Since about 80% of the patients with the hypopharyngeal carcinoma have advanced stages (III, IV) at the first examination, the prognosis is poor (the 5-year-survival rate is only 20-30%) . Therefore, the early detection of this carcinoma is especially important.
We investigated 146 patients, treated at our hospital from 1978 to 1986; 110 pyriform sinus type (PS), 21 postcricoid type (PC), and 15 posterior wall type (PW) . For the initial symptoms, about half of the patients complained of characteristic pains of the pharynx (fairly localized pain, especially when swallowing), about 20% neck nodal swelling (i. e. already advanced stage) . There existed no definite correlation between the interval from the appearance of initial symptoms to the first examination and the stage of the disease, but most patients with stage I, II visited doctors within 3 months. About 80% of the patients visited an otolaryngologist, and about 20% visited a surgeon or a physician, for the first time. Many of the latter group had the symptom of neck nodal swelling. There were three patients whose carcinomas were detected unexpectedly by medical examination for cancer of the lung or the stomach. By the analysis of the courses of the patients, it was suggested that about 20% of the carcinomas would have been detected one-four months earlier, if examined in detail at the first visit, and about 30% detected four months earlier, if visited a doctor before the secondary symptoms appeared.
There are the following three risk factors for the carcinoma; i. e. smoking and drinking (Brinkman index=600, Sake index=60), sideropenic anemia, and radiation. Because of the very low incidence of the carcinoma, it is important to keep these factors in mind when examine the patients older than 50 years.
Sputum cytology for three cosecutive days seems to be very useful for screening the patients at risk. The positive rate was 55. 5% in Ti and 69. 6% in T2.
For the suspicious cases, the endoscopy (e. g. fiberscope with hood) must be done actively.
