How to Detect Tonsil Cancer

What is Tonsil Cancer?

Tonsillar carcinoma or cancer of the tonsils is an oral malignancy. Tonsil cancer is an oropharyngeal condition, part of the head and neck region of the body. Head and neck cancer (HNC) is the generic name for tumors found in the oral cavity, including the mouth, larynx, and pharynx. The terms cancer, carcinoma, and malignancy are used interchangeably and are differentiated from the term benign. A cluster of cells or a tumor, which is not capable of invading and spreading to other parts of the body, is benign or noncancerous. Carcinoma in the tonsillar region is very uncommon, but must be caught in the early stages and treated aggressively.

Tonsil cancer is a very specific type of cancer. People may describe the condition in a variety of ways, according to their level of understanding, or what a physician may have told them. A person may say they have:

  • head cancer
  • neck cancer
  • voicebox cancer
  • throat cancer
  • mouth cancer
  • thyroid cancer
  • gullet cancer
  • gum cancer
  • hard palate cancer

The exact location and precise medical name of the cancer is very important for treatment and prognosis. For instance, cancer at the base/back of the tongue is also an oropharyngeal cancer. However, the likelihood of survival is much lower for tongue cancer than tonsil cancer. Using the term throat cancer is misleading, as many structures comprise the throat including the pharynx, the esophagus, the tongue, tonsils and lymph nodes. Tonsil cancer is, however, the most common oropharyngeal squamous cell cancer (OSCC).

Forms of Cancer

Cancer occurs when a single abnormal cell ignores its boundary and grows. The single cell forms a colony of mutated cells and invades neighboring normal cells. The abnormal cell colony gains an advantage over the normal cells with aggressive genetics and cellular makeup. The journey from a normal cell to malignancy may take anywhere from 6-10 unseen genetic steps, hastened in development by aging and exposure to carcinogens. The visual or microscopically defined changes are:

  • Hyperplasia – cells may look normal but are increased in number.
  • Dysplasia – cells may have changed in characteristics and/or in number but are still within their boundaries. These cells are not totally normal or cancerous.
  • Carcinoma in situ – precancerous cells which are still located within their boundary, or reside in place.
  • Invasion – malignant cells break the barrier and access other tissues and blood vessels, and can travel to other parts of the body.
  • Squamous Cell Carcinoma (SCC or SqCC) are thin, flat and polygonal cells that line the inside of the oropharynx. The cells look like “the scale of a fish or serpent” (squama). Older terms include, “epidermoid carcinoma” and “squamous cell epithelioma.” Oropharyngeal cancer is usually (95%) squamous cell carcinoma rather than lymphoma.
  • Lymphoma – originates in the lymph nodes and becomes a part of the lymph nodes. Cells mutate and become a mass with volume and shape.
  • Metastasis – Cancer spreads in the body through normal tissues, through the lymph system, and through the blood. When the original cancer invades a distant part of the body, the cancer in the new site is called by the original name. If tonsil cancer invades the lungs, it is called tonsil cancer and not lung cancer.

Tonsil Cancer Epidemiology

Human papilloma virus (HPV-16) induced oropharyngeal cancer patients are generally younger (30 to 60 years old) and have more sexual partners. People with six or more oral-sex partners have ten times the risk of tonsil cancer. This type of causative agent for tonsil cancer is becoming widespread among black people and non-hispanic men. More evidence is growing that sexual, behavioral and lifestyle-related factors may be contributing to oropharyngeal cancers.

  • Oropharyngeal cancers are increasing in incidence worldwide.
  • Head and neck cancer claims 2.1 percent of cancers deaths in the U.S.
  • 70 percent of tonsil cancer patients first see a physician when the cancer is already in advanced stages.
  • Most patients are in the age range of 55-65 years and are usually of male gender, outnumbering women with a ratio 4:1
  • Thirty-six males out of 100,000 people can expect to get tonsillar cancer.
  • Females have a 7 in 100,000 chance for tonsillar carcinoma.
  • Survival rates are the same for men and women.
  • Fifty percent of tonsillar cancer patients can be expected to have early mortality.
  • This prognosis of only one half-survival rate has not improved over the last forty years.

Anatomy

The oropharynx is the medical name for where the mouth meets the throat. The mouth connects to the top of the throat behind the tongue. The other parts of the throat are called the nasopharynx and the laryngopharynx, which connect the mouth to the nasal passages and to the esophagus. The tissues and structures which comprise the oropharyngeal cavity include:

  • Tongue – the back third of the tongue.
  • Soft Palate – The soft area at the back of the roof of the mouth.
  • The tonsils – palatine tonsils and the nasopharyngeal tonsils (adenoids) are located on either side of the upper throat. They are spongy cells called lymphoepithelial tissues.
  • Throat – the side and back walls of the throat.

