Treatments for stage 4 hypopharyngeal cancer

The following are treatment options for stage 4 hypopharyngeal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Resectable hypopharyngeal cancer means that the cancer can be removed with surgery.

Surgery is the main treatment for stage 4 resectable hypopharyngeal cancer. It is used to remove the tumour along with a margin of healthy tissue around it. You may have a laryngopharyngectomy and a neck dissection. A laryngopharyngectomy removes part or all of the larynx (voice box), part or all of the pharynx (throat) and part of the esophagus. A neck dissection removes the lymph nodes in the neck (cervical lymph nodes).

Other procedures may be done to help with breathing and nutrition. These include:

• placement of a breathing tube (called a tracheostomy) to help you breathe
• placement of a feeding tube (usually a gastrostomy) to make sure you get enough nutrients

Surgery for hypopharyngeal cancer may affect your ability to speak and swallow. It may also affect your appearance. Reconstructive surgery is often done to improve the look and function of the mouth and neck as much as possible. It is usually done at the same time as the surgery to remove the hypopharyngeal tumour.

Chemoradiation is a main treatment for resectable stage 4 hypopharyngeal cancer. In chemoradiation, chemotherapy is given during the same time period as radiation therapy. The chemotherapy makes the radiation more effective.

For stage 4 resectable hypopharyngeal cancer, cisplatin is usually the chemotherapy drug given along with radiation to the tumour and lymph nodes on both sides of the neck.

External radiation therapy is a main treatment for resectable hypopharyngeal cancer. It is usually given along with chemotherapy (called chemoradiation) or a targeted therapy drug.

Intensity-modulated radiation therapy (IMRT) is a specialized type of external radiation therapy. It may be used to lessen the damage to tissues around the tumour.

Radiation for unresectable hypopharyngeal cancer is given to the tumour in the hypopharynx and lymph nodes in the neck. Where the radiation is given depends on where the tumour started and where the cancer has spread (metastasized).

Chemotherapy may be given with or without radiation therapy for resectable stage 4 hypopharyngeal cancer. It may be given before radiation therapy or chemoradiation. The most common chemotherapy drug combination used to treat hypopharyngeal cancer is cisplatin and fluorouracil. Sometimes another drug is added to this combination.

Unresectable hypopharyngeal cancer means that the cancer is too large or has spread too far to be completely removed by surgery.

Chemoradiation is a main treatment for unresectable stage 4 hypopharyngeal cancer. In chemoradiation, chemotherapy is given during the same time period as radiation therapy. The chemotherapy makes the radiation more effective.

For stage 4 unresectable hypopharyngeal cancer, cisplatin is usually the chemotherapy drug given along with radiation to the tumour and lymph nodes on both sides of the neck.

External radiation therapy is a main treatment for unresectable hypopharyngeal cancer. It is usually given along with chemotherapy (called chemoradiation) or a targeted therapy drug.

Intensity-modulated radiation therapy (IMRT) is a specialized type of external radiation therapy. It may be used to lessen the damage to tissues around the tumour.

Radiation for unresectable hypopharyngeal cancer is given to the tumour in the hypopharynx and lymph nodes in the neck. Where the radiation is given depends on where the tumour started and where the cancer has spread (metastasized).

Chemotherapy may be given with or without radiation therapy for unresectable stage 4 hypopharyngeal cancer. It may be given before radiation therapy or chemoradiation. The most common chemotherapy drug combination used to treat hypopharyngeal cancer is cisplatin and fluorouracil. Sometimes another drug is added to this combination.

You may be offered targeted therapy for unresectable stage 4 hypopharyngeal cancer. It is often combined with radiation therapy. Cetuximab (Erbitux) is the most common targeted therapy drug used to treat hypopharyngeal cancer.

You may be offered immunotherapy for metastatic hypopharyngeal cancer.

Pembrolizumab (Keytruda) may be used as a first-line therapy to treat metastatic hypopharyngeal cancer. It may be given with or without chemotherapy.

Nivolumab (Opdivo) may be used to treat metastatic hypopharyngeal cancer that has stopped responding to chemotherapy with platinum drugs such as cisplatin or carboplatin.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with hypopharyngeal cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.