20 A Novel Case of Metastatic Hypopharyngeal Carcinoma Without Nodal Involvement

Abstract Introduction In the UK, patients with hypopharyngeal carcinoma are managed via a multidisciplinary team approach based on UK National MDT Guidelines. Hypopharyngeal cancer often presents late, 80% of patients presenting with Stage III or IV disease, with PET-CT recommended for these patients to assess for metastases. Aim To report a novel case of an elderly ex-smoker with hypopharyngeal carcinoma without nodal involvement. Method An 86-year-old ex-smoker presented to the otolaryngology department with a T2N0 hypopharyngeal carcinoma, which was later upstaged to T3N0M1 following a PET-CT scan. Results & Conclusions This case highlights discrepancies between the MDT Guidelines and NICE guidance over when to perform staging scans. NICE recommends PET-CT for T4 or N3 disease compared to Stage III or IV disease in the National MDT guidelines. Our patient would not have qualified for PET-CT under NICE guidance and his metastatic disease would have been undiagnosed. This case highlights that lack of nodal involvement does not exclude metastases and there should be a low index of suspicion for distant metastases in patients with significant systemic symptoms.