The oropharynx, nasopharynx and the laryngopharynx have many functions. Air and food pass through the pharynx on its way to the lungs and to the stomach. Voice, words and song are produced from this region. In other words, humans taste, chew, swallow, breathe and talk with these systems. The larynx also aids in immunosuppression by acting as a guard for invading bacteria and viruses. Lymph nodes in the neck are close to the oropharyngeal cavity. These glands are often targets for oropharyngeal cancers. However, when cancer begins in the lymph node instead of spreading to them, the carcinoma is termed a lymphoma. Only 5% of tonsillar cancers are lymphomas.

Causes of Tonsil Cancer

Smoking – The strongest predictors for tonsil cancers are tobacco use (cigarettes and chewing tobacco) and alcohol use. The smoke from cigarettes contains carcinogens and pro-carcinogens, meaning that they are known to cause cancer. Polycyclic aromatic hydrocarbons and aromatic amines are activated by enzymes like cytochrome P450 during the smoking process. For smokeless tobacco, nitrosamines are considered the culprits in oropharyngeal cancers. Alcohol-induced carcinogenesis is caused by alcohol dehydrogenase activated acetaldehyde. People who use both tobacco and alcohol have a much higher risk.

Tonsil Cancer Pictures

Human Papilloma Virus (HPV-16) infection is also a likely cause for tonsil cancer for people not exposed to smoking or alcohol. One hundred and twenty strains of HPV, which affect the skin and mucosal areas of the body, have been identified in humans, with about 40 strains in the mouth and genital tracts. HPV-16 affects the mouth and oral cavities because at the cellular level, the cells are similar to the vagina and cervix. HPV-16 infection causes mostly tonsil cancer and sometimes base of the tongue cancer. Those at high risk for HPV are people with more sexual partners.

The carcinogenesis of HPV is not well understood, however, a tumor suppressing gene, p53, is thought to be deactivated by HPV. HPV tumors are recognized pathologically and in the clinic, and do offer a better prognosis for treatment. HPV-positive patients with tonsil cancer can expect a reduced risk of death and better response to chemotherapy and radiation treatments.

Head and neck cancers which include cancers of the mouth, nose, sinuses, salivary glands, throat and lymph nodes are complex and have many mutations. Defects in the tumor suppressor gene, P53, are known to investigators. However, others have found mutations in the NOTCH family of genes, regulators of cell development. Other teams of scientists have found 231 new genes, which may be important in head and neck carcinogenesis.

0 How to Detect Tonsil Cancer

Stages of Tonsil Cancer

Stage 0 – carcinoma in situ; abnormal cells are found but have not spread into normal tissue in the lining of the oropharynx.

Stage I – cancer has formed, the mass is 2 cm or smaller and is confined to the oropharynx only. This stage is considered an early stage disease.

Stage II – the cancer mass is larger than 2 cm but less than 4 cm and is confined to the oropharynx only. This stage is considered early stage disease.

Stage III – the mass is either:

  • 4 cm or smaller, spread to one lymph node on the same side and the lymph node is 3 cm or smaller.
  • larger than 4 cm or has spread to the epiglottis, the flap that covers the trachea during swallowing.

At this stage, the cancer is considered locally advanced and resectable, or able to be removed with surgery.

Stage IV-A – the cancer has spread to:

  • the larynx
  • front part of the roof of the mouth
  • lower jaw
  • the tongue
  • one lymph node on the same side and the lymph node is between 3-6 cm.
  • more than one lymph node anywhere in the neck and the tumor is any size and has spread to other parts of the oropharynx.

At this stage, the cancer is considered locally advanced and resectable, or able to be removed with surgery.

Stage IV-B – the cancerous mass may be any size, spread to more than one lymph node larger than 6 cm, and spread to the carotid artery, the jaw, the bones, nasopharynx and/or the base of the skull. This is a locally advanced cancer and is unresectable, or unable to be removed by surgery.

Stage IV-C – the tumor is any size and spread to other regions of the body including the liver, lungs, or bones (distant metastases).

Recurrent – cancer that is ongoing or has come back after initial treatment. Cancer may come back in the same spot, elsewhere in the oropharynx, or in other parts of the body.

