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Occult tonsillar carcinoma in the unknown primary
S J McQuone1, D W Eisele, D J Lee
1Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
The Laryngoscope
|November 18, 1998
Summary
Routine tonsillectomy is effective for detecting squamous cell carcinoma of unknown primary, with occult tonsillar cancers showing significantly lower recurrence and spread. This procedure improves outcomes for these patients.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Oncology
Background:
- Squamous cell carcinoma of unknown primary in the neck presents a diagnostic challenge.
- Identifying the primary tumor site is crucial for effective treatment and improved patient prognosis.
Purpose of the Study:
- To evaluate the effectiveness of routine tonsillectomy in identifying the primary site of squamous cell carcinoma of unknown primary in the neck.
- To compare the outcomes of patients with occult tonsillar carcinoma to those with other unknown primary sites.
Main Methods:
- Retrospective review of 37 patients with unknown primary tumors over a 10-year period.
- Analysis of patient demographics, diagnostic methods, biopsy sites, N stage, extracapsular spread, recurrence, and survival data.
- Inclusion of tonsillectomy findings in the evaluation.
Main Results:
- All identified primary lesions originated from the tonsil (9/9) in patients undergoing tonsillectomy with direct laryngoscopy.
- Patients with occult tonsillar carcinoma had no recurrence (0/9) compared to 60% (15/25) in other groups.
- Tonsillar primaries showed less extracapsular spread (25%) than non-tonsillar primaries (67%).
Conclusions:
- Occult tonsillar carcinoma is a more frequent cause of unknown primary neck cancer than previously recognized.
- Bilateral tonsillectomy is recommended for increased detection and to identify rare bilateral disease.
- Lower rates of extracapsular spread and recurrence in occult tonsillar carcinoma suggest an improved prognosis.