The pyriform sinus, a pear-shaped region in the lower part of the hypopharynx, is located on both sides of the epiglottis. Mr. Tung was diagnosed with a malignant squamous cell carcinoma that had invaded, causing vocal cord paralysis and metastasis to the esophagus, necessitating chemoradiation. One month after completing the treatment, he experienced difficulty breathing and sought examination at Tam Anh General Hospital in Ho Chi Minh City (TP HCM).

Mr. Tung's MRI results revealed a tumor occupying the right pyriform sinus (neck region), measuring 14x22x37 mm. The tumor had spread into the esophagus and filled the laryngeal ventricle, with several mediastinal lymph nodes above the left clavicle. Professor Doctor Tran Phan Chung Thuy, Director of the Ear, Nose, and Throat Center, confirmed that Mr. Tung's pyriform sinus cancer had recurred, with invasion and metastasis, causing grade one dyspnea.

To alleviate breathing difficulties, Mr. Tung underwent a tracheostomy, allowing oxygen to bypass the obstructed nasopharyngeal area and directly enter his lungs. Subsequently, the surgical team removed the tumor. Immunohistochemistry (PD-L1) testing was performed to determine the tumor's biological characteristics and molecular markers, guiding a personalized treatment plan.

Professor Chung Thuy (right) performing surgery on Mr. Tung. Photo: Tam Anh General Hospital

Test results indicated that Mr. Tung had no gene mutations, making him unsuitable for immunotherapy or combined chemotherapy and immunotherapy. He could only receive single-agent chemotherapy. According to Professor Chung Thuy, the current treatment goal is to slow disease progression and provide palliative care to manage symptoms, support his physical condition, relieve pain, and improve his quality of life.

Professor Chung Thuy explained that the pyriform sinus is located deep within the hypopharynx, often hidden from view during conventional endoscopy. Lesions are typically detected through specialized flexible endoscopy. Pyriform sinus tumors often develop silently over a long period with no symptoms or non-specific manifestations, leading to misdiagnosis. Symptoms usually become apparent when the tumor grows and spreads to adjacent structures, which is why patients are often diagnosed at a late stage.

Pyriform sinus tumors also exhibit rapid local invasion and early metastasis due to the rich lymphatic network in the area. The tumor originates from the mucosa, quickly spreading to the larynx and esophagus, and metastasizing to distant sites. Some cases, like Mr. Tung's, experience early recurrence despite prior chemoradiation.

"The deeper the invasion, the more challenging the treatment," Professor Chung Thuy stated. He added that in early stages, when the tumor is localized, endoscopic surgery through the mouth can preserve laryngeal function, with a five-year survival prognosis of approximately 61%. However, if the tumor has invaded adjacent structures or metastasized distantly, the survival prognosis decreases to 36% and 20% respectively.

The exact cause of pyriform sinus cancer remains unclear, but risk factors include long-term smoking and alcohol consumption, especially concurrent use of both, malnutrition, and virus infections.

To prevent the disease, it is crucial to limit alcohol, quit smoking, and maintain adequate nutrition. Doctors recommend that individuals with risk factors undergo regular health check-ups and ear, nose, and throat cancer screenings for early detection, which increases treatment effectiveness and helps preserve laryngeal function.

If you experience a sore throat, difficulty swallowing, or persistent hoarseness lasting more than two weeks, and treatment does not improve the condition, you should consult an ear, nose, and throat specialist. Flexible endoscopy can help accurately assess the cause and facilitate timely treatment; do not self-medicate.

Uyen Trinh

*Patient's name has been changed