Prognosis and Survival Rate after 5 Years

The prognosis or likelihood of survival for oropharyngeal cancers depends on many factors. Early death usually occurs when oropharyngeal cancer reoccurs or cannot be controlled. Survival chances are increased with:

  • having tonsil cancer – soft tissue lesions have the best prognosis.
  • finding the cancer early
  • not having repeat or recurring cancer
  • not having lymph node involvement
  • not having spreading or metastasizing cancers
  • having HPV induced cancer – human papilloma virus-related disease states are being more closely studied to determine prognosis. This type of cause for tonsil cancer confers an advantage in outcomes. The presence of oncoprotein E6 in HPV-16 induced tonsil cancer may be advantageous for survival. Radiation therapy is more effective with this oncoprotein as the radiation induces more apoptosis, or cell death.
  • optimizing radiation quality and minimizing toxicity

Survival chances are decreased with:

  • late diagnosis
  • base of tongue involvement – extension into the base of the tongue has a worse prognosis because of their greater size, spreading to adjacent structures, and the increased rate of lymphatic spread.
  • pharyngeal wall – has very serious outlook.
  • lymph node involvement
  • poor general health
  • epidermal growth factor receptor (EGFR) in the tumor shows a worse prognosis. EGFR signaling is recognized in many types of epithelial cancers. Researchers are working to target EGFR alone or in combination with its downstream mediators.

No effect on survival rates:

  • The age of the patient, or whether or not one is older or younger than 40.

Listed below is a table that describes average survival rates after five years. The table is broken down according to anatomical site, average survival rates, and average survival rates depending on the stage at which cancer is diagnosed.

Tonsil Cancer Diagnosis

Tonsil cancer is changing from predominately older, male patients with a history of smoking and drinking to younger sexually active patients. Physicians have commonly suspected that people older than 60 years with oral pain and weight loss may have tonsil cancer. Now, people aged 30-60 years old with a recurring sore throat, difficulty swallowing and a neck mass are suspect for head and neck cancer.

Primary care physicians may not have the proper equipment for a thorough examination of the oropharynx but they can look down the throat with a mirror to check for abnormal cells or lumps. Primary care physicians can take a history and identify risk factors. They can screen for cancer and educate patients about sexual practices. They can identify ulcerations or tonsillar masses, prescribe antibiotics and make referrals to an otolaryngologist, an ear, nose, and throat specialist.

Cancer is usually diagnosed by taking a small sample of affected tissue. Depending on the location, biopsies can be simple and minimally invasive. The tissue is sent to a laboratory for technicians to examine under a microscope. Patients also undergo imaging studies to determine the exact size and location of the malignant cells.

Risk Factors

The factors that increase the chances of getting oropharyngeal cancer and tonsil cancer include smoking, drinking, multiple sexual partners and oral sex. Having risk factors does not mean that cancer is certain or not. People with risk factors can modify some of their behaviors and/or talk to a physician about the risks. Risk factors include:

  • Smoking and chewing tobacco – may be responsible for one quarter of oropharyngeal cancers. Smoking is more likely than alcohol to cause tonsillar cancer. Smokers who light up first thing in the morning have a slightly higher risk of cancer than those who light up their first cigarette later in the morning.
  • Heavy alcohol use – higher daily doses of alcohol increases the risk, mainly for those who have three or more drinks a day. Heavy drinkers have twice the risk as people who never drink.
  • Smoking and Drinking – a potent combination; may be responsible for seventy-five percent of all head and neck cancers.
  • A diet low in fruits and vegetables.
  • Drinking maté, a stimulant drink common in South America.
  • Chewing betel quid, a stimulant commonly used in parts of Asia.
  • HPV-16 infection – linked to oral sex. Men and women are carriers of HPV and transmit the disease to their partners. Oral sex is a risk factor for oropharyngeal cancer and other sexually transmitted diseases including gonorrhea, chlamydia, herpes and syphilis.
0 How to Detect Tonsil Cancer

Tonsil Cancer Signs and Symptoms

People diagnosed with tonsil cancer often present to a physician in late stages of the disease. Sometimes, cancer is found incidentally at a dental office. However, seventy percent of patients may not have these common symptoms until cancer is actively spreading. Throat cancer symptoms include:

  • Persistent sore throat
  • Dysphagia – trouble swallowing
  • Neck mass – a lump in the back of the mouth, throat, or neck.
  • Weight Loss
  • Cough
  • Oral pain
  • Otalgia – ear pain
  • A change in voice
  • Trismus – difficulty opening the mouth
  • Airway distress

Screening

Oropharyngeal cancer has no specific screening method. A Tolduidine stain may be performed to identify leukoplakia (white patches) or erythroplakia (red patches) that may be precancerous. Darker stained patches are more likely to become cancerous and referred for a biopsy. HPV-16 tonsil brush biopsies may be performed and identified with consensus primer PCR and/or type-specific PCR. A test for HPV-16, similar to a cervical pap test, is not as feasible due to limitations in accessing certain parts of the oral cavity. A positive test for HPV in the cells or in the antibodies in the blood does not mean that a person will develop cancer.

