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Aetiology of Head and Neck Cancer
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Patients with HPV-positive tonsil cancer tend to be young, non-smokers and non-drinkers. The molecular characteristics are completely different from HPV-negative tonsil cancers. HPV-positive tonsil cancers have shown a better prognosis.
Oropharynx
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Examination under anaesthesia is recommended to assess the involvement of local structures, as this is difficult to assess on imaging. In the era of availability of transoral surgery (either laser or robotic) for oropharyngeal carcinoma, it is important to recognise the role of tonsillectomy or tonsil biopsy. In patients where the tumour is clinically obvious it is enough to perform incisional biopsy to obtain diagnosis. In patients where the tonsils are clinically normal, then tonsillectomy should be performed to ensure the optimal chance of identifying the tumour. Standard tonsillectomy, in the setting of tonsil cancer, is not therapeutic or advantageous to the patient; however, it can make subsequent transoral surgery more challenging and therefore limit the therapeutic options available to the patient.
Head and neck cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Each year in the United Kingdom there are almost 3000 cases of oropharyngeal cancer, with incidence roughly three times higher in men than women, reflecting a doubling in incidence over the last decade. The oropharynx comprises the tonsils, posterior third of the tongue, soft palate and posterior wall of the oropharynx down to the level of the hyoid bone. As the oropharynx is a direct extension of the oral cavity, tumours arising in this region are similar in their epidemiology, presentation and pathology. Of those developing oropharyngeal cancer, over 70% have evidence of prior infection with HPV, especially type 16, rising to one-half of those developing tonsil cancer. Such individuals are less likely to smoke or drink alcohol in excess, and much more likely to have had multiple oral sex partners. The relative risk for developing oropharyngeal cancer is around 3 for each of smoking and alcohol, but around 30 for HPV-infected individuals. HPV-associated cancers have a much better prognosis.
Prophylactic contralateral neck dissection has no advantage in patients with early stage HPV-positive tonsil cancer
Published in Acta Oto-Laryngologica, 2022
Kwang-Jae Cho, Min-Sik Kim, Jung-Hae Cho, In-Chul Nam, Choung-Soo Kim, Geun-Jeon Kim, Young-Hoon Joo
A retrospective chart review of 54 patients diagnosed with squamous cell carcinoma of tonsils who underwent upfront surgical resection of the primary tumor with bilateral neck dissection at the Department of Otolaryngology-HNS, the Catholic University of Korea (Seoul, Korea) from 1999 to 2019 were reviewed. These patients had undergone 47 (87.0%) transoral lateral oropharyngectomies and 8 (13.0%) open surgical treatments with lateral pharyngotomy approach. All patients received a neck dissection at the time of the primary surgery. pCND was performed for tonsil cancer patients in clinical or radiologic negative contralateral lymph nodes. For ipsilateral cervical lymph nodes, radical neck dissection for 4 cases, modified radical neck dissection for 47 cases, and selective (levels II–IV or I–IV) neck dissection for 3 cases were performed. For contralateral cervical lymph nodes, selective (levels II–IV or I–IV) neck dissection for 52 cases and modified radical neck dissection for 2 cases were performed. Tumor HPV status was considered positive if p16 immunohistochemistry was positive.
Distinct microbial communities colonize tonsillar squamous cell carcinoma
Published in OncoImmunology, 2021
Angelina De Martin, Mechthild Lütge, Yves Stanossek, Céline Engetschwiler, Jovana Cupovic, Kirsty Brown, Izadora Demmer, Martina A. Broglie, Markus B. Geuking, Wolfram Jochum, Kathy D. McCoy, Sandro J. Stoeckli, Burkhard Ludewig
Current conclusions about the association of the microbiome with oralpharyngeal cancer have been mainly drawn from studies using saliva or oral rinse microbiomes.41,43,44 Using tonsillar crypt biopsies, our study has identified a set of bacterial species that appears to be tonsil cancer-predictive. The elevated abundance of P. melaninogenica in tonsil cancer is consistent with the heightened presence of this bacterial species in saliva of oral cancer patients.45 The latter study of Mager et al.45 has used DNA hybridization to detect 40 distinct bacterial species in saliva specimen. A later study based on 16S rRNA gene amplicon sequencing has found a higher abundance of F. nucleatum subspecies polymorphum and Porphyromonas aeruginosa in archived frozen tissue of oral squamous cell carcinoma patients, whereas bacterial species such as Streptococcus mitis, Rothia mucilaginosa and Haemophilus parainfluenzae were more frequent in epithelial swabs of healthy controls.35 These previous studies, together with the data presented here indicate that the assessment of bacterial dysbiosis with the quantification of differentially abundant bacterial “indicator” species could guide the diagnosis of oropharyngeal malignancies. Clearly, future studies will be required to further validate the set of bacterial species for diagnosis of tonsil cancer elaborated here and to define niche-specific microbiome alterations in other oropharyngeal cancer entities.
Identification of antigen-specific neutrophils in the tonsils with recurrent acute inflammation
Published in Autoimmunity, 2020
Cai-Jie Zhou, Li-Hua Mo, Xiang-Qian Luo, Gui Yang, Wei-Liang Diao, Shi-Ping Hu, Ping-Chang Yang
Surgically removed Rtn tonsils and the marginal non-tumour tonsillar tissues of tonsil cancer (Ttn, in short; proved by pathologists) were collected. The tonsillar tissues were processed for paraffin sections and H&E staining. Profound inflammatory cell infiltration was observed in the Rtn tissues (Figure 1(A)). The inflammation scores were determined for each sample, which was significantly higher in the Rtn group than that in the Ttn group (Figure 1(B)). Single cells were prepared with the tonsillar tissues and analyzed by flow cytometry. The major inflammatory cells, PMNs, and eosinophils were counted. Rtn PMNs occupied about 1/3rd of the tonsil single cells, while less than 5% PMNs were detected in Ttn samples (Figure 1(C,D)). About 3% of eosinophils were detected in tonsil single cells in both Rtn and Ttn samples (Figure 1(E,F)). A positive correlation (r = .7352; p = .0002) between the inflammation scores and PMN counts was determined (Figure 1(G)). A positive correlation was also found between Rtn inflammatory scores and MPO (Figure 1(H,I), r = .6565, p = .0017), or neutrophil elastase (Figure 1(J,K), r = .6687, p = .0013). The results suggest that PMNs may play an important role in the pathogenesis of Rtn.