Deciding on a Treatment Plan 

Before starting treatment, your doctor will make sure that the following steps are completed:

 Pre-treatment Evaluation

A full history and physical examination, including a complete head and neck exam (mirror and fibreoptic exam if needed)

  • An evaluation by the members of a head and neck cancer team
  • A biopsy of the primary site or FNA of the neck to confirm a diagnosis of cancer
  • Imaging of the lungs to check for spread, if needed
  • Imaging of the primary tumour and the neck with CT and/or MRI
  • Maybe a PET-CT for advanced cancers
  • Examination under anaesthesia with endoscopy
  • A dental evaluation
  • Nutrition, speech, and swallowing evaluation and maybe even a hearing evaluation
  • Pulmonary function tests may be considered if a candidate for conservation surgery
  • Pre-treatment medical clearance and evaluation of the risks of anaesthesia

Then your doctor will recommend a course of treatment for you, depending on several factors.

As with all cancers in the head and neck, there are three general options to consider:

  • Surgical removal(with or without reconstruction)
  • Radiation(a few different types)
  • Medications(chemotherapy and biologic medications)

For hypopharynx cancer, there is not one clear treatment method. You should have an extensive discussion with your cancer team to decide upon the best treatment course for you personally. The options that your doctor will recommend will likely be as follows, based on the stage of cancer that you have:

 

Most T1, N0 

Select T2, N0 (not requiring total laryngectomy)

For cancers in this category that do not require removal of the voice box to get the cancer completely out, there are several options:

·         Radiation alone, followed by surgery if the cancer remains

·         Partial laryngopharyngectomy with neck dissection

·         A clinical trial

If the first treatment that you and your doctor decide upon is surgical removal of the cancer, then the cancer has to be analysed under the microscope to determine if additional treatment is needed. Your doctors will be on the lookout for any adverse features (red flags).

·         If there are no adverse features, then no additional treatment is necessary.

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·         If the adverse features include spread of cancer outside of the capsule of the lymph node with or without positive margins, then chemotherapy and radiation will be recommended.

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·         If there is cancer at the margins of the surgical removal, then either additional surgical removal, or radiation alone are recommended. Chemotherapy and radiation may be considered but only for T2 tumours.

If there are other adverse features, then either radiation alone is recommended or radiation along with chemotherapy may be considered.

Advanced cancer requiring pharyngectomy with total laryngectomy 

T1, N+

T2-3, Any N

For cases in which removing the hypopharynx cancer will require a total laryngectomy, there are a few options for the initial treatment:

·         Chemotherapy along with radiation, followed by surgical removal if any cancer is left over or comes back.

·         Surgery to remove the larynx and pharynx (laryngopharyngectomy) with neck dissection, followed by either radiation alone or chemotherapy with radiation, depending on pathology. If there are no adverse features, then no additional treatment is necessary.

·         Induction chemotherapy followed by either radiation alone, chemotherapy with radiation or surgery, depending on the response to initial chemotherapy.

·         A clinical trial

T4a, Any N  In these cases of a large primary tumour, there are still a few options:

·         Surgical removal along with a neck dissection followed by radiation alone or chemotherapy with radiation, depending on pathology.

·         Chemotherapy with radiation, followed by surgery if cancer remains or comes back.

·         Induction chemotherapy followed by radiation alone, radiation with chemotherapy or surgical removal, depending on the response to initial chemotherapy

·         A clinical trial