Lump on the tonsil: causes and methods of treating a tumor on the tonsil

When children get sick often, this is a sure sign that the immune system is not working at a sufficient level. To cope not only with the manifestation of the disease itself, but also to take a comprehensive approach to solving the problem that has arisen, you first need to make an appointment with a pediatrician and then an otolaryngologist. His consultation is indispensable when frequent diagnoses of a child at different ages sound like:

• ARVI, acute respiratory infections;
• exacerbation of chronic tonsillitis and adenoiditis;
• otitis;
• laryngitis;
• pharyngitis;
• angina.

Specialists from the first children's medical center in Saratov will help you select a comprehensive and effective treatment, who will conduct diagnostics, prescribe active treatment measures, and in addition select effective methods of prevention.

Symptoms of tonsil cancer

• Dysphagia (difficulty swallowing) – the tumor interferes with swallowing, causing difficulty swallowing.
• Odynophagia (pain when swallowing) – the tumor grows, leads to the formation of ulcers, grows into the nerves, which leads to pain.
• Lump – spread of cancer to the lymph nodes makes the tumor clinically noticeable: the patient may notice a firm, palpable mass in the neck.
• Otalgia (ear pain) - the innervation of the oropharynx and ear has some connection, which means that the brain can “replace” pain in the oropharynx with pain in the ear (referred pain). The most alarming is pain in the ear on one side, without any other ear problems, not going away, unexplained by other diseases. It is important to understand that most causes of ear pain are associated with middle ear infection, eustachian tube dysfunction and other diseases of the ENT organs. But a combination of several symptoms may indeed indicate an oncological process.
• Trismus (spasm of the pterygoid muscles, causing difficulty opening the mouth).
• Feeling of a lump in the throat.
• A sore throat.
• Bleeding from the mouth.
• Change in speech (muffled voice).
• Weight loss.

Medial pterygoid muscle. getbodysmart.com

How to protect the body?

Since more than 600 strains of human papillomavirus are known in the world today, it is difficult to combat such microparticles comprehensively and constantly. First of all, it is necessary not only to see a doctor once, but also to undergo a regular course of treatment. Using folk remedies without supervision from medical personnel, formations on the larynx can develop into a malignant tumor, so self-medication, especially if the patient is a child, is strictly prohibited.

During the transitional climatic period, as well as in winter, there is a frequent exacerbation of chronic tonsillitis. This is due to the fact that the child does not always inhale frosty cold air through the nose, but breathes through the mouth. As a result, it is observed:

• elevated temperature;
• inflammatory processes in the throat;
• dry or wet cough;
• weak appetite;
• bad mood, high level of moodiness.

At an appointment with an otolaryngologist, a red throat is also diagnosed, and as a result, complications can spread to the nose, causing a chronic runny nose, and to the ears, causing otitis media, which is difficult and painful.

Sometimes, due to the fact that there is an exacerbation of chronic tonsillitis, it is difficult to visually determine the presence of a growth on your own. A swollen throat does not allow you to independently diagnose the formation, and if you do not consult a doctor for primary indications, you can lose valuable time for treatment.

There are times when, when it is necessary to treat otitis, all attention is switched to inflammatory processes in the ear, and parents do not even look into the child’s oral cavity. As a rule, concomitant diseases of the ear-nose-throat-system occur together, and competent comprehensive treatment is important so that getting rid of one ailment does not switch the development of the disease and complications in the other direction.

In the most advanced cases, complete removal of the affected “tonsil” is required (as patients often call the palatine tonsils). That is why it is important to consult a doctor in time to minimize this risk. If a child has frequent manifestations of colds, laryngitis or pharyngitis is diagnosed, then in addition to consultations with specialists at the center during the active stage and recovery from the disease, it is worth regularly showing the baby to doctors in order to exclude possible complications in the development of diseases.

The tumor on the tonsil itself does not go away, it may simply decrease in size, but this is not a reason to put off visiting a specialist. You shouldn’t risk your health, much less the health of your baby. Particular attention to the throat cavity should be paid in the following cases:

• when visiting a kindergarten and mass illness of children in it;
• when starting visits to sports sections, in particular the swimming pool.

A gathering of people who may also be carriers of the papilloma virus in one place can negatively affect the child’s health. The reason for a more thorough analysis of the throat cavity may be the use of antibiotics before this, non-compliance with the hygiene regime, as well as the active manifestation of oral diseases. If before this the child had a sore throat, and is now in the recovery period, then it is worth paying special attention to the condition of the throat in order to protect the child from formations on the tonsils. In case of mild laryngitis or pharyngitis, experts recommend carefully observing the child’s throat for a couple of days. To do this, in the morning and evening, ask the child to open his mouth to visually inspect for any formations on it, watch how the child eats, drinks and breathes.

