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Pyriform Sinus Cancer

The hypopharynx extends from the plane of the hyoid bone above to the plane of the lower border of the cricoid cartilage below. It does not include the larynx and has 3 parts: the pyriform sinus, the postcricoid area, and the posterior pharyngeal wall. The lymphatic drainage from the pharynx is into the jugulodigastric, jugulo-omohyoid, upper and middle deep cervical, and retropharyngeal nodes. This anatomic region when involved by cancer does not give rise to symptoms until late in the course of the disease. As a result of this fact and the high incidence of metastasis early in the course of the disease, survival rates for carcinoma of the hypopharynx are perhaps the lowest of all sites in the head and neck. Almost all malignancies arising in this region are squamous cell carcinomas. A history of excess use of tobacco or alcohol is commonly associated with these malignancies. The Plummer-Vinson syndrome, characterized clinically by achlorhydria, sideropenic anemia, and atrophy of the mucous membranes of the mouth, pharynx, and esophagus, is frequently associated with carcinoma of the hypopharynx, oral cavity, or esophagus in women.

The pyriform sinus is the most frequently involved site in the hypopharynx. Postcricoid and posterior hypopharyngeal wall carcinomas account for only one- third of hypopharyngeal cancers. Cervical node metastasis is frequent, occurring in 70% of pyriform sinus lesions, 40% of postcricoid carcinomas, and 50% of posterior hypopharyngeal wall lesions. (See NCI physician or patient site)

The results with radiation alone are satisfactory in early stage patients (here) but for patients with advanced disease the results are best with surgery followed by postoperative radiation. MDA reported T3-4N2-3 81% local control and 23% NED survival at 3 years and in a more recent study an 89% rate of local control and 50% survival. A series from Hong Kong reported the following survival stats with combined surgery/radiation: stage I (74%) stage II (63%) stage III (32%) and stage IV (14%). A French study reported the following local control with combined therapy: T1-2N1-2 (69%) T1-2N2-3 (34%) T3-4N) (68%) T3-4N2-3 (28%). Most of the patients with advanced hypopharynx are now treated with chemotherapy plus radiation (see chemoradiation here).

 

(see anatomy #1, anat #2, #3, #4, #5 CT Images, more CT, PET-CT, port film, survival stats, radiation results)  also see guidelines from  the NCCN, review#1 and review#2