Role of radiotherapy

Squamous cell carcinomas rising from these sites are mostly poorly differentiated carcinomas; they tend to infiltrate the adjacent structures with involvement of the underlying cartilage and musculature with poorly defined borders. Owing to the lack of severe symptoms, tumors arising from the hypopharynx tend to be extensive, frequently with extensive cervical lymph node metastases, often bilateral. The principal nodes of involvement are the subdigastric, superior, deep jugular, midjugular, and para- and retropharyngeal nodes (Rouviere's nodes). The ominous premalignant field change seen elsewhere in the oral cavity is also significantly associated with carcinoma of the hypopharynx. Approximately 15 to 20% of the patients have a second primary neoplasm, either concurrently or sequentially, the most frequent areas of involvement being in the upper aerodigestive tracts. The majority of tumors, 60 to 70%, arise from the pyriform sinus and approximately one-fourth from the posterior pharyngeal wall. The postcricoid tumors are in fact tumors of the upper cervical esophagus and in the United States are the least common. Evaluation of the extent of the lesion calls for careful inspection of the hypopharynx by indirect laryngoscopy and digital palpation of the lesion. X-ray examinations, including plain films, xerograms, contrast studies, and polytomes, often yield invaluable information as to the extent of the disease, particularly in lesions of the posterior pharyngeal wall and carcinomas of the pyriform sinus for subglottic extension. The mobility of the laryngeal structures and the pliability of the lateral pharyngeal walls likewise can be studied by appropriate radiological examinations