Hypopharyngeal carcinoma
| Classification according to ICD-10 | |
|---|---|
| C13 | Malignant neoplasm of the hypopharynx |
| ICD-10 online (WHO version 2019) | |
The hypopharyngeal carcinoma ( Eng. "Throat cancer") is a cancer belonging to the head and neck cancer . It is almost exclusively squamous cell carcinoma .
anatomy
The hypopharynx , also known as the laryngopharynx, is one of three areas of the human throat ( pharynx ). It forms the swallowing street at the level of the larynx skeleton. It is the lowest ( Greek hypo = "below") part of the throat from the upper edge of the epiglottis to the upper mouth of the esophagus , or an imaginary line at the level of the cricoid cartilage of the larynx (larynx).
For the hypopharynx itself, three sub-districts are defined:
- The piriform sinus , which extends caudally to the mouth of the esophagus on both sides of the aryepiglottic fold ( plica aryepiglottica ) . About 60% of all hypopharyngeal carcinomas arise in the piriform sinus .
- The post-cricoid region that runs from the outer posterior wall of the larynx to the lower edge of the cricoid cartilage. About 30% of hypopharyngeal cancers develop in this region.
- The posterior wall of the hypopharynx, in which about 10% of all hypopharyngeal carcinomas originate.
In many cases, the exact location of the formation cannot be precisely located at the initial diagnosis due to the advanced growth, as the larynx is often already infiltrated. The tumor spreads rapidly because there are no morphological barriers.
Epidemiology
Malignant tumors of the lower pharynx are rare, accounting for 2 to 8 percent of head and neck carcinomas. Men are affected much more often than women.
The maximum age is between the ages of fifty and sixty. The proportion of men to women in diseases is in the range from 4: 1 to 8: 1. Due to the generally observable increase in tobacco and alcohol abuse among women, the ratio has slowly adjusted in recent years.
etiology
As is the case with many malignant tumors in the head and neck area, smoking and alcohol consumption are the main causes of illness. The interaction between alcohol and nicotine is crucial here.
Other risk factors include exposure to certain oils, metal dusts (e.g. nickel ), coal and tar products, and asbestos cement .
Poor oral hygiene and a genetic predisposition obviously also play a role in the development of the disease.
Symptoms
The symptoms are mostly uncharacteristic. For example, unclear swallowing difficulties, globus syndrome , bad breath or a "scratchy throat". However, these symptoms can also have many other causes. Late symptoms include swallowing inability spitting of blood to the ears radiating pain and neck lymph node metastasis .
diagnosis
In many cases, hypopharyngeal carcinoma can already be diagnosed by a mirror examination . As a rule, a pan endoscopy of the entire pharynx is also performed under anesthesia . Small tissue samples are taken from the patient by biopsy , which are examined in fine tissue to confirm the diagnosis .
Imaging methods such as computed tomography (CT) or magnetic resonance tomography (MRT) are used for tumor staging and therapy planning . This allows the neck lymph nodes to be examined and assessed. In principle, this can also be done by sonography (ultrasound).
The stage of hypopharyngeal carcinoma is classified as follows:
- T1 tumor limited to one area ( piriform sinus , retrocricoid region, posterior wall of the hypopharynx)
- T2 tumor spread to several districts or neighboring districts without fixation to the surroundings
- T3 tumor spread to several districts or neighboring districts with fixation to the surroundings, e.g. B. Larynx, esophageal entrance or oropharynx
- T4 tumor extension exceeds the hypopharynx with massive tumor invasion into the surrounding area such as the larynx, cervical soft tissues and other neighboring organs
therapy
Smaller hypopharyngeal carcinomas can be removed with laser surgery . Under certain circumstances, areas of the closely adjacent larynx must also be removed. As a rule, a therapy method is chosen that allows the speech function to be retained after the tumor has been eliminated, but in more advanced tumors the entire larynx must often be removed as well. The voice rehabilitation then takes place as with larynx cancer . If larger parts of the pharyngeal tube have to be removed, local or pedicled flaps are used to restore the food pathway. Since lymph node metastases often occur, a functional neck dissection is usually also carried out.
In many cases, radiation therapy , often in combination with chemotherapy , is also performed after the operation.
forecast
Compared to other carcinomas of the upper respiratory tract and food tract, the prognosis for hypopharyngeal carcinoma is extremely poor. The cause is the high incidence of regional and distant metastases and the frequent development of secondary cancers. The very late recognition of the initial symptoms also worsens the prognosis considerably.
Individual evidence
- ↑ Mast, G, Tumorzentrum München (Ed.): Head and Neck Malignancies: Recommendations for Diagnosis, Therapy and Follow-up Care ( whereby squamous cell carcinoma as the most common form of malignancy takes up most of the space ... ) , 5th edition, W. Zuckschwerdt Verlag, Germering near Munich 2014, ISBN 978-3-86371-134-4 .
- ^ NC Gellrich et al.: Head and Neck Tumors - Recommendations for Diagnostics, Therapy and Follow-up Care , 1st edition, Tumorzentrum Freiburg, April 2004.
- ↑ Sebastian Bürger: Hypopharyngeal carcinoma - oncological and functional results after laser surgery and traditional treatment . dissertation.de, Berlin 2002, ISBN 978-3-89825-417-5 .
- ↑ a b c d R. Jakse et al: head / neck malignancies. ( Memento from August 2, 2011 in the Internet Archive ) Austrian Society for Surgical Oncology, accessed on January 30, 2008.
- ↑ a b c d e Malignant diseases of the head and neck area . Heidelberg University Hospital. Retrieved April 18, 2017.
- ^ Health North Hesse: What is throat cancer? ( Memento from May 28, 2013 in the Internet Archive )
- ↑ M. Bremke: Value of the planned neck dissection after primary radio-chemotherapy of oropharyngeal and hypopharyngeal carcinomas in stage IV. (PDF; 1.1 MB), dissertation. Philipps University of Marburg, 2007.
literature
- S. Bürger: Hypopharyngeal carcinoma - oncological and functional results after laser surgery and conventional treatment. Dissertation . University of Hamburg, 2000.
- M. Bremke: Value of the planned neck dissection after primary radio-chemotherapy for oropharyngeal and hypopharyngeal carcinomas in stage IV. Dissertation. Philipps University of Marburg, 2007. (PDF file; 1.09 MB)
