Tonsil Cancer - Causes, Symptoms, Diagnosis and Treatment

About Tonsil Cancer

Tonsil Cancer

Head and neck squamous cell cancer (HNSCC) is the sixth most common malignancy worldwide and there are 40,000 new cases per year. Oropharyngeal carcinomas of the primary HNSCC are the third most common and the most common site of malignancy in the tonsil oropharynx.

What are the symptoms of tonsil cancer?

In patients with tonsil cancer, the disease may manifest itself only by neck mass. The reason for this is that cancer can occur in the depths of the pit cavities called crypts in the tonsil structure, and the deep epithelial invasions of the surface epithelium make it jump to the neck lymph nodes without creating a marked mass formation in the mouth.

Symptoms of Tonsil Cancer

Squamous cell tonsil cancers can occur in 1 or more sites in the deep areas of the tonsils. In addition, the patient can swell significantly into the oral cavity without any symptoms.

Tonsils are lymphoid tissues and have rich lymphatic veins. It contains abundant lymphatics, which helps cancer to enter the neck nodes and metastasize.

All of these factors, and perhaps other unknown ones, explain why patients may present with neck mass.

There are also studies reporting that cervical metastases may be cystic.

Therefore, tonsil examination and examination should be performed in patients with cystic neck lymph node with a hidden primary tumor. Occult primary squamous cell carcinomas seen as neck lymphadenopathy are a common problem faced by otorhinolaryngologists.

Tissue cancers are the most common site of lymph nodes in the neck, usually the jugulodigastric region. With the exception of neck swelling and lymph node enlargement, the following symptoms can occur in tonsil cancers:

  • throat ache
  • earache
  • sensation of foreign body or mass
  • bleeding possible
  • trismus (jaw locking) - a sign that the disease may be locally aggressive or common, possibly suggesting the spread of the tumor to the parapharyngeal area
  • weight loss
  • feeling of fatigue

Bademck cancers can sometimes be large enough to cover the carotid sheath (carotid sheath). In addition, the tumor may extend to the skull or mediastinum.

Careful palpation may reveal cervical lymphadenopathy, although neck mass is not evident in daily examinations.

When the tumor spreads to the base of the tongue, the lymph nodes of the opposite neck may also be involved.

Primary tonsillar tumors can grow on the entire surface. Therefore, the examiner may not see anything suspicious or may not be noticed by the patient in the form of slight increase in tonsil size or hardening of the region.

Central ulceration, necrotic ulcer, white or red areas can be seen in tonsil tumors.

Types and incidence of tonsil cancer

Types and incidence of tonsil cancer

Tonsil cancer accounts for slightly more than 0.5% of new cancers in the US each year. Each year more than 8,000 oropharyngeal carcinomas are diagnosed in the United States. It is thought that more than 70% of malignancies in this region are squamous cell carcinoma. Squamous cell carcinomas are 3-4 times more common than males and are mostly tumors that develop after the fifth decade (50 years) or later.

Tonsil lymphomas are the second most common malignancy in this region. Other less common malignancies include small salivary gland tumors and metastatic lesions.

Causes of tonsil cancer

Causes of tonsil cancer

According to the American National Cancer Institute, smoking and alcohol use are among the risk factors accepted for squamous cell carcinoma. Recently, however, some indicators suggest that viral etiology should also be considered. Although Epstein-Barr virus (EBV) is an important issue in nasopharyngeal carcinoma, human papilloma virus (HPV) is seen as a threat in this region.

Some studies have identified symptoms of HPV in about 60% of tonsillar carcinomas.

When the tonsil is included in the studies of the entire oropharyngeal region, the risk factors include:

• A diet without fruits and vegetables

• South America Consumption of "Mate beverage", a South American caffeine-rich beverage drink

• Betel (Piper betle) is a vine leaf belonging to the Piperaceae family, which includes chewing (pepper and kav.) Betel leaf is mostly consumed by some Asian immigrants in Asia and anywhere in the world with peas or paan, Areca nuts and / or tobacco (source > Betel - Wikipedia).