Diagnostic Procedures

Diagnosis of tonsil cancer is confirmed by a tissue biopsy and a histological examination of the abnormal cells. Some biopsies can be performed in the physician’s office. More difficult to reach tumors are referred to a surgeon for an excision biopsy under general anesthesia. After the histological diagnosis, additional studies may be required in order to stage the disease, or identify the stage that the cancer has become, in order to treat it. Imaging tests are used to describe the tumor’s size and location, as a physical examination cannot identify abnormal cells submucosally. Imaging tests and procedures can be used alone or in combinations to identify primary and secondary tumors:

  • CT scan – usually the first examination performed, commonly called computed tomography, computerized tomography, or computerized axial tomography. A dye may be injected or swallowed to allow organs and tissues to show more clearly.
  • MRI –magnetic resonance imaging may allow smaller tumors, bone marrow involved and dental involved tumors to be more readily seen.
  • Triple endoscopy – naso/laryngo/pharyngoscopy, esophagoscopy, and bronchoscopy. A thin, tube like instrument with a light, camera, and sometimes a biopsy tool is inserted through the patient’s nose or mouth to make a physical exam of the suspected cancer.
  • Positron Emission Topography (PET) scan – can identify secondary tumors and tumors which have distant metastases. A solution of fluorodeoxyglucose (F-18 FDG) and sugar is given intravenously and detected within cancer cells because cancer cells have an inability to metabolize the radioactive solution. PET scans also improve treatment options with the ability to better target radiation therapy.

Metastatic Spread

Tonsil cancer may spread to the soft palate, the tongue and the pharyngeal wall. Additionally, cancer may spread to the lymphatic network including the lymphatic ducts and the lymph nodes of the subdigastric, upper cervical, parapharyngeal, and the submaxillary lymph nodes. Cancer may also spread to distant sites with the lungs being the most common site for metastases.

Classification

Oropharyngeal cancer is staged, graded, and classified according to systems that vary by country and medical association. The American Joint Committee on Cancer describes the primary tumor (T stage), regional lymph nodes (N stage), and presence or absence of distant metastases (M stage). After these criteria are met, a final overall stage is grouped and quantified. In addition, researchers and physicians may use criteria to assess the functional status and quality of life of the patient, in order to inform treatment decisions.

Primary tumor (T stage)

  • Tx: primary tumor cannot be assessed.
  • T1: tumor ≤2 cm in greatest dimension.
  • T2: tumor >2 cm but ≤4 cm in greatest dimension.
  • T3: tumor >4 cm in greatest dimension.
  • T4a: tumor invades the larynx, deep/extrinsic muscle of tongue, medial pterygoid, hard palate, or mandible.
  • T4b: tumor invades lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull base, or encases carotid artery.

Regional lymph nodes (N stage)

  • Nx: regional lymph nodes cannot be assessed.
  • N0: no regional lymph node metastasis.
  • N1: metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension.
  • N2: metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension.
  • N2a: metastases in a single ipsilateral lymph node >3 cm but ≤6 cm in greatest dimension.
  • N2b: metastasis in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension.
  • N3: metastasis in a lymph node >6 cm in greatest dimension.

Distant metastases (M stage)

  • Mx: distant metastases cannot be assessed.
  • M0: no distant metastasis.
  • M1: distant metastasis present.

Stage Grouping

  • Stage I: T1N0M0
  • Stage II: T2N0M0
  • Stage III: T3N0M0; T1-T3N1M0
  • Stage IVA: T4aN0-1M0; T1-T3N2M0
  • Stage IVB: T4bN1-N2M0; T1-T4aN3M0
  • Stage IVC: M1

Functional Status

  • Grade 0: active and functional, able to complete daily activities without restriction.
  • Grade 1: strenuous activity is difficult, but the patient is able to walk around and carry out light activities.
  • Grade 2: the patient can walk around and is capable of self-care but is not able to carry out any effortful activities.
  • Grade 3: patient is confined to a bed or chair during half of the waking hours and is only capable of limited self-care.
  • Grade 4: totally disabled, confined to a bed or chair and incapable of self-care.
  • Grade 5: dead.

