Stage IV hypopharyngeal cancer is divided into stages IVA, IVB, and IVC. In stage IVA, the tumor is (1) any size and has spread to nearby soft tissue, connective tissue, the thyroid, or the esophagus; cancer may be found either in one lymph node on the same side of the neck (the lymph node is 3 centimeters or smaller) or in one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller); or (2) in only one area of the hypopharynx, is 2 centimeters or smaller, and has also spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller); or (3) in more than one area of the hypopharynx, is in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx; cancer has spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller); or (4) larger than 4 centimeters or has spread to the larynx; cancer has also spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller). In stage IVB, the tumor either (1) has spread to nearby soft tissue, connective tissue, blood vessels, the thyroid, or the esophagus, and may have spread to lymph nodes of any size; or (2) is any size and has spread to lymph nodes that are larger than 6 centimeters. In stage IVC, cancer has spread beyond the hypopharynx to other parts of the body.