BACKGROUND The aim of the study was to analyze whether there were any changes in incidence and prognosis of hypopharyngeal carcinomas diagnosed between 1960 and 1989 in Sweden. METHODS Data of primary hypopharyngeal malignant tumors reported to the Swedish Cancer Registry were collected. The total number of cases was 2012, 1396 men and 616 women, and the end of follow-up was December 31, 1992. RESULTS For women, a significant decrease in the age-standardized incidence (ASI) was seen, with an average decrease of 2% per year (p < .001), which was most evident in rural counties. The male patients, on the contrary, showed a significant increase of about 1.5% per year (p < .001); the metropolitan areas had an ASI about twice that of more-rural areas. The 2- and 5-year overall survival was poor, only 25% and 13%, respectively. For women aged <60 years, no difference in survival between the different 10-year periods was seen, but survival for men of corresponding ages improved significantly (p < .01) during the last decade, to reach a survival similar to that in women. For patients aged > or = 60 years, no difference in survival between the different periods or between sexes was seen. CONCLUSIONS The increased incidence in hypopharyngeal cancer in men is similar to that observed for oral and pharyngeal cancer in many European countries during this period. The disappearance of Plummer-Vinson syndrome may explain the decreased incidence among women. The treatment results in hypopharyngeal cancer are still very poor, and improvements of the therapeutic methods are needed.