Tonsil Cancer Treatment

Cancer is a negative condition, which usually requires intervention to stop the damage. When cells mutate and divide, action must be taken to halt the undesirable progress of cancer cells. Treatment options will vary according to the stage of the cancer, its location and the health of the patient. Surgery may be performed to cut away the bad cells from the good ones. Chemotherapy, radiation and medications are also options for tonsil cancer patients. Only a physician can recommend treatment options and explain the benefits and risks. The stage of the disease, access to medical care and insurance status influences treatment and survival rates.

Regimens for treatment will also vary according to the wishes of the patient. Maximizing survival while minimizing toxic effects are the primary goals of treatment. A multidisciplinary team of physicians and surgeons use surgery, chemotherapy, radiotherapy, monoclonal antibodies, and emerging treatments to halt tonsil cancer. Considerations for treatment include:

  • Is the cancer localized to the head and neck region?
  • Has the cancer spread to the nearby lymph nodes?
  • Has the cancer spread into other parts of the body?

Stage Treatment

Tumors of the tonsillar region are treated with varying doses of irradiation alone or with surgery. Porting the radiation to the appropriate area involves demarcating the site with at least a 2 cm margin beyond the clinical evidence of disease. Typical points which can serve to identify the site for radiation or surgery.

  • external auditory canal
  • tip of the mastoid
  • foramen magnum
  • thyroid notch
  • pharyngeal wall
  • lymph nodes
  • spinal cord
  • base of skull
  • floor of the sphenoid sinus
  • faucial arch
  • supraglottic larynx

T1 – T2 tumors – treated with irradiation or surgery alone.

T1 – T3 tumors – patients tolerate higher doses of radiation therapy when used without surgery. Regional lymph nodes are treated with radiation and interstitial brachytherapy.

T3 – T4 tumors – a combination of radiation and surgery works better than using one method alone. A radical tonsillectomy is usually performed with a neck dissection followed by radiation therapy.

Stage Treatment Details

Stage I or II

  • radiotherapy
  • surgery

Stage III or IVA

  • surgery
  • radiotherapy
  • chemoradiotherapy
  • induction chemotherapy
  • cetuximab medication and radiotherapy

Stage IVB

  • chemoradiotherapy
  • induction chemotherapy and chemoradiotherapy
  • cetuximab medication and radiotherapy

Stage IVC

  • chemotherapy with or without cetuximab medication

Surgery

Surgery is a curative option which removes abnormal cells or a mass of cells from normal organs and tissues. Radiation is sometimes used before surgery in order to shrink the cancer to a more manageable size before removal. The type of surgery will depend on whether the cancer is confined to the tonsils, in the lymph nodes and surrounding tissues of the mouth, neck and head. Some early stage cancers require local anesthesia and laser surgery. More advanced or bigger cancer masses need to be removed with invasive surgery, general anesthesia and an overnight or extended stay in the hospital. This type of surgery is known as a radical tonsillectomy. A partial or whole neck dissection to remove lymph nodes may be performed at the same time. More complicated surgeries involve partial or whole removal of the soft palate, tongue and pharyngeal wall.

Side Effects – Surgical complications may include swelling in the head and throat area. This may cause difficulty in breathing, eating and speaking. Some patients may need a temporary hole in the windpipe called a tracheostomy. Others may need a feeding tube. Some complications are temporary while others may be a lifelong condition.

Radiation

External radiotherapy and internal radiotherapy (brachytherapy) are both curative options used in the treatment of tonsil cancer. Radiation may be used first, last or in combination with surgery and other therapies. A targeted energy beam acts to kill cancer cells, shrink tumors, and provide relief from painful or debilitating symptoms. Some patients preparing for radiotherapy are advised to see a dentist and a gastroenterologist to anticipate any problems with chewing and eating that radiotherapy may cause. A gastric tube may be inserted prior to radiation to prevent malnutrition and weight loss. Two types of radiation are available:

  • External radiotherapy – treatment is often given once a day for a few weeks. The dose depends on what stage the cancer is in, the location of the tumor, the size of the tumor and the health of the patient. Curative (radical) radiotherapy is often given with the patient lying down and the radiotherapy beam applied from different positions in order to more effectively hit the target.
  • Brachytherapy – a radioactive source that is implanted in the body. Internal radiotherapy is often used for smaller cancers and to treat reoccurring cancer. Implants may be removed the same day, sometime later, or left in the body permanently when the radiation runs out. Limiting the toxic effects of the radiation is important both for the patient and the people around them. Sometimes patients are advised to temporarily limit contact with other people to protect them from the toxic effects.

