSN 0926-9959.
  5. Cox JA, Bartlett E, Lee EI (May 2014). “Vascular malformations: a review”. Semin Plast Surg. 28 (2): 58–63. doi:10.1055/s-0034-1376263. PMC 4078214. PMID 25045330.
  6. Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, Oklu R (December 2016). “Venous malformations: clinical diagnosis and treatment”. Cardiovasc Diagn Ther. 6 (6): 557–569. doi:10.21037/cdt.2016.11.10. PMC 5220204. PMID 28123976.
  7. Cox JA, Bartlett E, Lee EI (May 2014). “Vascular malformations: a review”. Semin Plast Surg. 28 (2): 58–63. doi:10.1055/s-0034-1376263. PMC 4078214. PMID 25045330.
  8. Guruprasad Y, Chauhan DS (September 2012). “Cervical cystic hygroma”. J Maxillofac Oral Surg. 11 (3): 333–6. doi:10.1007/s12663-010-0149-x. PMC 3428451. PMID 23997487.
  9. Werner RL, Schroeder JW, Castle JT (March 2014). “Bilateral laryngoceles”. Head Neck Pathol. 8 (1): 110–3. doi:10.1007/s12105-013-0478-4. PMC 3950389. PMID 23881550.
  10. Prasad KC, Vijayalakshmi S, Prasad SC (December 2008). “Laryngoceles – presentations and management”. Indian J Otolaryngol Head Neck Surg. 60 (4): 303–8. doi:10.1007/s12070-008-0108-8. PMC 3476818. PMID 23120570.
  11. Mahdoufi R, Barhmi I, Tazi N, Abada R, Roubal M, Mahtar M (July 2017). “Mixed Pyolaryngocele: A Rare Case of Deep Neck Infection”. Iran J Otorhinolaryngol. 29 (93): 225–228. PMC 5554815. PMID 28819622.
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Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Faizan Sheraz, M.D. [3]

Overview

The prevalence of hypopharyngeal cancer is estimated to be 2,500 new cases in the U.S annually and hypopharyngeal cancer is a very rare type of cancer. Hypopharyngeal cancer commonly affects patients in 55 to 65 years of age. Males are commonly affected with a hypopharyngeal cancer compared to women. Hypopharyngeal cancer comprises about 7% of all cancers of the head and neck.

Epidemiology and Demographics

Prevalence

  • The prevalence of hypopharyngeal cancer is estimated to be 2,500 new cases in the United states, annually.[1]
  • Hypopharyngeal cancer comprises about 7% of all cancers of head and neck.[2]

Incidence

  • The incidence of hypopharyngeal cancer is estimated to less than 1 per 100,000 individuals in the United States, annually.[3][2]

Age

  • Hypopharyngeal cancer commonly affects patients in 55 to 65 years of age.[4]

Gender

Region

  • Hypopharyngeal cancer is more common in Japan, India and Iran.[2]

References

  1. DeVita, Vincent (2011). DeVita, Hellman, and Rosenberg’s cancer : principles & practice of oncology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-1-4511-0545-2.
  2. 2.0 2.1 2.2 2.3 2.4 International Journal of Recent Scientific Research. doi:10.24327/IJRSR. ISSN 0976-3031. Missing or empty |title= (help)
  3. Hypopharyngeal cancer epidemiology and treatment. http://www.cancer.gov/types/head-and-neck/hp/hypopharyngeal-treatment-pdq
  4. Barnes, Leon (2001). Surgical pathology of the head and neck. New York: M. Dekker. ISBN 0-8247-0109-7.
  5. Barnes, Leon (2001). Surgical pathology of the head and neck. New York: M. Dekker. ISBN 0-8247-0109-7.

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Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Faizan Sheraz, M.D. [3]

Overview

Common risk factors in the development of hypopharyngeal cancer are tobacco use, and abuse of alcohol consumption.

Risk Factors

Common Risk Factors

Common risk factors for the development of hypopharyngeal cancer include[1]:

Less Common Risk Factors

Less common risk factors for development of hypopharangeal cancer include:

References

  1. Maasland, Denise HE; van den Brandt, Piet A; Kremer, Bernd; Goldbohm, R Alexandra; Schouten, Leo J (2014). “Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study”. BMC Cancer. 14 (1). doi:10.1186/1471-2407-14-187. ISSN 1471-2407.
  2. Novacek, Gottfried (2006). Orphanet Journal of Rare Diseases. 1 (1): 36. doi:10.1186/1750-1172-1-36. ISSN 1750-1172. Missing or empty |title= (help)
  3. Toland, Amanda Ewart; Joo, Young-Hoon; Lee, Youn-Soo; Cho, Kwang-Jae; Park, Jun-Ook; Nam, In-Chul; Kim, Chung-Soo; Kim, Sang-Yeon; Kim, Min-Sik (2013). “Characteristics and Prognostic Implications of High-Risk HPV-Associated Hypopharyngeal Cancers”. PLoS ONE. 8 (11): e78718. doi:10.1371/journal.pone.0078718. ISSN 1932-6203.
  4. Guha, Neela; Warnakulasuriya, Saman; Vlaanderen, Jelle; Straif, Kurt (2014). “Betel quid chewing and the risk of oral and oropharyngeal cancers: A meta-analysis with implications for cancer control”. International Journal of Cancer. 135 (6): 1433–1443. doi:10.1002/ijc.28643. ISSN 0020-7136.
  5. Auluck A, Hislop G, Poh C, Zhang L, Rosin MP (2009). “Areca nut and betel quid chewing among South Asian immigrants to Western countries and its implications for oral cancer screening”. Rural Remote Health. 9 (2): 1118. PMC 2726113. PMID 19445556.
  6. Langevin SM, O’Sullivan MH, Valerio JL, Pawlita M, Applebaum KM, Eliot M, McClean MD, Kelsey KT (December 2013). “Occupational asbestos exposure is associated with pharyngeal squamous cell carcinoma in men from the greater Boston area”. Occup Environ Med. 70 (12): 858–63. doi:10.1136/oemed-2013-101528. PMC 4227396. PMID 24142981.
Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Faizan Sheraz, M.D. [3]

Overview

According to the National Cancer Institute and American Cancer Society, screening test for hypopharyngeal cancer is not recommended.

Screening

According to the National Cancer Institute and American Cancer Society, screening test for hypopharyngeal cancer is not recommended.

References

Natural History, Complications and Prognosis

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References

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 complications and prognosis
Diagnosis

Staging | History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

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