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Tonsil Cancer

If an adult in your life has tonsil cancer, you may want to learn more about it. This page contains information about tonsil cancer, its types and what to expect.

First, you should understand what cancer is. Cancer is a disease caused by abnormal cells that grow too rapidly. Our bodies are made of cells so tiny you need a microscope to see them. Cancer cells don’t look or act like normal cells, and they don’t allow our normal cells to work properly. There are many different types of cancer that can grow anywhere in the body.1 Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7.

In most people, the tonsils can be seen by looking inside the mouth. The tonsils are actually part of the oropharynx (throat), not the oral cavity (mouth). The oropharynx is the part of the throat, which includes the tonsils, base of the tongue, soft palate and posterior oropharyngeal wall. Because the tonsils are considered part of the throat, many doctors will group tonsil cancer with throat cancers NOT oral cancers.

Like with all head and neck cancers, tonsil cancer (and oropharyngeal cancer in general) is often seen in older men with a history of smoking and drinking. However, over the last decade, doctors have been seeing more oropharyngeal cancers in patients who are younger, healthier and non-smokers. These patients often have large cancerous lymph nodes in the neck. When this happens, it is often associated with a virus called the human papillomavirus (HPV). Researchers are still figuring out the details about oropharyngeal cancer associated with HPV, but one thing is certain—it behaves quite differently than oropharyngeal cancers not associated with HPV. As a general rule, these patients have improved outcomes with current treatment strategies.1 Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7.

Understanding the anatomy

To understand tonsil cancer, you need a basic understanding of the anatomy (parts) of the head and neck.

The tonsils are part of the oropharynx, which is the part of the throat located at the back of the mouth. The nasopharynx is located above, while the hypopharynx is situated below.

04a_throat_overview CROP

The tonsils are the ball-shaped structures at the back and on the sides of the throat. They can cause problems such as infections and snoring in younger people. They are made up of lymphoid tissue (tissue that has infection-fighting cells). One of the most common surgeries in the U.S. is removal of tonsils when they get large in children and cause recurrent infection or a sleeping disorder known as obstructive sleep apnea. Interestingly, removing the tonsils does not seem to hinder the body’s ability to fight infections (you have many back-up systems to fight infections in the body). In general, each of the tonsils should be about the same size (though in some people they are slightly different in size).

41_1_tonsil

A ring of tonsil-like tissue is located in the side walls and base of tongue portions of the oropharynx. The adenoid tissue, located on the roof of the nasopharynx, completes the superior portion of the tonsillar rings known as the Waldeyer’s ring.

Structures related to the tonsils include:

  • Anterior tonsil pillar: This is the fold of tissue just in front of the tonsil. It is also called the palatoglossus because it extends from the soft palate above down to the tongue.
  • Posterior tonsil pillar: This is the fold of tissue just behind the tonsil. It is also called the palatopharyngeus because it extends from the soft palate above to the pharyngeal wall on the back.
  • Glossotonsillar sulcus: This is the bottom part of the palatine tonsil where it blends into the lingual tonsil tissue. It is basically an area between the tonsil and the base of tongue.

Causes of tonsil cancer

You may want to know what caused the tonsil cancer. The short answer is that we don’t know. You can be sure that you did nothing to cause it. Also, it is not contagious (you can’t catch it).

By far the most common contributor to most head and neck cancers is using tobacco, particularly smoking it. Drinking too much alcohol also adds to the risk of developing head and neck cancer.

Major factors that increase the chance of developing tonsil cancer include:

  • Tobacco: Smoking cigarettes, cigars or pipes and using chewing tobacco greatly increase the chance of getting a throat cancer.2 Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer research. Jun 1 1988;48(11):3282-3287.
  • Alcohol: Drinking too much alcohol is strongly related to getting a throat cancer. And if one both smokes and drinks heavily, the risk more than doubles.2 Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer research. Jun 1 1988;48(11):3282-3287.
  • Viruses: Exposure to certain strains of human papillomavirus (HPV) is linked with oropharyngeal cancer. The strains 16 and 18 are the main ones we are concerned about. This virus is quite common and is associated with intimate sexual contact. Why some people get cancer from this virus while others don’t is still a mystery.3 D'Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. The New England journal of medicine. May 10 2007;356(19):1944-1956.
  • Exposure to radiation in the past: Being exposed to radiation through previous treatment for another disease, certain working conditions or even a natural disaster can increase the chances of some throat cancers.
  • Genetic factors: This is important in all cancers, and the details are still being determined.
  • Certain foods: Lack of some vitamins and poor oral hygiene might be associated with oropharyngeal cancers.4 Moreno-Lopez LA, Esparza-Gomez GC, Gonzalez-Navarro A, Cerero-Lapiedra R, Gonzalez-Hernandez MJ, Dominguez-Rojas V. Risk of oral cancer associated with tobacco smoking, alcohol consumption and oral hygiene: a case-control study in Madrid, Spain. Oral oncology. Mar 2000;36(2):170-174.

