Education And Debate

Lesson of the Week: Hypopharyngeal tumours may be missed on flexible oesophagogastroscopy

BMJ 1995; 311 doi: (Published 02 September 1995) Cite this as: BMJ 1995;311:623
  1. J E Fenton, senior registrara,
  2. S Hone, registrara,
  3. P Gormley, consultantb,
  4. T P O'Dwyer, consultantc,
  5. D P Mc shane, consultantd,
  6. C I Timon, consultanta
  1. a Departments of Otolaryngology and Head and Neck Surgery, St James Hospital, Dublin,,
  2. bUniversity College Hospital, Galway,
  3. c Mater Misericordiae Hospital, Dublin,
  4. d MANCH Hospitals, Dublin
  1. Correspondence to: Mr J Fenton, 352 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia.
  • Accepted 8 November 1994

Patients with dysphagia may be referred by their general practitioners to either the otoloaryngology or the gastroenterology service, so both specialties should complement each other in the diagnosis and management of this symptom. One cause of dysphagia requiring exclusion is hypopharyngeal carcinoma. Tumours of the hypopharynx and the cervical oesophagus comparise 10% of malignancies affecting the upper part of the gastrointestinal tract from the hypopharynx to the gastric cardia.1 The pyriform fossa and posterior pharyngeal wall are affected in about 60% of these cases.2 These tumours are usually late in presenting because the hypopharynx is a wide and expansile part of the digestive tract and symptoms are moderate until the malignancy is well advanced. The overall survival rate is disappointing (25-30% at five years2), but earlier diagnosis may improve this.

Bingham et al reported a study of 10 cases of pharyngeal and hypopharyngeal causes of dysphagia that were missed or inadequately assessed on fibreoptic oesophagogastroscopy.3 Flexible endoscopy after a barium swallow examination is the routine protocol for the investigation of dysphagia. This is sufficient for the diagnosis …

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