TUMOURS OF THE TUMOURS OF THE HYPOPHARYNXHYPOPHARYNX

DEPT OF DEPT OF OTORHINOLARYNGOLOGYOTORHINOLARYNGOLOGY

J J M M CJ J M M CDAVANAGEREDAVANAGERE

SUBSITES OF HYPOPHARYNXSUBSITES OF HYPOPHARYNX► Pyriform sinusPyriform sinus

► Post cricoid regionPost cricoid region

► Posterior Posterior pharyngeal wallpharyngeal wall

BENIGN TUMOURSBENIGN TUMOURS► Exceptionally uncommon: present as Exceptionally uncommon: present as

smooth well defined pedunculated smooth well defined pedunculated and mobile massand mobile mass

a)a) PapillomaPapillomab)b) AdenomaAdenomac)c) LipomaLipomad)d) FibromaFibromae)e) leiomyomaleiomyoma

MALIGNANT TUMOURSMALIGNANT TUMOURS► Carcinoma of the hypopharynx is Carcinoma of the hypopharynx is

very common in our country very common in our country ► Most of the tumours are squamous Most of the tumours are squamous

cell type with various grades of cell type with various grades of differentiationdifferentiation

► In order of frequency In order of frequency a)a) Pyriform sinus (60%)Pyriform sinus (60%)b)b) Post cricoid region (30%)Post cricoid region (30%)c)c) Posterior pharyngeal wall (10%) Posterior pharyngeal wall (10%)

CARCINOMA OF PYRIFORM CARCINOMA OF PYRIFORM SINUSSINUS

►Mostly affects male above 40 years of Mostly affects male above 40 years of ageage

►Growth is either Exophytic, ulcerative Growth is either Exophytic, ulcerative and deeply infiltrativeand deeply infiltrative

►Because of large size of pyriform sinus Because of large size of pyriform sinus growth of this region remain growth of this region remain asymptomatic for long timeasymptomatic for long time

►Metastatic neck nodes is the most Metastatic neck nodes is the most common presenting symptomcommon presenting symptom

CARCINOMA OF PYRIFORM CARCINOMA OF PYRIFORM SINUSSINUS

►Spread: localSpread: local Upwards: vallecula and base of tongueUpwards: vallecula and base of tongue Downwards: post cricoid regionDownwards: post cricoid region Medially: AE fold and ventricleMedially: AE fold and ventricle Laterally: thyroid cartilage, thyroid gland Laterally: thyroid cartilage, thyroid gland

and may present as soft tissue mass in and may present as soft tissue mass in neckneck

Lymphatic spread: upper and middle Lymphatic spread: upper and middle group of jugular cervical nodesgroup of jugular cervical nodes

Distant metastasis: occur late and may Distant metastasis: occur late and may be seen in lung, liver, bonebe seen in lung, liver, bone

CLINICAL FEATURESCLINICAL FEATURES►Metastatic neck nodes may be the first Metastatic neck nodes may be the first

signsign►Sticking/pricking sensation in throatSticking/pricking sensation in throat►Referred otalgiaReferred otalgia►OdynophagiaOdynophagia►DysphagiaDysphagia►Hoarseness of voiceHoarseness of voice►stridorstridor

DIAGNOSISDIAGNOSIS► Indirect laryngoscopyIndirect laryngoscopy►Barium swallowBarium swallow►Flexible nasopharyngoscopyFlexible nasopharyngoscopy►CT scan: helpful to evaluate the extent CT scan: helpful to evaluate the extent

of growth and status of nodesof growth and status of nodes►Direct laryngoscopy and biopsyDirect laryngoscopy and biopsy

Treatment Treatment ► Early growth without nodes: radiotherapy Early growth without nodes: radiotherapy

(preserves voice)(preserves voice)►Growth limited to pyriform fossa: total Growth limited to pyriform fossa: total

laryngectomy and partial pharyngectomy and laryngectomy and partial pharyngectomy and pharyngeal reconstruction often combined pharyngeal reconstruction often combined with neck dissectionwith neck dissection

►Growth extending to post cricoid region: total Growth extending to post cricoid region: total laryngopharyngectomy with block dissection. laryngopharyngectomy with block dissection. Pharyngo-oesophageal segment is Pharyngo-oesophageal segment is reconstructed with myocutaneous flap or reconstructed with myocutaneous flap or gastric pull up gastric pull up

► Post operative radiotherapy Post operative radiotherapy

CARCINOMA OF POST CRICOID CARCINOMA OF POST CRICOID REGIONREGION

►Constitutes 30% of hypopharyngeal Constitutes 30% of hypopharyngeal tumourstumours

►Plummer-Vinson syndrome is an important Plummer-Vinson syndrome is an important etiological factor (seen in 1/3etiological factor (seen in 1/3rdrd of patients) of patients)

►Spread: local spread to cervical Spread: local spread to cervical oesophagus, arytenoids, RLN and oesophagus, arytenoids, RLN and cricoarytenoid jointcricoarytenoid joint

►Lymphatic spread to paratracheal nodes, Lymphatic spread to paratracheal nodes, may be bilateral due to midline nature of may be bilateral due to midline nature of lesion lesion

CARCINOMA OF POST CRICOID CARCINOMA OF POST CRICOID REGIONREGION

►Clinical features: females are usually Clinical features: females are usually affected in the age group of 20-40affected in the age group of 20-40

►Progressive dysphagia (predominant Progressive dysphagia (predominant presenting symptom)presenting symptom)

►Voice changeVoice change►Weight lossWeight loss►Diagnosis: indirect laryngoscopy, Diagnosis: indirect laryngoscopy,

laryngeal crepitus will be lost, lateral laryngeal crepitus will be lost, lateral soft tissue neck x-ray, CT scan, barium soft tissue neck x-ray, CT scan, barium swallow, direct laryngoscopy and swallow, direct laryngoscopy and biopsybiopsy

CARCINOMA OF POST CRICOID CARCINOMA OF POST CRICOID REGIONREGION

►Treatment: prognosis is poor with Treatment: prognosis is poor with irradiation and surgical treatmentirradiation and surgical treatment

►Radiotherapy: preserves laryngeal Radiotherapy: preserves laryngeal functionfunction

►Surgical: laryngo-pharyngo-Surgical: laryngo-pharyngo-oesophagectomy with gastric pull up oesophagectomy with gastric pull up or colon transposition for or colon transposition for reconstructionreconstruction

CARCINOMA OF POSTERIOR CARCINOMA OF POSTERIOR PHARYNGEAL WALLPHARYNGEAL WALL

► Least common hypopharyngeal malignancyLeast common hypopharyngeal malignancy► Mostly seen in males above 50 years of ageMostly seen in males above 50 years of age► Spread: prevertebral fascia, muscles and vertebraeSpread: prevertebral fascia, muscles and vertebrae► Lymphatic: usually bilateral, retropharyngeal and Lymphatic: usually bilateral, retropharyngeal and

deep cervical nodes involveddeep cervical nodes involved► Clinical features: dysphagia, metastatic neck nodeClinical features: dysphagia, metastatic neck node► Diagnosis: indirect laryngoscopy, lateral soft tissue Diagnosis: indirect laryngoscopy, lateral soft tissue

neck x-ray, CT scan, direct laryngoscopy and biopsyneck x-ray, CT scan, direct laryngoscopy and biopsy► Treatment: early lesions Treatment: early lesions radiotherapy radiotherapy early small lesionsearly small lesions surgery by lateral surgery by lateral

pharyngotomy approach pharyngotomy approach advanced lesionsadvanced lesions

laryngopharyngectomy with block dissectionlaryngopharyngectomy with block dissection