Signs and symptoms of tonsil cancer

The symptoms of tonsil cancer, like other oropharyngeal cancers, depend on where and how big the tumor is. The patient sees or feel a growth in his or her mouth on one of the tonsils, or the doctor will see one tonsil bigger than the other (when they were the same size in the past). However, it is not uncommon for the first symptom of a cancer in the tonsils to be a lump in the neck. In any case, oropharyngeal cancer can appear with many different symptoms, including5, Koivunen P, Rantala N, Hyrynkangas K, Jokinen K, Alho OP. The impact of patient and professional diagnostic delays on survival in pharyngeal cancer. Cancer. Dec 1 2001;92(11):2885-2891.6, Roistacher SL, Tanenbaum D. Myofascial pain associated with oropharyngeal cancer. Oral surgery, oral medicine, and oral pathology. May 1986;61(5):459-462.7 Rogers SN, Vedpathak SV, Lowe D. Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective. The British journal of oral & maxillofacial surgery. Jul 2011;49(5):349-353.:

  • Pain or difficulty with swallowing in the throat: This can occur because a tumor is in the way of swallowing, so it becomes difficult or painful to swallow. Also, there can be ulceration (an area of dead cells) and bleeding as the tumor grows, causing pain.
  • A lump in the neck: This will be a symptom of oropharyngeal cancer if it has spread to lymph nodes in the neck. This can be the first symptom that brings a patient to the doctor.
  • Ear pain (particularly on one side, with no other ear problems): Ear pain, also known as otalgia, happens because the nerves of the throat reach the brain through the same pathway as one of the nerves in the ear. Therefore, the brain might think a pain in the throat is coming from the ear. This is called referred pain. For this reason, unexplained ear pain that doesn’t go away should be evaluated by a specialist. It is important to understand that most causes of ear pain are due to simple problems such as middle ear infection, dysfunction of the Eustachian tube or TMJ pain due to a problem in the joint located in front of the ear.

Other symptoms might include:

  • Difficulty opening the mouth widely (trismus)
  • Feeling a lump in the throat
  • Bleeding from the mouth
  • A change in speech
  • Weight loss

These symptoms sound scary, but don’t jump to conclusions. A person could have one or more of these symptoms but NOT have tonsil cancer. There are several non-cancerous causes of the same symptoms. That’s why the patient needs to see a specialist.

What will happen at the doctor visit

Step 1: History

First, the doctor will listen to the patient talk about his or her health. The doctor will probably ask many questions, too.

The doctor might ask some of these questions:

  • How long has the problem been there?
  • Is it getting worse, better or staying the same?
  • Does it come and go?
  • Have you tried anything to make it better?
  • Is it painful?
  • Do you have any lumps or bumps in your neck?
  • Are you having difficulty with hearing?
  • Do you have any lumps or bumps anywhere else in your body?
  • Are you losing weight?
  • Are there any other problems associated with your main problem?
  • Do you have any other medical issues?
  • Have you had any surgeries in the past?
  • What medications do you take? And do you have any allergies?
  • Have you ever been exposed to radiation in the area?
  • What do you (or did you) do for a living?
  • Do you have a family history of cancer?

Step 2: Physical Exam

Next, the doctor will look at and feel the patient’s head and neck. The throat typically requires a specialist to examine it because it is not easy for a general doctor to see and feel. In general, the specialist might do some of the following:

  • Look inside and probably even feel inside the mouth
  • Feel the neck extensively and carefully to check for any lumps or bumps
  • Look inside the ears
  • Look inside the front of the nose
  • Check the cranial nerves, do some simple hearing tests and test sense of touch all over the face

Step 3: Reviewing Tests

After getting background information and doing a physical exam, the doctor will look at the results of any tests the patient has already had.