Diagnostics

• Anamnesis collection, visual examination and palpation of the mucous membranes of the floor of the mouth, the anterior two-thirds of the tongue, the tonsils and base of the tongue, the mucous membrane of the palate, cheeks and gums, and the posterior wall of the pharynx.
• Diagnosis of HPV infection: immunohistochemical determination of the surrogate marker p16 in tumor tissue.
• Computed tomography of the chest and abdominal cavity to exclude metastatic lesions.
• Biopsy – cancer can be diagnosed only by taking a tissue sample from a growth that is suspicious for a malignant process.
• MRI of the soft tissues of the neck provides more accurate detail of the soft tissues compared to CT. Performed to assess the prevalence of the process.
• Ultrasound of the lymph nodes of the neck to determine their structure (if there is metastasis in the lymph nodes, they may not change their size, but the structure of the lymph node changes).
• PET-CT may be ordered if occult distant metastases are suspected in some situations.
• Fibercolonoscopy, fibrogastroduodenoscopy, laryngoscopy and some other studies may also be prescribed.

HPV-associated squamous cell carcinoma of the right tonsil (A) demonstrating p16 overexpression by immunohistochemistry (B) and evidence of high-risk HPV by in situ hybridization (C). Patients with HPV-related tonsil squamous cell carcinoma rarely harbor oncogenic HPV infection at other pharyngeal sites, SelvamThavaraj et all., ELSEVIER April 2014

Determination of stage

Determination of the stage of cancer is carried out according to the TNM system (T - tumor, N - nodulus, M - metastasis), including the size of the primary tumor, the spread of tumor cells to regional (located next to the primary tumor) lymph nodes and to distant areas (lungs, liver) . Today, the Russian Federation has adopted the seventh classification of tumors (the newest is the eighth). The connection between tonsil cancer and HPV infection is also taken into account during staging (but only for the eighth classification) - with similar morphological data of the tumor and its distribution, the stage of tonsil cancer associated with HPV infection is often lower, in contrast to cancer associated with other factors . In general, the prognosis for tonsil cancer associated with HPV infection is more favorable.

Tonsil cancer staging based on tumor size is “T”. headandneckcancerguide.org

Treatment

Early tonsil cancer can be treated with radiation therapy or surgery: small tumors confined to normal tonsil tissue can be cured by removing the tonsil (tonsillectomy). If the tumor extends beyond the tonsil itself, then the soft palate and the wall of the pharynx may need to be removed. Depending on the presence of tumor cells in the lymph nodes, lymphatic dissection may be performed - removal of regional lymph nodes (for head and neck tumors, they are located in the neck). Otherwise, the tumor can be treated with radiation without the need for surgery. The effectiveness of radiation therapy and surgery is similar.

So, for the treatment of early tonsil cancer there are two approaches:

• surgical treatment, which, depending on the results of pathomorphological examination, may be continued with a course of radiation therapy (adjuvant radiation therapy) either alone or simultaneously with chemotherapy;
• radiation therapy – alone or simultaneously with chemotherapy (simultaneous chemoradiotherapy).

Late cancer of the tonsils, growing into the peripharyngeal space, penetrating into the bones, base of the skull, and medial pterygoid muscle may be accompanied by symptoms such as temporal pain and trismus (spasm of the masticatory muscles, leading to difficulty opening the mouth). Treatment of advanced cancer is often accompanied by chemoradiotherapy. An option is surgical treatment of advanced cancer followed by chemoradiotherapy.

When performing surgical intervention, the decision on the need for subsequent treatment is made on the basis of a pathomorphological examination of postoperative material. Spread of the tumor beyond the capsule of the lymph node, removal of the tumor outside of healthy tissue (the tumor is not removed radically, that is, not completely), significant spread of the tumor to the lymph nodes and a large size of the primary lesion, as well as tumor invasion of nerves, lymphatic and blood vessels - all these characteristics are predictors of an unfavorable course of the tumor process and may require additional postoperative treatment in the form of reoperation (if the tumor is not completely removed), chemotherapy and/or radiation therapy.