• Infection with HPV

• Tobacco use

• Use of ethanol (alcohol)

Tonsil cancer treatment

Tonsil cancer treatment

Historically, surgeries with or without adjuvant radiotherapy have been performed in the treatment of tonsil cancer. Considering the important role of oropharynx during speech and swallowing, organ sparing chemoradiation treatment (non-surgical treatment) has played a role in the treatment of tonsil carcinoma in attempts to prevent the morbidity of surgery. However, organ-protected chemoradiation is also present in its morbidity. In addition, minimally invasive transoral surgical techniques (for early stage cancers) are becoming increasingly common in the treatment of tonsillar carcinoma and may reduce the morbidity associated with surgical treatment. Transoral robotic surgery is also one of the prominent applications in the treatment of tonsil cancer. Segmental mandibulectomy and reconstruction methods are generally required for tumors extending lateral to the base of the mouth and mandible.

Treatment differences between early and late stage in the treatment of tonsil ...

Tonsil cancer

Tonsillary squamous cell carcinoma (SCC) is a very treatable disease when diagnosed early. However, advanced stage disease has a poor prognosis and stage 5 disease survival is approximately 50% or less. In addition to the poor prognosis in advanced disease, it may cause significant morbidity in the patient in relation to the effect of speech and swallowing in treatment. Both radical surgery and radical chemoradiotherapy, due to tracheostomy and gastrostomy tube, can cause significant impairment in swallowing and may adversely affect the quality of life of the patient.

Regional lymph metastasis is common in tonsil cancers. Neck metastases are present in approximately 65% ​​of patients. In patients with clinically negative neck, occult neck disease may occur in approximately 30% of these patients (although manual examination does not reveal lymph node enlargement; lymph nodes may have tumor splashes)

It is important to inform patients about oral and dental health care personnel about tonsil cancers and to treat them early.

Tonsil cancer distant metastases

Metastasis away from tonsillary SCC occurs in approximately 15-30% of patients. The most common sites are the lung, then the liver, and then the bone.

Indications and contraindications for surgical treatment of tonsil cancer

Considering surgery for tonsillary SCC, it should consider several factors before surgery:

• Is the primary tumor resectable?

• Can neck disease be resected?

• Is there distant metastatic disease?

• What is the expected functional outcome after surgery?

• Are there additional patient conditions that may affect surgical outcomes?

• What is the patient's preference for treatment?

Tonsil tumors are considered to be unresectable when they invade the lateral pterogoid muscle, pterigoid plate, lateral nasopharyngeal wall, skull base or carotid artery completely surrounding.

When the tumor causes vertebral colon invasion, skull base invasion, Horner syndrome, phrenic nerve palsy or brachial plexus invasion, it is accepted that it cannot be resected completely by surgical treatment. Surgical treatment is not performed in case of distant metastasis and if the patient has systemic disease that may make anesthesia or surgery very risky.

Contraindications for tonsil cancer surgery

Contraindications to surgery include:

• Medical conditions that do not require general anesthesia

• The patient's refusal of surgical treatment

• Tumor enclosure of carotid artery

• Paraspinous muscle invasion

• Vertebral colon invasion

• Skull base invasion

• Lateral pterogoid muscle invasion

• Pterygoid plate invasion

• Distant metastatic disease

• Throat disease that cannot be resected

Unilateral tonsil growth!

Tek taraflı bademcik büyümesi - Tek taraflı bademcik şişmesi - Unilateral tonsiller hipertrofi - Tonsiller asimetri - Asimetrik tonsil hipertrofisi
Unilateral tonsil growth!