Step 4: Suggestions

Finally, the doctor will make suggestions about next steps. This will probably include more tests and doctor visits.

Diagnosing tonsil cancer

If the symptoms haven’t been present for very long, or if the history and physical examination make the doctor less worried that the lesion is cancer, the doctor might try some medications and rehabilitation before jumping to a diagnosis of cancer.

However, if the doctor is worried, he or she may choose one or more of the following actions.

Imaging

Imaging refers to radiologic studies, or scans, that make pictures of the structures inside the head and neck. In general, imaging might not be necessary for small tumors that can be easily seen by the doctor. For larger tumors, or tumors in locations difficult to examine, the doctor will probably order some sort of imaging to get more information about the tumor location to see if the tumor has spread to nearby lymph nodes. An important reason to get a scan for sinonasal tumors is to see if there is any evidence of spread into nearby structures. Spread into other structures will influence what treatment the doctor recommends.

Some surgeons also say getting some imaging (pictures of the inside of the head and neck) will lower the chance of surprises in the operating room. Imaging will also give some clues about whether the tumor is really cancer. This will prepare the patient and the surgeon for what to expect during surgery.

There are many different kinds of imaging scans. The doctor may recommend more than one kind of scan to see a better picture of the tumor.

The two main types of imaging used in the U.S. are CT scans and MRI scans.

CT SCAN MRI
 CT Scan MRI
Advantages A computed tomography (CT) scan is a quick test that shows a great deal of useful information. A CT scan can show the size of the tumor and how far it has spread. It can help a surgeon plan an operation. Magnetic resonance imaging (MRI) is better at showing how the tumor has spread to body parts around it. The patient will not be exposed to radiation during an MRI.
Disadvantages A CT scan uses radiation, which can be dangerous. The pictures might not be clear if the patient moves or has a lot of dental work. Also, a CT doesn’t show damage to nearby body parts as clearly unless the damage is moderate to severe. An MRI takes a lot longer than a CT scan. It requires the patient to lie perfectly still for almost an hour. The patient can’t have an MRI if he or she has metal implants.

For most head and neck cancers, if imaging is required, the doctor will likely start with a CT scan with contrast. Other tests might include an MRI and/or a positron emission tomography (PET) scan.

Biopsy

A biopsy is the main way to find out if a growth is cancer. For a biopsy, the doctor takes out a small piece of the lump or the entire tumor. Another doctor, called a pathologist, then looks at the sample under a microscope to see if it is cancer. Doctors often do biopsies because they can usually be done quickly and safely. The doctor can sometimes do a biopsy during the first visit with very little risk.

Fortunately, biopsies of the skin are more straightforward than for other sites, mainly because they are easier to get to. Typically, skin cancers can be biopsied in the office with a little numbing medicine. It usually takes only a few seconds to do a biopsy. The tissue is then sent to a pathology doctor to see if it is cancer and, if so, what type and how far it has spread.

A biopsy can help the doctor plan the surgery if he or she decides it is needed. A biopsy can also prevent unnecessary surgery.

As good as biopsies sound, there are a few problems. First, biopsies are not 100 percent accurate. A biopsy could show that a growth is NOT cancer when it really is; this is called a false-negative biopsy. A false-positive is also possible when the biopsy seems to show that a growth is cancer but more testing shows it isn’t. Sometimes doctors can’t be completely sure a tumor is cancerous from a biopsy.7 Rogers SN, Vedpathak SV, Lowe D. Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective. The British journal of oral & maxillofacial surgery. Jul 2011;49(5):349-353.

Determining the type of tonsil cancer

After the tumor has been closely looked at, the doctor will need to figure out what type of cancer it is. He or she may be able to tell from biopsy results. The doctor may also want a second opinion from a specialist to be sure. Remember, not all lumps and bumps inside the throat are cancer. Some growths are benign (non-cancerous), and some tumors are on the border between benign and malignant (cancerous).