For the treatment of metastatic tonsil cancer (M1), surgical treatment and radiation therapy are not indicated. In this case, the main approach is systemic therapy, the choice of which will be based on the presence/absence of previous systemic treatment, the patient's condition, certain tumor characteristics (PD-L1 expression), the rate of disease progression and some other factors. Options for systemic therapy include chemotherapy drugs: platinum drugs (cisplatin, carboplatin), fluorouracil and taxanes (docetaxel, paclitaxel); targeted drugs (cetuximab); immunotherapy drugs (pembrolizumab, nivolumab). The combination of drug groups is determined by the above characteristics.

In the presence of a single distant metastasis, metastasectomy may be offered in addition to systemic therapy, which is likely to prolong the time to eventual disease progression.

Regardless of the extent of tonsil cancer, patients may be offered participation in clinical trials.

Patients with severe comorbidities and/or poor health status are best treated with supportive care.

What to do if growths are visible in a child’s throat?

It is not uncommon for tumors to appear on the tonsils. This is a consequence of the papilloma virus, which manifests itself on the skin and mucous membranes. It would seem, where can a child catch this dangerous virus, which infects more than 70% of all inhabitants of the planet? First of all, in the womb, during birth, and also through contact and everyday life.

In the pharynx, neoplasms are most often found on the tonsils, but can be on the small tongue, palatine arches, and buccal mucosa. Only a pediatrician or otolaryngologist can make a diagnosis after examination.

Neoplasms on the larynx in children can form from birth; clinical manifestations often manifest in early childhood from 2 to 5 years. In children, this form of the disease indicates that treatment is necessary quickly and as competently as possible. Only an ENT doctor can diagnose such a localization of the process.

The active papilloma virus most often affects boys, but after 30 years, more women are affected. As a rule, the growths begin to manifest as impaired vocal function in the form of hoarseness, decreased timbre and rapid fatigue.

Complications of treatment

Indeed, there are two directions in the treatment of tonsil cancer with the same outcome, but different techniques: surgical treatment and radiation therapy. It is important to note that these approaches will have different complications.

Radiation therapy may be complicated by bone or soft tissue necrosis and swallowing problems, especially in patients with advanced tonsil cancer. Myelitis, trismus, hypoglossal nerve damage, and long-term risk of another malignancy are also possible.

Complications of surgery include difficulty swallowing, fistula formation, failure of flap healing, poor wound healing, and aspiration of food and saliva, sometimes leading to laryngectomy. The risk of severe and/or fatal complications after surgery is higher than with radiation therapy.

Complications of systemic therapy include fatigue, skin toxicity, mucositis, diarrhea, hepatotoxicity, pneumonitis, hypo- and hyperthyroidism, myelotoxicity, neuropathies, metabolic disorders, etc.

Treatment of tonsil cysts

Treatment of cysts can be either conservative or surgical. Often, specialists first prescribe effective drug therapy to relieve inflammation and prepare the patient for surgery. Conservative treatment of a cyst will not reduce its size, but can stop the active growth of the tumor and prevent complications. Treatment tactics should be selected by a competent specialist based on medical history, diagnosis and professional examination.

Conservative therapy for tonsil cysts includes the following measures and procedures:

• gargling with herbal decoctions, antiseptic solutions that disinfect tissues and have an anti-edematous and anti-inflammatory effect;
• physiotherapy: ultraviolet irradiation, massage, ultrasound - physiotherapeutic treatment methods are used to increase blood supply to tissues in the area where the tumor is located, to ensure lymph outflow;
• pumping out pus using hardware methods, which makes it possible to stop the development of the infectious process and the spread of infection to surrounding tissues;
• injection rinsing of the tonsils with anti-inflammatory drugs and antiseptics to cleanse plaque and purulent contents;
• strengthening the immune system with multivitamin complexes and immunostimulants;
• giving up bad habits that contribute to traumatization of the tonsils and the preservation of the chronic inflammatory process.

Some specialists practice opening the cyst and pumping out its contents. But, as a rule, the therapeutic effect does not last long and the tumor is filled with fluid again. Therefore, if the cyst has not disappeared after several weeks of active medical therapy, it is better to remove it surgically.

Forecast

The prognosis for patients with HPV-associated tonsil cancer is significantly better than for patients with other etiologies of cancer. It is impossible to predict with high accuracy the life expectancy of a particular patient, but there are average graphs that can be used to determine what percentage of patients with a certain stage are alive after n years: for example, almost 90% of patients with stage I HPV-associated oropharyngeal cancer are alive 4 years after diagnosis, while for HPV-unassociated oropharyngeal cancer at the same stage, only 80% are alive 4 years after diagnosis.

Overall survival of HPV-associated and HPV-non-associated oropharyngeal cancer according to TNM classification 7. ICON-S