First of all, I would like to say a few things that you should not worry about immediately:

If your tonsils appear asymmetric, it is likely that one of them is close to the midline and the other is close to the outside due to the difference in placement.
In the case of unilateral tonsillitis, as in the photo above, it is natural that the infected tonsils have flushing and swelling.
don't worry if you have a long time size difference between your tonsils and your tonsil size doesn't change except for infections

Other than that, I would like to summarize the following situations:

- if the size difference between the tonsils becomes more pronounced, if a tonsil grows without signs of infection
you are in the above risk group (alcohol and smoking, HPV positivity, genetic predisposition ...)

- if there is painless lymph node enlargement in the neck and the lymph nodes are also growing gradually

- It is appropriate to consult an ENT specialist even if there are no signs of additional ulceration bleeding, necrosis on the tonsil surface.

Sometimes in a tumor involving the neck (such as Hodgkin's Lymphoma), growth can occur in the tonsils by hyperplastic reaction without a tumor.

Most of the tumors in the tonsils are tumors of the tonsils. The possibility of cancer splashing from the surrounding tissues to the tonsils is very low (there is an article on a case of lung cancer metastasizing to the tonsils in a source link below). It is reported that foreign body sensation is usually the first complaint in metastatic tonsillar tumors.

Tonsil cancer imaging methods

Tonsil cancer imaging
In patients with tonsil cancer, the following data can be evaluated with Magnetic Resonance Imaging (MRI), which is superior in soft tissue details, and Computed Tomography (CT), which is superior in bone tissue details:

• tumor size and tumor thickness

• Reach along the midline of the tumor

• spread beyond the internal muscles of the tongue

• involvement of neighboring structures

• involvement of the nerovascular bundle and submandibular canal at the base of the mouth

• involvement of the mandible (lower jaw bone)

Thin section CT is the most sensitive method to evaluate early bone erosion.

Ultrasonography (USG) is also used for the evaluation of neck lymph nodes and assisting fine needle aspiration biopsy (FNAB) of suspected nodes.

Positron emission tomography - computed tomography (PET / CT) has become an invaluable tool for head and neck cancer imaging. In this method, a glucose analogue (18F) -FDG is introduced into the cells in a physiological state by a glucose-like mechanism, and the higher the metabolism, the higher the uptake of this substance into the cell. Tissues with high metabolism are detected by PET / CT and shown as glowing regions in the results. However, interpretation of PET / CT studies, complex anatomical sites, some physiological variations, and unusual forms of high FDG uptake in the head and neck may cause interpretation errors.

Below are the PET / CT images of a patient with right tonsil squamous cell cancer seen above. Glare due to high involvement in the right tonsil region is remarkable. Asymmetric PET/CT FDG uptake in the right tonsil is seen

Asymmetric PET/CT FDG uptake in the right tonsil - Tonsil cancer

Asymmetric PET/CT FDG uptake in the right tonsil - Tonsil cancer

Asymmetric PET/CT FDG uptake in the right tonsil - Tonsil cancer

Asymmetric PET/CT FDG uptake in the right tonsil - Tonsil cancer

Asymmetric PET/CT FDG uptake in the right tonsil - Tonsil cancer

Asymmetric PET/CT FDG uptake in the right tonsil - Tonsil cancer

Differential diagnosis of tonsil cancer

The differential diagnosis of tonsil squamous cell carcinoma mainly involves several non-neoplastic lesions, as well as other malignant lesions of the oral cavity. These:

• other cancers that close to tonsillary areas

• lymphoma

• all salivary gland tumors, adenoid cystic carcinoma, adenocarcinoma, mucoepidermoid carcinoma

• rhabdomyosarcoma

• liposarcoma

• infection

• tongue root lymph node growth

Similar links > Larynx Cancer - Definition, Causes, Risk Factors, Symptoms and TreatmentTongue Cancer Definition, Causes, Risk Factors, Symptoms and Treatment / Don't Underestimate Hoarseness: Right Vocal Cord Papilloma

Source links:
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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