It is very important to know if an oropharyngeal cancer is associated with HPV. This can be determined from a biopsy by running some special tests, including looking for DNA of the virus or looking for certain proteins, such as P16, related to the virus. While we know that patients with HPV-related oropharyngeal cancers have better outcomes, we are not quite at the stage where we can treat them differently.

  • Squamous cell carcinoma: These are by far the most common oropharyngeal cancers.9 Krause CJ, Carey TE, Ott RW, Hurbis C, McClatchey KD, Regezi JA. Human squamous cell carcinoma. Establishment and characterization of new permanent cell lines. Arch Otolaryngol. Nov 1981;107(11):703-710. They arise from cells lining the oropharynx. They should be divided into two main types, depending on some cellular findings relating the cancer to the human papillomavirus (HPV positive versus HPV negative).10 Licitra L, Perrone F, Bossi P, et al. High-risk human papillomavirus affects prognosis in patients with surgically treated oropharyngeal squamous cell carcinoma. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. Dec 20 2006;24(36):5630-5636.

Rare cancers found in the oropharynx include:

  • Salivary gland cancers: There are minor salivary glands located under the lining of the throat. This is why cancers that we typically see in salivary glands can arise in this region. They include diagnoses such as mucoepidermoid carcinomas, adenocarcinomas and adenoid cystic carcinomas, to name a few.11 Eveson JW, Cawson RA. Tumours of the minor (oropharyngeal) salivary glands: a demographic study of 336 cases. Journal of oral pathology. Jul 1985;14(6):500-509. See Salivary Gland Cancer for more information.
  • Lymphoma: Lymphoma is cancer of the lymphatic system, which includes lymph nodes, lymph channels, lymphatic fluid and lymphoid tissue. The throat is lined with lymphoid cells. Some major sites of lymphoid tissue include the adenoids in the nasopharynx and palatine tonsils and lingual tonsils in the oropharynx. This is why lymphoma might appear as a lump in the throat area.
  • Mucosal melanoma: These cancers come from skin cells that give skin its color. In rare cases, melanoma can be found in the lining of the mouth, nose and/or throat.

Although extremely rare, these cancers can also develop in the oropharynx:

  • Sarcomas such as chondsarcoma, liposarcoma and synovial sarcoma
  • Malignant fibrous histiocytoma
  • Peripheral Neuroectodermal Tumor (PNET)
  • Cancer spread from another site

The doctor will determine the treatment for the cancer based on the category (type), grade (abnormality) and stage (severity) of the tumor.

Determining the grade of the tumor

Pathologists will typically report on the grade of the tumor. This is a qualitative interpretation by the pathologist of how much the cancerous cells resemble normal tissue from that site. There are a number of different grading systems that might be used. The most common is as follows:

  • GX: Grade cannot be assessed
  • G1: Well differentiated
  • G2: Moderately differentiated
  • G3: Poorly differentiated
  • G4: Undifferentiated

Differentiation refers to how closely the cells taken from a tumor or lesion resemble normal cells from the healthy tissue surrounding the tumor. “Well differentiated” means that the cells look similar to normal cells in that area. “Undifferentiated” means the cells look nothing like normal cells in that area.

While it is important to report the tumor’s grade, few doctors use this information to make decisions regarding treatment or prognosis for this particular cancer type.

Determining the stage of the cancer

The final step before treatment is identifying the stage or the extent of the cancer. This will be determined by studying the physical exam, imaging studies, laboratory work and biopsies.

Like with all cancers of the head and neck, doctors in the U.S. use the AJCC Cancer Staging Manual (7th Ed) to figure out the stage based on three factors.

Factors that go into determining the stage of the cancer
T Characteristics of the main tumor mass
N Status of the lymph nodes in the neck (i.e., evidence of cancer spread)
M Status of cancer spread to parts of the body outside of the head and neck

T stage: the main tumor

Based on a physical examination and review of any imaging, the doctor should be able to assign a T stage that falls within one of the following categories.

