Tonsil cancer: Lymphoma

• What is Tonsil Cancer (Lymphoma of the Tonsil)
• Statistics on Tonsil Cancer (Lymphoma of the Tonsil)
• Risk Factors for Tonsil Cancer (Lymphoma of the Tonsil)
• Progression of Tonsil Cancer (Lymphoma of the Tonsil)
• Symptoms of Tonsil Cancer (Lymphoma of the Tonsil)
• Clinical Examination of Tonsil Cancer (Lymphoma of the Tonsil)
• How is Tonsil Cancer (Lymphoma of the Tonsil) Diagnosed?
• Prognosis of Tonsil Cancer (Lymphoma of the Tonsil)
• How is Tonsil Cancer (Lymphoma of the Tonsil) Treated?

What is Tonsil Cancer (Lymphoma of the Tonsil)

Tonsil cancer may be of the Lymphoma type and usually arise from the lymphatic cells which are found in the wall of the tonsils.

The pharynx is the continuation of the nose and mouth. It is a muscular tube that continues downwards through the neck and is responsible for the passage of both air (to the larynx, trachea and lungs) and food (to the oesophagus and then stomach). The pathways for food and air cross over in the pharynx. In addition, the auditory canal opens onto the upper part of the pharynx.

The walls of the pharynx are composed of fascia and muscle layers all lined by a mucous membrane. The pharynx is divided into three different areas based on anatomical location: the nasopharynx (behind the nose); oropharynx (behind the mouth); and the laryngopharynx (behind the larynx).

The tonsils are a ring of lymphoid tissue around the upper part of the pharynx. They consist of the lingual tonsil in the posterior part of the tongue, the palatine tonsils and the pharyngeal tonsils. Lymphoid tissue acts as a barrier against infection.

Statistics on Tonsil Cancer (Lymphoma of the Tonsil)

Tonsil cancer is uncommon, but lymphoma of the head and neck is the second most common site of extranodal (not occuring within the lymph nodes) disease after the gastrointestinal tract. It occurs with highest incidence in adulthood with sex incidence being slightly male predominant.

Geographically, the cancerous tumor is found worldwide, with variation depending on the underlying cause. For instance, Burkitt’s lymphoma is more common in Africa.

Risk Factors for Tonsil Cancer (Lymphoma of the Tonsil)

The cause of most cases of Non-Hodgkin’s lymphoma is unknown although a number of predisposing factors have been identified. These are:

• some types of NHL (e.g. Burkitt’s lymphoma) have been shown to contain particles of the Epstein-Barr Virus;
• HIV/AIDS predisposes to NHL, possibly as a result of the immune suppression but the virus itself may be implicated;
• immune suppression from anti-rejection drugs;
• exposure to certain chemicals;
• previous anti-cancer treatment; and
• certain genetic and chromosomal abnormalities.
  

  Progression of Tonsil Cancer (Lymphoma of the Tonsil)

  This type of cancerous tumor spreads by local extension, particularly into the soft palate and destruction of adjacent tissue. Lymphatic invasion with spread to the cervical lymph nodes is almost universal at the diagnosis of tonsil cancer. Up to 60% of patients presenting with non-Hodgkin’s lymphoma of the head and neck will have systemic disease.

  How is Tonsil Cancer (Lymphoma of the Tonsil) Diagnosed?

  General investigations into tonsil cancer may show anaemia or abnormal liver function tests. If haemolysis is present, the serum haptoglobin level may be lowered.

  Prognosis of Tonsil Cancer (Lymphoma of the Tonsil)

  Low grade lymphomas are usually slow growing and therefore compatible with a long life expectancy. They are not usually curable, but normally respond to treatment with long remission periods achievable. High grade lymphomas usually respond rapidly to treatment and a good proportion are curable. Prognosis of tonsil cancer can vary widely depending on the lymphoma type. For example, follicular small cleaved cell lymphoma has an average survival of 9 years. Low grade lymphomas usually have a first remission lasting approximately 3 years.

  How is Tonsil Cancer (Lymphoma of the Tonsil) Treated?

  The cancer treatment options available in non-Hodgkin’s lymphoma are radiotherapy and chemotherapy. If the cancerous tumor is highly localised to the tonsils or head and neck region, then the tonsil cancer treatment of choice is radiotherapy and is very effective. More advanced tonsil cancer will require systemic cancer treatment with chemotherapy, but may also include radiotherapy as part of the cancer treatment regime.

  As a general rule, low-grade non-Hodgkin’s lymphoma is usually treated with chlorambucil and prednisolone. This has the effect of putting people into cancer remission for a variable period of time. The low-grade non-Hodgkin’s lymphomas usually relapse, but also usually respond to re-treatment of the cancer.

  High-grade lymphomas are potentially curable with intensive chemotherapy. Some examples are given below:

  Cancer treatment for non-Hodgkin’s lymphoma had not really changed much in 25 years until very recently. Rituximab, a specific monoclonal antibody against a protein found on B lymphocytes has brought the first major advance in treatment since CHOP was first used in the 1970s.

  Currently only available on the PBS in Australia for low-grade non-Hodgkin’s lymphoma, haematology and oncology specialists are eagerly awaiting the results of trials involving rituximab plus chemotherapy for high-grade lymphoma. It is expected that rituximab will increase the effectiveness of chemotherapy for tonsil cancer.

  As every cancer patient is different, your treating specialist will be able to advise you on which treatment of tonsil cancer is best for you.

  Improvement in symptoms of tonsil cancer is an important measurement. Specific monitoring may be by measurement of the size of the involved lymph nodes. This may often be done with a simple ruler of tape measure if the nodes are easily felt e.g. in the neck. If the lymph nodes are deep inside, e.g. in the chest or abdomen, then imaging such as CT can show the response to cancer treatment.

  The symptoms that may require attention are fatigue from anaemia, and pain from organ or bone involvement. Radiotherapy is used for treating specific problems that require focal therapy, such as bone pain from bone involvement or treating obstruction of the Superior Vena Cava (the large vein that drains the face and upper body).