Side effects – radiotherapy can cause tooth decay during therapy and long after radiotherapy is complete. The muscles which open and close the mouth may become inelastic and restrict mouth movement. The immune system may become compromised with a reduced ability to heal. Many patients develop mucositis which is a painful ulceration in the mouth and anywhere in the digestive tract. Hearing loss may also occur for some patients.

Chemotherapy

Chemo is a non-curative option for tonsil cancer as it has not been clearly shown to improve prognosis. Chemotherapy or neoadjuvant treatment is a second or third option in treating patients. A non-invasive regimen of cisplatin-based chemotherapy is often used with radiation as the two drugs together may be more effective in shrinking the cancer than using one of them alone. Cisplatin, cetuximab and fluorouracil are commonly used drugs, however, other chemotherapy drugs have been used in the past, and scientists continue to investigate new drugs. These drugs are cytotoxic or anti-cancer, and they act by targeting cells which divide rapidly like tonsil cancer cells.

Side effects – the drugs which kill cancer cells also kill normal cells especially in the bone marrow, digestive system and hair follicles. Decreased platelets and clotting factors may cause oral bleeding. Painful inflammation in the digestive tract and mouth may develop. Hair loss is a common side effect, as well.

Common Complications

Survivors of tonsillar cancer have an increased risk of developing another tumor in the head, neck, and digestive tract. Discovery of a secondary tumor further reduces survival rates. The anatomic location of tonsillar cancer poses special complications as well. The side effects of treatment may be more problematic for oropharyngeal patients than for those with cancer at different sites. Surgeries, chemotherapy, radiotherapy, and drug therapy may impact vital organs and tissues necessary for swallowing and respiration. Surgery, radiation and chemotherapy are radical treatments necessary to cure tonsil cancer but they each carry their own particular side effects. Some patients are disfigured or unable to swallow or speak. Treatment for tonsil cancer may cause any number of complications including:

  • The airway may become blocked.
  • Swallowing (dysphagia, odynophagia, and stricture) may become difficult.
  • Speech (hoarseness and speech loss) difficulties
  • Vascular complications
  • Pain
  • Cosmetic deformities
  • Pneumonia
  • Hypothyroidism
  • Psychosocial distress
  • Difficulty eating
  • Inflammation
  • Weight loss
  • Social distress
  • Facial disfigurement
  • Sleep disorders
  • Hair loss
  • Bleeding
  • Immunosuppression
  • Oral and systemic infection (viral, bacterial, and fungal)
  • Salivary gland dysfunction
  • Taste alterations
  • Abnormal dental development

End Care

Patients with advanced cancer and cancer which has spread to other parts of the body, may have to prepare for the worst outcome. Palliative care is important to manage pain, and assist with daily living issues. Some patients may be cared for at home, others are cared for at a hospice or nursing facility, while others may face their end of days in the hospital.

Tonsil Cancer Prevention

Smoking, drinking and oral sex cause tonsil cancer. Cessation of these behaviors will reduce the risk of tonsil cancer. Choosing safer sex techniques may be helpful in reducing the risk, as well. Strains of HPV that cause oropharyngeal, vaginal, cervical, anal, penile, and vulvar cancer are extremely common. Condoms for men and dental dams for women will help reduce the risk for sexually transmitted diseases and high-risk oncogenic HPV.

HPV Vaccine – a vaccination is recommended for girls, ideally before they become sexually active. Girls can be vaccinated as young as nine years old through the age of twenty-six. The vaccination is also available to boys of the same age, however, this is not commonly recommended. This vaccination only covers some genital and anal strains of HPV, not specifically oropharyngeal strains of HPV.

0 How to Detect Tonsil Cancer

Emerging Possibilities

Photodynamic therapy (PDT)

PDT can be performed in a physician’s office or on an outpatient basis. The procedure is simple and proven effective for some cancers. The patient applies a drug-laced lotion to the cancerous area or is injected with the drug. The photosensitive drug is activated by a light source. An oxygen molecule then acts to destroy cancer cells. This procedure is called selective tissue destruction and is, in theory, considered better than radiation, which kills good cells, too. PDT causes the cancerous cells to hold the drug longer within its walls, thereby limiting damage to healthy tissue. Additionally, the drug may cut off blood vessel supply to the tumor and trigger the immune system to kill the cancer cells.

