Hypopharyngeal cancer diagnostic study of choice: Difference between revisions

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{{Hypopharyngeal cancer}}
{{Hypopharyngeal cancer}}
{{CMG}}; {{AE}}
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== Overview ==
== Overview ==
The [[diagnostic]] study of choice for hypopharyngeal cancer is [[CT scan]] with [[contrast]] of [[head]] and [[neck]]. The definitive [[diagnosis]] of hypopharyngeal cancer is [[biopsy]] of the [[tumor]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
*[[Diagnostic]] study of choice for hypopharyngeal cancer is [[CT scan]] with [[contrast]] of [[head]] and [[neck]].<ref>{{cite book | last = Edge | first = Stephen | title = AJCC cancer staging manual | publisher = Springer | location = New York | year = 2010 | isbn = 978-0-387-88440-0 }}</ref>
*Definitive [[diagnosis]] of hypopharyngeal cancer is [[biopsy]] through [[endoscopy]].<ref name="pmid12560383">{{cite journal| author=Helliwell TR| title=acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx. | journal=J Clin Pathol | year= 2003 | volume= 56 | issue= 2 | pages= 81-5 | pmid=12560383 | doi= | pmc=PMC1769882 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12560383  }} </ref>


=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].


OR
==Staging==


The following result of [gold standard test] is confirmatory of [disease name]:
According to the American Joint Committee of Cancer (AJCC) [[TNM staging system]], there are 5 stages of hypopharyngeal cancer based on the [[tumor]] size, [[lymph]] node involvement, and distant [[metastasis]].
* [Result 1]
* [Result 2]


OR
*The following stages are used for hypopharyngeal cancer:<ref name="urlHypopharyngeal Cancer Stages">{{cite web |url=https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer/detection-diagnosis-staging/hypopharyngeal-staging.html |title=Hypopharyngeal Cancer Stages |format= |work= |accessdate=}}</ref>
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |AJCC
Stage
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Stage
Grouping
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Stage description
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |0
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Tis
N0


[Name of the investigation] must be performed when:
M0
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
|
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
* The [[tumor]] is only in the top layer of cells lining the inside of the [[hypopharynx]] and has not grown any deeper (Tis).


OR
* [[Cancer]] has not spread to nearby [[lymph nodes]] (N0) or to distant parts of the body (M0).
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |I
| style="background: #DCDCDC; padding: 5px; text-align: center;" |T1
N0


[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
M0
|
* The [[tumor]] has grown deeper, but it is only in one part of the [[hypopharynx]], and it is no more than 2 centimeters (cm) across (T1).


OR
* [[Cancer]] has not spread to nearby [[Lymph node|lymph nodes]] (N0) or to distant parts of the body (M0).
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |II
| style="background: #DCDCDC; padding: 5px; text-align: center;" |T2
N0


The diagnostic study of choice for [disease name] is [name of the investigation].
M0
|
* The [[tumor]] has grown into more than one part of the [[hypopharynx]], OR it has grown into a nearby area, OR it is larger than 2 but no larger than 4 cm across and has not affected the vocal cords (T2).


OR
* [[Cancer]] has not spread to nearby [[lymph nodes]] (N0) or to distant parts of the body (M0).
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |III
| style="background: #DCDCDC; padding: 5px; text-align: center;" |T3
N0


There is no single diagnostic study of choice for the diagnosis of [disease name].
M0


OR
OR


There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
T1 to T3


OR
N1


[Disease name] is primarily diagnosed based on the clinical presentation.
M0
|
* The [[tumor]] is larger than 4 cm across, OR the tumor is affecting the movement of the [[vocal cords]], OR the tumor has grown into the [[esophagus]] (T3).


* [[Cancer]] has not spread to nearby [[lymph nodes]] (N0) or to distant parts of the body (M0).
OR
OR
* The [[tumor]] can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a [[vocal cord]] (T1 to T3).


Investigations:
* Cancer has spread to a single [[lymph node]] on the same side of the neck as the [[tumor]], which is no larger than 3 centimeters (cm) across (N1). [[Cancer]] has not spread to distant parts of the body (M0).
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |IVA
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |T4a
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
N0 or N1
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]


===== Sequence of Diagnostic Studies =====
M0
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.


OR
OR


The various investigations must be performed in the following order:
T1-T4a
* [Initial investigation]
* [2nd investigation]


=== Name of Diagnostic Criteria ===
N2


'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
M0
 
|
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* The [[tumor]] has grown into the [[thyroid]] or [[cricoid cartilage]], the hyoid bone, the [[thyroid gland]], or nearby areas of muscle or fat. This is also known as a '''moderately advanced local disease''' (T4a).


* Cancer has not spread to nearby lymph nodes (N0), or it has spread to a single [[lymph node]] on the same side of the neck as the [[tumor]], which is no larger than 3 centimeters (cm) across (N1). [[Cancer]] has not spread to distant parts of the body (M0).
OR
OR
* The tumor can be any size and might or might not have grown into structures outside the [[hypopharynx]] (as far as a moderately advanced disease), and it might or might not have affected a [[vocal cord]] (T1 to T4a). The cancer is N2:
**It has spread to a single [[lymph node]] on the same side of the neck as the [[tumor]], which is larger than 3 centimeters (cm) but no larger than 6 cm across, OR
**It has spread to more than one [[lymph node]] on the same side of the neck as the [[tumor]], none of which is larger than 6 cm across, OR
**It has spread to at least one [[lymph node]] on the other side of the neck, none of which is larger than 6 cm across.


