Radiology and Physical Medicine

Pyriform sinus cancer Carcinoma de seno piriforme

July 9, 2014 | Translate

Hypopharyngeal cancer is rare and highly related with heavy smoking and alcohol consumption. It usually appears as a squamous carcinoma, infiltrating the submucosae and producing distant metastasis.

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Complementary tests:

Cancer of hypopharynx tends to infiltrate the submucosae, which cannot be detected by the symptoms nor endoscopy. CT is the first tool to evaluate locoregional extension of tumors in the maxillofacial and ENT area. MRI is reserved for cases in which CT is doubtful, or to complete the information obtained in it. The appearance of distant metastasis and the existence of primary tumor in a different location are common, and due to that the use of these techniques is essential1.

Treatment:

Pyriform sinus cancer is usually diagnosed in advanced stages in which the adjacent structures already are affected2. Retrospective studies demonstrate that 80 % of the patients presented a III or IV stage in the moment of the diagnosis, due to a paucity of symptoms3. The traditional treatment approach consists on surgery and adjuvant radiotherapy. Nevertheless, the administration of neoadjuvant chemotherapy has appeared to be very useful for locoregional management of the disease and organ preservation, especially if lymphatic nodes are affected, like in the case given4. Functional organ preservation is always recommended, especially if the larynx is involved. By avoiding the surgery the survival does not increase but patient’s quality of life does, as the patient will keep his ability to speech and swallowing5.

References:

1. Spector JG, Sessions DG, Haughey BH, et al.: Delayed regional metastases, distant metastases, and second primary malignancies in squamous cell carcinomas of the larynx and hypopharynx. Laryngoscope 111 (6): 1079-87, 2001. [PUBMED Abstract]

2.Karatzanis AD, Psychogios G, Waldfahrer F, Kapsreiter M, Zenk J, Velegrakis GA, et al. Management of locally advanced laryngeal cancer. Journal of Otolaryngology-Head & Neck Surgery. 2014;43.

3.http://www.sciencedirect.com/science/article/pii/S2173573509700912

4. Mak MP, Glisson BS. Is there still a role for induction chemotherapy in locally advanced head and neck cancer? Current Opinion in Oncology. 2014;26(3):247-51.

5.Steiner W, Ambrosch P, Hess CF, Kron M. Organ preservation by transoral laser microsurgery in piriform sinus carcinoma. Otolaryngol Head Neck Surg 2001; 124:58.

 

Author: Macarena Valenzuela de Damas
4º Course, Medicine. Granada University

El cáncer de hipofaringe es un cáncer poco común, muy relacionado con hábitos tóxicos como el consumo de alcohol y tabaco. Suelen presentarse como carcinoma escamoso que infiltra la submucosa y produce metástasis a distancia.

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Pruebas diagnósticas complementarias:

Los tumores de hipofaringe tienden a infiltrar la submucosa, lo que no se detecta mediante la clínica o la endoscopia. La TAC es la técnica de elección para valorar la extensión locorregional de los tumores del área maxilofacial y ORL. La resonancia magnética se reserva para casos en los que la TAC sea dudosa, o para completar los datos obtenidos en ella. Además es muy frecuente la aparición metástasis a distancia y la existencia de tumor primario de diferente localización, que haría necesaria la realización de estas técnicas 1.

Tratamiento:

El cáncer de seno piriforme suele diagnosticarse en estadios avanzados en los que las estructuras adyacentes ya están afectadas2. Estudios retrospectivos demuestran que el 80% de los pacientes presentaban un estadio III o IV en el momento del diagnóstico, debido a su clínica inespecífica3. El tratamiento tradicional consiste en cirugía y radioterapia adyuvante.  Sin embargo, la administración de quimioterapia neoadyuvante se ha mostrado de gran utilidad para el control locorregional de la enfermedad y la preservación anatómica, sobre todo si hay adenopatías asociadas, como en este caso4. Siempre que se pueda se intentara la preservación anatómica, en este caso de la laringe. Al evitar la cirugía, no se aumenta la supervivencia pero sí la calidad de vida del paciente que mantendrá su capacidad de tragar y fonatoria 5.

Bibliografía:

1. Spector JG, Sessions DG, Haughey BH, et al.: Delayed regional metastases, distant metastases, and second primary malignancies in squamous cell carcinomas of the larynx and hypopharynx. Laryngoscope 111 (6): 1079-87, 2001. [PUBMED Abstract]

2. Karatzanis AD, Psychogios G, Waldfahrer F, Kapsreiter M, Zenk J, Velegrakis GA, et al. Management of locally advanced laryngeal cancer. Journal of Otolaryngology-Head & Neck Surgery. 2014;43.

3. http://www.sciencedirect.com/science/article/pii/S2173573509700912

4. Mak MP, Glisson BS. Is there still a role for induction chemotherapy in locally advanced head and neck cancer? Current Opinion in Oncology. 2014;26(3):247-51.

5. Steiner W, Ambrosch P, Hess CF, Kron M. Organ preservation by transoral laser microsurgery in piriform sinus carcinoma. Otolaryngol Head Neck Surg 2001; 124:58.

 

Autora: Macarena Valenzuela de Damas
4º Curso, Grado de Medicina. Universidad de Granada

Categorised in: Clinical Cases