Diagnosing Hypopharyngeal Cancer

Doctors at NYU Langone are experts in diagnosing hypopharyngeal cancer. The hypopharynx is the bottom part of the pharynx, or throat. This tube-like structure carries air from the nose and mouth to the trachea, or windpipe. It also transports food and liquid from the mouth to the esophagus, which is the muscular tube that delivers these contents to the stomach.

Most hypopharyngeal cancers develop in squamous cells, which are thin, flat cells that line the hypopharynx.

Risk Factors and Symptoms of Hypopharyngeal Cancer

Smoking and alcohol use, especially when combined, increase the risk of developing hypopharyngeal cancer. NYU Langone doctors encourage people to stop smoking and to drink in moderation—no more than two drinks per day for men and no more than one drink per day for women. Talk with your doctor about how to find support if you want to cut back. If you smoke, NYU Langone’s Tobacco Cessation Programs offer the guidance and support you need to quit.

Symptoms of hypopharyngeal cancer include voice changes, difficulty swallowing because of food pooling at the back of the throat, throat pain, or a painless lump in the neck.

To diagnose the condition, doctors ask about your symptoms and medical history, which usually includes questions about alcohol consumption and smoking.

Doctors also perform a physical exam. During this exam, doctors look and feel for masses in the head and neck and examine your lymph nodes. Lymph nodes are small bean-shaped organs that make and store lymphocytes, white blood cells that help fight infection. Lymphocytes travel throughout the body through a network of lymph vessels. Hypopharyngeal cancer cells can spread through these vessels to the lymph nodes in the neck, causing them to swell.

Doctors may also conduct one or more of the following tests.

Endoscopy

If a doctor suspects a tumor is present, he or she inserts an endoscope—a thin, lighted tube with a lens at the tip that transmits images to a monitor—through the nose and into the throat to view the hypopharynx.

The procedure can be performed in the doctor’s office with no anesthesia, although an anesthetic spray may be used to numb the nose and throat.

Biopsy

If the doctor identifies a suspicious growth in the hypopharynx, he or she can take a tissue sample, or biopsy. A pathologist examines the sample under a microscope to determine whether or not it contains cancer.

Your doctor can perform a biopsy at the same time as endoscopy. To do so, he or she passes small surgical tools through or alongside the scope to take a tissue sample. Doctors use local anesthesia for this type of biopsy. You can go home the same day. You may experience a sore throat, hoarseness, or mild bleeding for several days afterward.

If access to a lesion is challenging or if doctors need a more thorough look at a tumor, they can perform a biopsy of a hypopharyngeal growth in a hospital operating room, using general anesthesia. This type of biopsy is also an option if you cannot tolerate an awake procedure. You can usually go home the same day, after the anesthesia has worn off.

Fine Needle Aspiration

If your doctor notices a swollen lymph node in the neck, he or she may perform a fine needle aspiration in the office. During this procedure, a small needle is used to withdraw fluid and cells, which are examined under a microscope for signs of cancer. The doctor may numb the area with a topical anesthetic before the procedure.

CT Scans

After you receive a diagnosis of hypopharyngeal cancer, a doctor may recommend a CT scan to determine whether the cancer has spread to nearby lymph nodes or other structures. These may include the esophagus and the larynx, or voice box, which contains the vocal cords.

A CT scan creates detailed cross-sectional images of the body using X-rays and a computer. A special dye may be injected into a vein in the arm to enhance the CT image.

PET Scans

To determine whether hypopharyngeal cancer has spread, your doctor may order a PET scan, which creates images of the entire body. This test requires an intravenous (IV) infusion of radioactive glucose, or sugar, into a vein.

The scan provides information about the tissue’s metabolic activity by showing how quickly a growth processes sugar. The more quickly the tissue metabolizes the sugar, the more likely it is to be cancerous.

Doctors may perform a combined PET/CT scan to provide more detailed information about the hypopharyngeal cancer and whether it has spread.

PET/MRI Scans

This imaging technology combines a PET scan and an MRI scan, which creates images of the body using a magnetic field and radio waves. The combined scan, available to patients enrolled in clinical trials, may provide a better view of cancer that has spread to other parts of the body than a PET scan alone.