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Tonsillar Cancer

Cancer of the tonsils occurs predominantly in men. It is strongly linked to smoking and alcohol consumption. Recent evidence suggests that human papillomavirus (HPV) is associated with tonsil cancer as well. People who have HPV-related tumors and who are non-smokers seem to have better survival rates. This cancer often spreads to the lymph nodes in the neck. Cancer of the tonsils occurs most often in people between the ages of 50 and 70.

A sore throat is often the first symptom. Pain usually radiates to the ear on the same side as the affected tonsil. Sometimes, however, a lump in the neck resulting from the cancer's spread to a lymph node (metastasis) may be noticed before any other symptoms. A doctor diagnoses the cancer by performing a biopsy of the tonsil, in which a sample of tissue is removed for examination under a microscope. Evaluation usually includes laryngoscopy (examination of the larynx), bronchoscopy (examination of the lungs), and esophagoscopy (examination of the esophagus). These areas are evaluated because of the high risk of additional cancers being present (up to 10%). A chest x-ray is done, and a computed tomography (CT) scan of the head and neck usually is also done.

About 50% of the people survive for at least 5 years after diagnosis, although the exact number depends on the stage of the cancer at the time of treatment.

Treatment typically includes radiation therapy, surgery, and chemotherapy. Small tumors may be treated with surgery alone or radiation therapy. Large tumors commonly are treated with a combination of chemotherapy and radiation therapy. Surgery may be needed for tumors that do not respond to the combination. Surgery may involve removal of the tumor, lymph nodes in the neck, and part of the jaw. There have been notable advances in the reconstruction used after surgery to remove the cancer, resulting in significant improvements in function and appearance.

Finding a Lump in the Neck

A doctor may discover an abnormal lump in the neck of a person who has no other symptoms. Most lumps are enlarged lymph nodes, which may enlarge because of a nearby infection, such as of the throat. However, an enlarged lymph node may also be caused by cancer, either a cancer of the lymph node (lymphoma) or a cancer that has spread to the lymph node from elsewhere in the body (metastasis). Lymph nodes in the neck are a common site for the spread of cancer from many parts of the body. Painless lumps are somewhat more worrisome than painful ones. Any lump that stays more than a few days should be evaluated by a doctor.

A doctor first examines the ears, nose, throat (pharynx), voice box (larynx), tonsils, base of the tongue, and thyroid and salivary glands. This examination often includes looking down the throat with a mirror or a thin flexible viewing tube. If there is no obvious source of infection or a visible cancerous spot, further tests are needed. The initial test is often a needle biopsy of the enlarged lymph node but may be computed tomography (CT) or magnetic resonance imaging (MRI) of the head and neck. Children, in whom lumps are caused most often by infection, are usually first given a trial of antibiotics. To look for cancer originating in other parts of the body, doctors usually obtain x-rays of the upper digestive tract, a thyroid scan, and a CT scan of the chest. Direct examination of the larynx (laryngoscopy), lungs (bronchoscopy), and esophagus (esophagoscopy) may be needed.

When cancer cells are found in an enlarged lymph node in the neck and there are no signs of cancer anywhere else, the entire lymph node containing the cancer cells is removed along with additional lymph nodes and fatty tissue within the neck. If the tumor is large enough, doctors may also remove the internal jugular vein, along with nearby muscles and nerves. Radiation therapy is often given as well.

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