Stages of Hypopharyngeal Cancer

After hypopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the hypopharynx or to other parts of the body.

The process used to find out if cancer has spread within the hypopharynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests and procedures used to diagnose hypopharyngeal cancer are often also used to stage the disease.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if hypopharyngeal cancer spreads to the lung, the cancer cells in the lung are actually hypopharyngeal cancer cells. The disease is metastatic hypopharyngeal cancer, not lung cancer.

The following stages are used for hypopharyngeal cancer:

The staging described below is only used for patients who have not had lymph nodes in the neck removed and checked for signs of cancer.

Stage 0 (carcinoma in situ)

In stage 0, abnormal cells are found in the lining of the hypopharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed in only one area of the hypopharynx and/or the tumor is 2 centimeters or smaller.

Stage II

In stage II, the tumor is:

• found in more than one area of the hypopharynx or in a nearby area; or
• larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx (voice box).

Stage III

In stage III, the tumor:

• is larger than 4 centimeters or has spread to the larynx (voice box) or the mucosa (inner lining) of the esophagus. Cancer may have spread to one lymph node on the same side of the neck as the tumor. The affected lymph node is 3 centimeters or smaller; or
• has spread to one lymph node on the same side of the neck as the tumor. The affected lymph node is 3 centimeters or smaller. Cancer is also found:
  • in only one area of the hypopharynx and/or the tumor is 2 centimeters or smaller; or
  • in more than one area of the hypopharynx or in a nearby area, or the tumor is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC as follows:

• In stage IVA, the tumor:
  • has spread to the thyroid cartilage, the bone above the thyroid cartilage, the thyroid gland, the cartilage around the trachea, the esophageal muscle, or the nearby muscles and fatty tissue in the neck. Cancer may have also spread to one lymph node on the same side of the neck as the tumor. The affected lymph node is 3 centimeters or smaller; or
  • is found in the hypopharynx and may have spread to the thyroid cartilage, the bone above the thyroid cartilage, the thyroid gland, the cartilage around the trachea, the esophagus, or the nearby muscles and fatty tissue in the neck. Cancer has spread to one of the following:
    • one lymph node on the same side of the neck as the tumor. The affected lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
    • more than one lymph node anywhere in the neck. The affected lymph nodes are 6 centimeters or smaller.

• In stage IVB, the tumor:
  • may be any size and cancer may have spread to the thyroid cartilage, the bone above the thyroid cartilage, the thyroid gland, the cartilage around the trachea, the esophagus, or the nearby muscles and fatty tissue in the neck. Cancer has spread to a lymph node that is larger than 6 centimeters or has spread through the outside covering of a lymph node into nearby connective tissue; or
  • has spread to the connective tissue covering the muscles that support the spinal column, the area around the carotid artery, or the area between the lungs. Cancer may have also spread to lymph nodes in the neck.

• In stage IVC, cancer has spread to other parts of the body, such as the lung, liver, or bone.

After surgery, the stage of the cancer may change and more treatment may be needed.

If the cancer is removed by surgery, a pathologist will examine a sample of the cancer tissue under a microscope. Sometimes, the pathologist’s review results in a change to the stage of the cancer and more treatment is needed after surgery.

Hypopharyngeal cancer can recur (come back) after it has been treated.

The cancer may come back in the hypopharynx or in other parts of the body.