42_tonsil_Tstages

Tx The doctor is unable to assess the main tumor.
T0 The doctor is unable to find the main tumor.
Tis Carcinoma in situ (or severe dysplasia); this means there are cancer type cells, but they have not yet invaded deep into tissue. This is more of a pre-cancer lesion.
T1 The tumor is 2 centimeters or less in greatest size.
T2 The tumor is more than 2 centimeters but less than or equal to 4 centimeters in greatest size.
T3 The tumor is more than 4 centimeters in greatest size or has grown into the tongue side of the epiglottis.
T4a This is moderately advanced local disease. The tumor has grown into the larynx, the outside the tongue muscles, the hard palate, the lower jawbone and/or the medial pterygoid muscles.
T4b This is very advanced local disease. The tumor has invaded into the lateral pterygoid muscle, the pterygoid plates, up to the sides of the nasopharynx, into the skull base or completely around the carotid artery.

N stage: spread of cancer to the lymph nodes in the neck

Next, the doctor will use all the available information to figure out the N stage. This is based on the assessment as to whether the cancer has spread to lymph nodes in the neck.

06_Nstages

Nx The neck lymph nodes cannot be assessed.
N0 There is no evidence of cancerous spread to the lymph nodes.
N1 There is a single cancerous lymph node, on the same side of the main tumor, that is 3 centimeters or less in greatest size.
N2a Cancer has spread to a single lymph node on the same side as the main tumor, and it is more than 3 centimeters but less than or equal to 6 centimeters in greatest size.
N2b There are multiple lymph nodes that have cancer on the same side as the main tumor, but none are more than 6 centimeters.
N2c There are cancerous lymph nodes in the neck on either the opposite side as the main cancer or on both sides of the neck, but none are more than 6 centimeters.
N3 The cancer has spread to one or more neck lymph nodes, and the size is greater than 6 centimeters.

M stage: spread of cancer outside the head and neck

Finally, the doctor will identify an M stage. The M stage is based on an examination of the entire body.

M0 No evidence of distant (outside the head and neck) spread.
M1 There is evidence of spread outside of the head and neck (i.e., in the lungs, bone, brain, etc.).

The cancer stage

After TNM staging, the doctor can assign a cancer stage based on the following chart.

Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
T1 N1 M0
T2 N1 M0
T3 N1 M0
Stage IVA T4a N0 M0
T4a N1 M0
T1 N2 M0
T2 N2 M0
T3 N2 M0
T4a N2 M0
Stage IVB T4b Any N M0
Any T N3 M0
Stage IVC Any T Any N M1

The clinical stage

Once the tests are completed, and before deciding on a treatment plan, the patient should be given a clinical stage that looks like this:

CLINICAL STAGE
Site Oropharynx
Subsite Left Tonsil
Type Squamous Cell Carcinoma
cT cT3
cN cN1
cM cM0
cStage cIII

Deciding on a treatment plan

Like with all cancers in the head and neck, there are three general treatment options:

Let’s look at the types of treatments available.

Surgery

The main treatment for tonsil cancers is complete surgical removal of the tumor. The surgeon will cut out the tumor plus a little bit of normal tissue around it to be sure to get all the cancer. Another doctor, called a pathologist, will look at the entire tumor under a microscope to identify a more exact stage for the tumor. This report, called the pathologic stage, can help the doctor decide if radiation and/or chemotherapy are needed.

Radiation

Radiation therapy kills cancer cells with high-energy radiation such as X-rays or gamma rays. Radiation may be used as a main treatment for tumors that cannot be easily removed. The surgeon will use radiation alone or radiation with chemotherapy, depending on the characteristics of the tumor. Radiation is also often used after surgery to lower the chances that the tumor will come back.

Chemotherapy

Chemotherapy, or “chemo,” uses drugs to kill cancer cells. It is especially helpful when:

  • Cancer has spread beyond the head and neck.
  • There is a T3 or T4 tumor in which surgery cannot remove all of the tumor.
  • There is a T3 or T4 tumor that has certain bad features found under the microscope, such as intermediate or high grade.
  • There are close edges.
  • There is growth into nerves.
  • There is spread into lymph nodes.
  • There is growth into lymphatics or vessels.

Determining the prognosis

The prognosis is a prediction of how the treatment will turn out. How likely is it that a person with cancer will be cured? Will the cancer come back? How will life change? These are the big questions on most people’s minds when they find out that someone they love has tonsil cancer.

The following aspects of the cancer may affect the prognosis.

