Tonsillar Cancer

Conclusions

Tonsillar cancers are the most common tumors of the oropharynx, and most have squamous cell histology. Cigarette smoking and alcohol consumption are the usual causative factors. Advanced lesions may involve more than one site in the oropharynx, and up to two-thirds of patients present with metastatic neck disease. Pretreatment evaluation includes a biopsy to establish the diagnosis, CT scan to evaluate regional extension and unsuspected disease in the neck, and endoscopy to rule out synchronous primaries. MRI scanning is indicated to inspect base-of-tongue involvement. Early tumors are treated equally well by irradiation and surgery. Advanced lesions are treated first with surgery (may require mandibulectomy) followed by irradiation in 6 weeks. The ipsilateral neck should be treated routinely; irradiation is chosen for the clinically negative neck. The clinically positive neck should be treated with neck dissection; postoperative irradiation to the neck is given if there are multiple positive nodes or extracapsular extension of disease.