Hypopharyngeal cancer: United Kingdom National Multidisciplinary Guidelines

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. With an age standardised incidence rate of 0.63 per 100 000 population, hypopharynx cancers account for a small proportion of the head and neck cancer workload in the UK, and thus suffer from the lack of high level evidence. This paper discusses the evidence base pertaining to the management of hypopharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care. Recommendations Cross-sectional imaging with computed tomography of the head, neck and chest is necessary for all patients; magnetic resonance imaging of the primary site is useful particularly in advanced disease; and computed tomography and positron emission tomography to look for distant disease. (R) Careful evaluation of the upper and lower extents of the disease is necessary, which may require contrast swallow or computed tomography and positron emission tomography imaging. (R) Formal rigid endoscopic assessment under general anaesthetic should be performed. (R) Nutritional status should be proactively managed. (R) Full and unbiased discussion of treatment options should take place to allow informed patient choice. (G) Early stage disease can be treated equally effectively with surgery or radiotherapy. (R) Endoscopic resection can be considered for early well localised lesions. (R) Bulky advanced tumours require circumferential or non-circumferential resection with wide margins to account for submucosal spread. (R) Offer primary surgical treatment in the setting of a compromised larynx or significant dysphagia. (R) Midline lesions require bilateral neck dissections. (R) Consider management of silent nodal areas usually not addressed for other primary sites. (G) Reconstruction needs to be individualised to the patients' needs and based on the experience of the unit with different reconstructive techniques. (G) Consider tumour bulk reduction with induction chemotherapy prior to definitive radiotherapy. (R) Consider intensity modulated radiation therapy where possible to limit the consequences of wide field irradiation to a large volume. (R) Use concomitant chemotherapy in patients who are fit enough and consider epidermal growth factor receptor blockers for those who are less fit. (R)