Human Papillomavirus (HPV) Status Unlike other head and neck cancers, squamous cell cancers of the oropharynx can be divided into HPV-related and HPV-unrelated cancers. Details are still being worked out, but it is becoming clear that with current treatment methods, those with HPV-related oropharyngeal cancer have a better chance at being cured than those with HPV-unrelated oropharyngeal cancer.1 Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7.
Stage It is very important to know the stage to help determine the chance of a cure.12 Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404. However, the staging system at this point does not separate HPV-positive from HPV-negative cancers.
Spread to Lymph NodesSpread of Cancer Cells Outside Lymph Node Capsule This goes along with stage. However, even without other factors, if there is spread to lymph nodes in the neck, there’s a diminished chance of a cure, particularly if there is evidence of spread of cancer outside the lymph nodes.12 Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404.Still, for HPV-related oropharyngeal cancer, there is some indication that spread outside of lymph nodes is not as bad a sign as HPV-unrelated oropharyngeal cancer.13Sinha P, Lewis JS Jr, Piccirillo JF, Kallogjeri D, Haughey BH. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer. 2012 Jul 15;118(14):3519-30.
Tumor Margins The ability to completely remove the tumor can be a very important factor that will influence the likelihood of being cured.12, Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404.14 Pradhan SA, Rajpal RM. Marginal mandibulectomy in the mangement of squamous cancer of the oral cavity. Indian J Cancer. 1987;24;167-171.
Spread into Local Structures Spread into large nerves, vessels or lymphatics might make the prognosis worse.14, Pradhan SA, Rajpal RM. Marginal mandibulectomy in the mangement of squamous cancer of the oral cavity. Indian J Cancer. 1987;24;167-171.15 Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42, 45-6.

What to expect after treatment is completed

When the person in your life who has cancer has completed treatment, he or she will need to follow up closely with the doctor. Follow-up doctor visits and testing are to make sure the cancer doesn’t come back or to catch it quickly if it does. In general, a person should have regularly scheduled doctor’s visits every one to three months for the first year, every two to six months in the second year and every four to eight months in the third to fifth year. In addition, the doctor will order scans to help in the monitoring process. After making it past the first five years, the person can then see the doctor once a year.


References

1 Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7.

2 Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer research. Jun 1 1988;48(11):3282-3287.

3 D'Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. The New England journal of medicine. May 10 2007;356(19):1944-1956.

4 Moreno-Lopez LA, Esparza-Gomez GC, Gonzalez-Navarro A, Cerero-Lapiedra R, Gonzalez-Hernandez MJ, Dominguez-Rojas V. Risk of oral cancer associated with tobacco smoking, alcohol consumption and oral hygiene: a case-control study in Madrid, Spain. Oral oncology. Mar 2000;36(2):170-174.

5 Koivunen P, Rantala N, Hyrynkangas K, Jokinen K, Alho OP. The impact of patient and professional diagnostic delays on survival in pharyngeal cancer. Cancer. Dec 1 2001;92(11):2885-2891.

6 Roistacher SL, Tanenbaum D. Myofascial pain associated with oropharyngeal cancer. Oral surgery, oral medicine, and oral pathology. May 1986;61(5):459-462.

7 Rogers SN, Vedpathak SV, Lowe D. Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective. The British journal of oral & maxillofacial surgery. Jul 2011;49(5):349-353.

8 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

9 Krause CJ, Carey TE, Ott RW, Hurbis C, McClatchey KD, Regezi JA. Human squamous cell carcinoma. Establishment and characterization of new permanent cell lines. Arch Otolaryngol. Nov 1981;107(11):703-710.

10 Licitra L, Perrone F, Bossi P, et al. High-risk human papillomavirus affects prognosis in patients with surgically treated oropharyngeal squamous cell carcinoma. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. Dec 20 2006;24(36):5630-5636.

11 Eveson JW, Cawson RA. Tumours of the minor (oropharyngeal) salivary glands: a demographic study of 336 cases. Journal of oral pathology. Jul 1985;14(6):500-509.

12 Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404.

13 Sinha P, Lewis JS Jr, Piccirillo JF, Kallogjeri D, Haughey BH. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer. 2012 Jul 15;118(14):3519-30.

14 Pradhan SA, Rajpal RM. Marginal mandibulectomy in the mangement of squamous cancer of the oral cavity. Indian J Cancer. 1987;24;167-171.

15 Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42, 45-6.

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