There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
* [[Cancer]] has not spread to distant parts of the body (M0).
 
|-
OR
| style="background: #DCDCDC; padding: 5px; text-align: center;" |IVB
| style="background: #DCDCDC; padding: 5px; text-align: center;" |T4b
Any N


The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
M0


OR
OR


The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
Any T


OR
N3


[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
M0
* Criteria 1
|
* Criteria 2
* The [[tumor]] is growing into the area in front of the spine in the neck, surrounds a [[carotid artery]], or is growing down into the space between the lungs. This is also known as a '''very advanced local disease''' (T4b).
* Criteria 3


* [[Cancer]] might or might not have spread to nearby [[Lymph node|lymph nodes]] (any N). It has not spread to distant parts of the body (M0).
OR
OR
* The tumor can be any size and might or might not have grown into structures outside the [[hypopharynx]], and it might or might not have affected a [[vocal cord]] (any T).


'''IF there are clear, established diagnostic criteria'''
* [[Cancer]] has spread to at least one [[lymph node]] that is larger than 6 cm across, OR it has spread to a [[Lymph nodes|lymph node]] and then grown outside of the [[lymph node]] (N3). It has not spread to distant parts of the body (M0).


The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |IVC
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Any T
Any N


OR
M1
|
* The [[tumor]] can be any size and might or might not have grown into structures outside the [[hypopharynx]], and it might or might not have affected a [[vocal cord]] (any T).


The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
* [[Cancer]] might or might not have spread to nearby [[Lymph node|lymph nodes]] (any N). [[Cancer]] has spread to distant parts of the body (M1).
 
|}
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].
 
==Staging==


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
 
{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Otolaryngology]]
[[Category:Surgery]]

Latest revision as of 18:31, 10 May 2019

Hypopharyngeal cancer Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2]

Overview

The diagnostic study of choice for hypopharyngeal cancer is CT scan with contrast of head and neck. The definitive diagnosis of hypopharyngeal cancer is biopsy of the tumor.

Diagnostic Study of Choice


Staging

According to the American Joint Committee of Cancer (AJCC) TNM staging system, there are 5 stages of hypopharyngeal cancer based on the tumor size, lymph node involvement, and distant metastasis.

  • The following stages are used for hypopharyngeal cancer:[3]
AJCC

Stage

Stage

Grouping

Stage description
0 Tis

N0

M0

  • The tumor is only in the top layer of cells lining the inside of the hypopharynx and has not grown any deeper (Tis).
  • Cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
I T1

N0

M0

  • The tumor has grown deeper, but it is only in one part of the hypopharynx, and it is no more than 2 centimeters (cm) across (T1).
  • Cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
II T2

N0

M0

  • The tumor has grown into more than one part of the hypopharynx, OR it has grown into a nearby area, OR it is larger than 2 but no larger than 4 cm across and has not affected the vocal cords (T2).
  • Cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
III T3

N0

M0

OR

T1 to T3

N1

M0

  • The tumor is larger than 4 cm across, OR the tumor is affecting the movement of the vocal cords, OR the tumor has grown into the esophagus (T3).
  • Cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

OR

  • The tumor can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a vocal cord (T1 to T3).
  • Cancer has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). Cancer has not spread to distant parts of the body (M0).
IVA T4a

N0 or N1

M0

OR

T1-T4a

N2

M0

  • Cancer has not spread to nearby lymph nodes (N0), or it has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). Cancer has not spread to distant parts of the body (M0).

OR

  • The tumor can be any size and might or might not have grown into structures outside the hypopharynx (as far as a moderately advanced disease), and it might or might not have affected a vocal cord (T1 to T4a). The cancer is N2:
    • It has spread to a single lymph node on the same side of the neck as the tumor, which is larger than 3 centimeters (cm) but no larger than 6 cm across, OR
    • It has spread to more than one lymph node on the same side of the neck as the tumor, none of which is larger than 6 cm across, OR
    • It has spread to at least one lymph node on the other side of the neck, none of which is larger than 6 cm across.
  • Cancer has not spread to distant parts of the body (M0).
IVB T4b

Any N

M0

OR

Any T

N3

M0

  • The tumor is growing into the area in front of the spine in the neck, surrounds a carotid artery, or is growing down into the space between the lungs. This is also known as a very advanced local disease (T4b).
  • Cancer might or might not have spread to nearby lymph nodes (any N). It has not spread to distant parts of the body (M0).

OR

  • The tumor can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a vocal cord (any T).
  • Cancer has spread to at least one lymph node that is larger than 6 cm across, OR it has spread to a lymph node and then grown outside of the lymph node (N3). It has not spread to distant parts of the body (M0).
IVC Any T

Any N

M1

  • The tumor can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a vocal cord (any T).
  • Cancer might or might not have spread to nearby lymph nodes (any N). Cancer has spread to distant parts of the body (M1).

References

  1. ↑ Edge, Stephen (2010). AJCC cancer staging manual. New York: Springer. ISBN 978-0-387-88440-0.
  2. ↑ Helliwell TR (2003). "acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx". J Clin Pathol. 56 (2): 81–5. PMC 1769882. PMID 12560383.
  3. ↑ "Hypopharyngeal Cancer Stages".
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