Hypopharyngeal carcinoma is relatively rare, representing approximately 3% of all head and neck malignancies. It also is characterized by having one of the worst prognoses at time of diagnosis. This is largely due to its tendency for late presentation. This article will review current literature including as well as the National Comprehensive NCCN Guidelines Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) for the treatment of hypopharyngeal cancer. Hypopharyngeal cancer often presents in an advanced stage and its prognosis is notoriously poor. Treatment goals are similar to other carcinomas of the head and neck and treatment typically involves multiple modalities including surgery, radiation, and chemotherapy. Organ sparing nonsurgical therapy has shown comparable survival outcomes to surgery in early stage hypopharyngeal cancer. Treating hypopharyngeal cancer remains a challenging prospect for the head and neck oncologist. A multidisciplinary approach is essential due to the necessity of combined therapy treatment protocols. There is opportunity for novel treatments and prospective trials to improve outcomes in hypopharyngeal carcinoma. Disease prevention by targeting environmental risk factors is likely to have the greatest impact in this disease.