The procedure has some limitations. First, the cancer must be a local cancer, meaning that it must not have spread to other parts of the body. Second, the cancer must be close to the skin, about 1 cm. so that the light can reach it. Side effects include burns, swelling, coughing, trouble swallowing, stomach pain, and painful breathing. Patients are advised to stay away from sunlight during treatment. Some of the conditions and cancers treated with PDT:

  • Acne
  • Rosacea
  • Skin cancer
  • Sun damage
  • Cosmetic skin improvement
  • Wrinkles
  • Warts
  • Psoriasis
  • Lung cancer
  • Esophageal cancer
  • Barrett’s esophagus
  • Cervical cancer
  • Prostate gland cancer
  • Brain cancer
  • Peritoneal cavity cancer

BioAgents

Anti-epidermal growth factor receptor agent erlotinib and anti-angiogenesis agents bevacizumab, when combined with radiation had a “marked and significant” decrease in tumor size. Following with radiation almost completely eliminated tumor growth. These bioagents are emerging possibilities to be used in conjunction with surgery, radiation and chemotherapy.

Swallowing Device

Many patients treated for tonsil cancer will develop temporary dysphagia, or trouble swallowing. Others may have part of the throat surgically removed and have permanent swallowing difficulties. To address this issue, physicians have been able to make a device implanted in the throat that helps patients swallow. An earring-like titanium stud extrudes about a quarter-inch above the skin of the throat. The patient can control the use of the device by pulling on it. The stud pulls the esophagus open to allow food and water down the throat.

Unnecessary Surgery

Because detecting small lymph node involvement in oropharyngeal is impossible with current methods, surgeons usually operate just in case the cancer has metastacized. This results in unnecessary surgeries, pain and disfigurement and cost for the patient. To avoid this, scientists have been working on genotyping head and neck cancers in order to predict the likelihood of metastases before surgery. Their gene signature efforts have resulted in identifying metastases 89% of the time. This presents a major advancement used by itself. Used in conjunction with imaging tests and sentinel biopsies, genotyping can reduce unnecessary surgeries by distinguishing metastasizing cancer from non-metastasizing cancer.

Curcumin

The chemotherapy drug, cisplatin, is extremely toxic. Patients who receive chemotherapy often have long-term side effects. Researchers therefore look for ways to lower the dose while maintaining tumor shrinking effectiveness. A curcumin-based compound (FLLL32), quartered the dose of cisplatin needed to kill cancer. In addition to lowering the dose and thereby the side effects, patients who become resistant to cisplatin may also benefit from the curcumin compound. The survival rate for oropharyngeal cancer has not changed over the years because of this resistance to drugs. FLLL32 acts to sensitize cancer cells to the antitumor effects of cisplatin thereby lowering the dose necessary to kill cancer cells.

UROD Enzyme

An enzyme called uroporphyrinogen decarboxylase (UROD) can also sensitize cancer cells to radiation and chemotherapy. The enzyme boosts the effectiveness of cancer treatment while limiting toxicity to normal cells. UROD is part of a pathway important to all vital body systems, the heme synthesis pathway. Targeting the enzyme works by increasing iron and free radical levels that kills cancer cells.

Sentinel Biopsy

Sentinel lymph node biopsy is a safe and effective procedure for tonsil cancer patients. A special dye is injected into the lymph node most likely to be affected by the cancer. If the node is clear of cancer, radical surgery is not performed on the lymph nodes. If the dye does show cancer in the node, a complete dissection is performed to remove additional lymph nodes and may be combined with radiation and chemotherapy.

Robotic Surgery

Transoral robotic surgery (TORS) is commonly used for many types of head and neck cancers. Robotic surgery for tonsil cancer is considered a clean, easy approach to oral surgery. Transoral laser microsurgery is accomplished by a surgeon sitting at a desk with controls for his instruments and camera. The robotic arms enter the mouth with a cautery or laser and a tool to extract tissue. Not all tonsil cancer patients will be candidates for this type of surgery, as much depends on the location and size of the tumor.

Related Conditions

Tonsillitis

Painful swallowing, sore throat, headache, fever, chills, red swollen tonsils with white patches, and enlarged tender lymph nodes may indicate this condition. A throat culture confirms the diagnosis and antibiotics resolve the symptoms.

Oral herpes simplex virus

People with a history of oral sex may be susceptible to this similar condition. Painful blisters appear in the oral cavity due to virus colonies. Symptoms resolve with acyclovir medication.

Oral cytomegalovirus infection

HIV patients may be susceptible to these painful, borderless ulcerations in the mouth. A viral culture of the tissues is performed and confirmed with histological examination. Ganciclovir medication resolves symptoms.

Aphthous ulcer

Diagnosis of this condition can be made in the clinic. The ulcer is elevated, round, yellowish, and covered by white or greyish membrane. The ulcer limits itself to a soft border, surrounded by normal tissue.

