Hypopharyngeal cancer: symptoms, diagnosis and treatment in the UK

The pharynx, or throat, is the passage that runs from the back of the nose and mouth down towards the food pipe and windpipe. Macmillan Cancer Support divides it into three parts: the nasopharynx, the oropharynx and the hypopharynx. The hypopharynx is the lowest part, sitting behind the voice box (larynx). Air passes along it into the airways to the lungs, and food and drink pass through it on the way to the gullet.

Hypopharyngeal cancer is a cancer that starts in the cells lining this area. It belongs to the family of head and neck cancers, which Macmillan describes as cancers that begin in places such as the mouth, throat, nose and sinuses, salivary glands and middle ear. Because it sits close to the larynx, its symptoms and treatment overlap with those of laryngeal cancer, and the two are often discussed together by the same specialist teams.

Cancer Research UK explains that laryngeal cancer is a type of head and neck cancer that begins in the voice box. For hypopharyngeal cancer specifically, patient information is sparser than for more common cancers, so this guide draws on Macmillan's head and neck cancer information and on Cancer Research UK's laryngeal cancer pages for the points that overlap.

Macmillan says the symptoms of head and neck cancer depend on where the cancer started. Symptoms that do not go away include a lump in the neck, a sore throat, hoarseness and problems swallowing. The most common place for head and neck cancer to spread is the lymph nodes in the neck, which can cause a swollen node.

Cancer Research UK's guidance on laryngeal cancer, which sits next to the hypopharynx, lists a hoarse voice that lasts more than 3 weeks, pain or difficulty swallowing, shortness of breath or a cough that will not go away, a lump or swelling in the throat or neck, weight loss when not dieting, an earache that does not go away and bad-smelling breath. Many of these are far more often caused by common conditions such as infections or acid reflux, but it recommends that they are checked.

• A sore throat, hoarseness or voice change that does not settle.

• Pain or difficulty swallowing, or a feeling of something stuck in the throat.

• A lump or swelling in the neck.

• An earache that does not go away.

• Weight loss without dieting.

• Noisy breathing or shortness of breath. Cancer Research UK says shortness of breath and stridor are serious symptoms that should not be ignored and need urgent medical attention.

Macmillan states that the main risk factors for head and neck cancer are tobacco and alcohol, especially when combined. Cancer Research UK says the same for laryngeal cancer: smoking tobacco and drinking alcohol are the factors that increase risk, and there are some other risk factors.

Many cancers of the oropharynx are linked to infection with human papillomavirus (HPV), but Macmillan describes that link specifically for oropharyngeal cancer rather than for the hypopharynx. Having risk factors does not mean someone will develop cancer, and some people with head and neck cancer have none of them.

Macmillan explains that with certain symptoms you may be seen by a specialist within 2 weeks, which is called an urgent referral. An urgent referral is a route to a quick check, not a diagnosis. Cancer Research UK adds that you usually start by seeing your GP, who will examine you and might refer you for tests or to a specialist.

The tests Macmillan describes for head and neck cancer include an ultrasound scan of the neck, removing a sample of tissue from a lump (a biopsy) and nasendoscopy, a test that looks at the back of the mouth, nose and throat. A biopsy of an abnormal-looking area may be taken on its own or during other tests. CT and PET-CT scans give a more detailed picture of the part of the body being scanned and help work out whether the cancer has spread.

Macmillan describes the stage of a cancer as its size and whether it has spread from where it started. Staging is slightly different for each type of head and neck cancer, and the result is central to deciding on treatment.

Macmillan says treatment for head and neck cancer depends on where the cancer is, its type and stage, the best way to maintain appearance, speech and swallowing, your general health and your preferences. A multidisciplinary team (MDT) plans care, and doctors aim to keep the effect on appearance, speech, swallowing and eating as small as possible. Because Macmillan says hypopharyngeal cancer may be treated in the same way as laryngeal cancer, the options below apply.

Macmillan says that after treatment you will have regular follow-up appointments for several years, and that you should report new symptoms such as a new ulcer or lump in the neck, pain, or difficulty swallowing or speaking. Preparing for treatment can include dental checks, dietary advice and help to stop smoking or reduce drinking, which can make treatment work better and reduce side effects.

Changes to speech, chewing and swallowing are among the main concerns. Macmillan notes that if an operation causes small changes to speech, chewing or swallowing, people can usually adapt to these quickly, and says treatment is planned to keep such changes as small as possible. Specialist support for speech and swallowing is a normal part of head and neck cancer care, and your team can explain what is available.

In the UK, suspected head and neck cancer is usually referred from the GP into an urgent NHS pathway, with treatment planned by a specialist MDT. Private consultations and scans are available to some people and may speed up an initial assessment, but a confirmed diagnosis still leads into the same specialist multidisciplinary planning, so it is worth asking how any private findings will be shared with the team that will treat you.