Objectives/Hypothesis The objective was to characterize incidence, treatment, and survival for hypopharyngeal cancer in the United States between 1988 and 2010, and to analyze associations between changes in treatment modality and survival. Study Design Retrospective cohort study. Methods A total of 3,958 adult patients with hypopharyngeal cancer were identified in the Surveillance, Epidemiology, and End Results database. Incidence, treatment, and survival, controlling for patient demographics and disease severity, were analyzed using two‐tailed t tests, Kaplan‐Meier analysis, and univariate and multivariate Cox regression. Results The incidence of hypopharyngeal cancer decreased from 1973 to 2010 with an average annual percent change (APC) of −2.0% every year (P < .05). Treatment with laryngopharyngectomy decreased (−2.5% APC, P < .001), treatment with radiotherapy without surgery increased (+2.0% APC, P < .001), and treatment with neither surgery nor radiotherapy increased (+0.5% APC, P < .001) between 1988 and 2010. There was a significant increase in the 5‐year overall survival between 1988 and 1990 and between 1991 and 1995 (P = .024) with no other significant temporal trends in survival. Multivariate analysis revealed that age (65–74, 75–84, or 85+ relative to 18–54 years old), race (white relative to non‐African races), T stage (T2, T3, or T4 relative to T1), N stage (N2 or N3 relative to N0), and treatment modality (−surgery/−radiation, −surgery/+radiation, and +surgery/−radiation relative to +surgery/+radiation) were all significantly associated with worse survival. Conclusions Hypopharyngeal cancer has had a decreasing incidence with little change in patient or tumor characteristics. Treatment has increasingly involved radiation without laryngopharyngectomy. This has not been associated with a decrease in survival. Controlling for patient demographics and disease severity, radiation with laryngopharyngectomy is associated with improved survival. Level of Evidence 2b Laryngoscope, 124:2064–2069, 2014