Oral syphilis

A positive VDRL test confirms this deep ulceration with irregular borders. Those with a history of oral sex may be more susceptible. Symptoms resolve with antibiotics.

Oral tuberculosis

Ulcerations, either alone or in colonies, may be present with or without lymph node drainage. A biopsy confirms this condition with granulomatous lesions and acid-fast bacilli. Symptoms are resolved with anti-tuberculous and antiviral therapy.

Non-Hodgkin’s lymphoma

A biopsy of the affected area shows a lesion or a lump of abnormal lymphocytes in the lymphoid tissues of the neck. The mass is diagnosed with immunophenotype analysis and flow cytometric analysis.

Taste Disorder

The mucus membranes of the oropharynx are susceptible to a common infection of Oropharyngeal Candidiasis. The patient may not have any noticeable symptoms, except for trouble swallowing. Candidiasis is treated pharmacologically.

Related Cancers

  • Acantholytic squamous cell carcinoma
  • Acinic cell carcinoma
  • Adenoid cystic carcinoma
  • Adenosquamous cell carcinoma
  • Basal cell adenocarcinoma
  • Basaloid squamous cell carcinoma
  • Carcinoma cuniculatum
  • Carcinoma ex pleomorphic adenoma
  • Clear cell carcinoma, not otherwise specified
  • Cystadenocarcinoma
  • Epithelial myoepithelial carcinoma
  • Haematolymphoid tumors
  • Kaposi’s sarcoma
  • Lymphoepithelioid carcinoma
  • Mucinous adenocarcinoma
  • Mucoepidermoid carcinoma
  • Myoepithelial carcinoma
  • Oncolytic adenocarcinoma
  • Papillary squamous cell carcinoma
  • Polymorphous low-grade adenocarcinoma
  • Salivary duct carcinoma
  • Salivary gland carcinoma
  • Spindle cell carcinoma
  • Verrucos carcinoma
  • Diffuse large B-cell lymphoma
  • Mantle cell lymphoma
  • Burkitt’s lymphoma
  • T-cell lymphoma
  • Extramedullary plasmacytoma
  • Mucosal malignant lymphoma

References

http://onlinelibrary.wiley.com/doi/10.1111/j.1749-4486.2011.02361.x/suppinfo

http://www.eurekalert.org/pub_releases/2011-09/hfhs-git091311.php

http://www.rxpgnews.com/cancer-research/convergence_on_a_cellular_process_525396.shtml

http://www.labspaces.net/99998/Studyfindsnewgenesassociatedwithheadandneck_cancer

http://www.uptodate.com/contents/overview-of-the-complications-of-head-and-neck-cancer-and-its-therapy

http://www.ncbi.nlm.nih.gov/pubmed/21836021

http://www.iarc.fr/en/media-centre/pr/2007/pr177.html

http://www.sciencenewsline.com/medicine/2011080808030015.html?continue=y

http://www.cancerstaging.org/mission/whatis.html

http://www.epa.gov/radtown/brachytherapy.html

http://www.nidcr.nih.gov/OralHealth/Topics/CancerTreatment/OralComplicationsCancerOral.htm

http://www.sciencedaily.com/releases/2011/01/110119120402.htm

http://www.ncbi.nlm.nih.gov/pubmed/21640497

http://www.astro.org/PublicPolicy/WhitePapersAndOtherDocuments/documents/SRSMPJan11.pdf

http://www.wiley.com/WileyCDA/PressRelease/pressReleaseId-98117.html

http://www.eurekalert.org/pub_releases/2011-02/esfm-nwt022311.php

http://www.drugs.com/clinical_trials/cetuximab-may-prolong-survival-head-neck-cancer-patients-87.html

http://www.ncbi.nlm.nih.gov/pubmed/21836021

http://www.ncbi.nlm.nih.gov/pubmed/21764375

http://www.ncbi.nlm.nih.gov/pubmed/21247264

http://www.drbicuspid.com/index.aspx?sec=sup&sub=orc&pag=dis&ItemID=307590

http://www.ncbi.nlm.nih.gov/pubmed/21365381

http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-young-women.htm

http://www.roboticsurgery.com/news/2011.htm

http://esciencenews.com/sources/science.centric/2010/12/01/uc.davis.surgeons.test.innovative.device.patient.with.swallowing.disorder

http://www.eurekalert.org/pub_releases/2011-02/esfm-get022311.php

http://kvoyfatib.posterous.com/sentinel-node-biopsy-safe-effective-in-head-a

http://www.eurekalert.org/pub_releases/2011-05/uomh-cci051911.php

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