Our body is made up of trillions of cells and cancer can grow anywhere. In case of abnormal growth of cells in your tonsils, it leads to tonsil cancer. Tonsil cancer can cause problems in swallowing and a sensation that something is stuck in your throat. It is usually detected after it has spread to the surrounding tissues.
We spoke to our expert Prof Dr J M Hans, Padmashree Awardee, Senior Consultant-ENT, Madhukar Rainbow Children’s Hospital, Malviya Nagar, New Delhi, who explained tonsil cancer, its symptoms, causes, and treatment measures.
What Is Tonsil Cancer
Tonsil cancer is the most common type of oropharyngeal malignancy(oropharyngeal cancer is a condition in which the tissues of the oropharynx develop malignant cells), comprising 23.1% of all malignancies in this region. There has been a sharp rise in its incidence in the last many years due to the increase in Human Papilloma Virus (HPV)-induced cancers. The “viral epidemic” of HPV has dramatically increased the incidences of oropharyngeal cancer in the last 40 years.
Also Read: Can Poor Oral Hygiene Increase The Incidence Of Oral Cancer? Expert Explains
Symptoms Of Tonsil Cancer
Generally, HPV-positive tumours are seen in young non-smokers, whereas, HPV-negative tumours are found in older males who smoke and have other comorbidities. The latter has a poorer prognosis.
Some of the common symptoms are:
- Sore throat
- Unilateral otalgia
- Sense of fullness in the throat
- Trismus (if there is a local invasion)
- Asymptomatic patient with an incidental finding of asymmetric tonsils
- Occult lesion with enlarged neck nodes (JD nodes)
We must also keep in mind the following symptoms – weight loss, loss of appetite, hoarseness of voice that’s persistent, and difficulty or pain while swallowing.
Causes Of Tonsil Cancer
Traditionally, we blamed smoking and alcohol misuse for tonsil cancer, however, smoking is a poor prognostic factor independently. In recent years, cases secondary to HPV have increased at a higher rate. HPV-16 is the most common strain found in oropharyngeal cancers. In addition to smoking and spirits, sharp teeth, spices, syphilis, and sepsis have also been attributed to oropharyngeal cancer.
Evaluation and Tests
A full ENT examination, along with palpation of the neck, is recommended. The tongue base, vallecula, lateral pharyngeal wall, and post-nasal space must also be examined.
A pan-endoscopy is done to rule out the secondaries and skip lesions in the upper airways and oesophagus.
Radiological investigations include MRI, CT, and PET-CT. MRI with contrast helps delineate local spread and gives the best views of soft tissues.
Treatment For Tonsil Cancer
The treatment for tonsil cancer involves surgery and chemoradiation.
Chemoradiation
Early lesions may be treated with surgery alone, whereas advanced ones may require chemoradiation as well. This is because surgery would involve extensive resections with poor postoperative functional outcomes.
Tonsillectomy
Small superficial lesions confined to the tonsil-peroral monobloc are treated by tonsillectomy; securing adequate margins in all three dimensions.
Larger lesions require TORS (Trans Oral Robotic Surgery) or TLM (Transoral Laser Microsurgery) to include the underlying pharyngeal wall and the adjacent base of the tongue to secure clear margins. They are advantageous because of less operating time, lesser hospital stay, and improved swallowing outcomes post-surgery. Since the tissue is removed in pieces in TLM, histopathological examination becomes difficult and so it is less preferred.
Much larger lesions need a lower cheek flap approach with either a marginal or segmental mandibulotomy.
Chemoradiotherapy is emerging as the treatment choice for advanced tonsillar cancer as it helps in preventing injury. Radiotherapy with cisplatin chemotherapy is commonly preferred. Sometimes medications, such as cetuximab are added when cisplatin is contraindicated.
Also Read: Tonsil Stones: Symptoms And How To Manage It
Takeaway
It is crucial to diagnose tonsil cancer in its initial stage and seek necessary treatment and prevent it from spreading. HPV-positive tumours have a significantly higher five-year survival rate than HPV-negative tumours. HPV-positive tumours in smokers have a comparatively poor prognosis.
