What Is Squamous Cell Carcinoma of the Tonsil?

Carcinoma of tonsil refers to malignant tumors that originate in the tonsil fossa on both sides of the oropharynx, accounting for 0.5% of systemic tumors. Occurs in men over 40 years of age, the peak age of onset is 40 to 60 years old, and the male to female ratio is 2 to 3: 1.

Basic Information

English name

carcinoma of tonsil

Visiting department

General surgery, tumor surgery

Common locations

tonsil

Common causes

Associated with long-term inflammation and smoking. Heavy drinking and long-term smoking may be important triggers

Common symptoms

With the progress of the disease, it can be manifested as a foreign body sensation in the pharynx and pain in the swallowing. In the later stage, the pain can be obvious.

Associated with long-term inflammation and smoking. Heavy drinking and long-term smoking may be important triggers. Pathological types include squamous cell carcinoma, lymphoepithelial carcinoma, undifferentiated carcinoma, and adenocarcinoma. Squamous carcinoma is more common.

There are no symptoms in the early stage, as the disease progresses, it can manifest as pharyngeal foreign body sensation and swallowing pain, late stage can be obvious sore throat, exacerbated when swallowing, and can be radiated to the same ear or face. Often bad breath, bleeding and difficulty opening mouth. Invasion of surrounding tissues can cause dysphagia, dyspnea, and cervical lymphadenopathy. Examination revealed that the tonsils on one side were nodular, cauliflower-shaped, or ulcerated, easily bleeding, hard, and could invade surrounding tissues. Squamous cell carcinoma often presents with ulcers on the surface. The cancerous tissue often spreads forward and backward in the pharyngeal column, the soft palate, and the base of the tongue. There may also be distant organ metastases. The most common distant metastatic organs are the lung, followed by bone, liver, and mediastinum.

1. Medical history: Ask the patient carefully whether there are long-term drinking, smoking history and other carcinogenic factors. If there are symptoms of persistent tonsil enlargement and sore throat, a detailed examination should be performed.
2. Local inspection (1) Oral, oropharyngeal, nasopharyngeal, hypopharyngeal, and laryngo-pharyngeal: focus on the anterior pharyngeal column, oral mucosa, posterior molar triangle, soft palate and ptosis. Indirect nasopharyngoscope, laryngoscope or fiberlaryngoscope was used to observe the nasopharynx, hypopharynx and laryngo-pharynx to determine the tumor range and its relationship with surrounding structures.
(2) Upper neck and submandibular area: Pay attention to the location, number, size, stiffness, and mobility of lymph nodes. If neck lymphadenopathy is found, cervical lymph node biopsy can be performed if necessary.
3. Imaging examination to observe the local location, size, scope, and degree of invasion of the surrounding structures, and to observe the cervical lymph nodes are conducive to the diagnosis, clinical stage, and prognosis, and can help to formulate radiotherapy plans.
4. Pathological examination Whether it is cervical lymph node resection or tonsillectomy pathological examination, is the main basis for the diagnosis of tonsil tumors.
5. Other blood routine and HPV tests. Chest X-ray, CT, abdominal B ultrasound and other tests to determine whether there is distant metastasis.

Diagnosis is based on medical history, clinical manifestations, and examinations. A tonsil biopsy can confirm the diagnosis of cancer cells.
T stage of tonsil cancer:
The maximum diameter of T1 tumor is 2cm.
The maximum diameter of T2 tumor is> 2cm, but 4cm.
The maximum diameter of T3 tumor is> 4cm.
T4 tumors invade adjacent structures such as the jawbone, hard palate, nasopharynx, internal and external pterygoid muscles, tongue base, internal carotid artery, etc.

The treatment of T1 and T2 stage tonsil squamous cell carcinoma can achieve good results regardless of radical radiation therapy or surgery alone, and the 5-year survival rate is about 75% to 90%.
T3 and T4 treatment principles for tonsil squamous cell carcinoma, tend to be a comprehensive treatment method based on radiotherapy, which can better preserve the quality of life of patients while ensuring the cure rate.
Adenocarcinoma of the tonsil and adenoid cystic carcinoma are not sensitive to radiotherapy, surgery should be given priority, and postoperative radiotherapy should be supplemented.