101 - Neoplasms of the Hypopharynx and Cervical Esophagus

Abstract

Neoplasms of the hypopharynx and cervical esophagus are some of the most challenging diseases managed by the head and neck surgeon. These tumors usually present at an advanced stage, and the majority of these lesions are squamous cell carcinoma (SCC). As with all advanced head and neck cancers, a multidisciplinary approach that involves head and neck surgeons, radiation oncologists, and medical oncologists is used in formulating a treatment plan. Unfortunately, the available modalities of treatment (surgery, chemotherapy, radiotherapy) yield a similar poor prognosis for patients with hypopharyngeal and cervical esophageal cancer. When primary surgically based approaches are utilized, a careful assessment of the tumor extent is critical because hypopharyngeal tumors can often have significant submucosal extension, which can have a great impact on the planned resection. Furthermore, the surgeon must consider the reconstructive challenges of the surgical defect, which impacts swallowing, speech, and respiration. When radiation and chemotherapy are used as initial modalities of therapy, great care must be taken to follow patients because of the high rate of stricture and the difficulty of surgical salvage after therapy. The goal of this chapter is to provide a comprehensive review of the anatomy, epidemiology, clinical presentation, staging, and treatment options for patients who develop cancers of the hypopharynx and cervical esophagus.