title: Current management of tonsillar cancer.
abstract: Traditionally, risk factors for the development of tonsil cancer include the use of alcohol and/or tobacco, however a significant proportion of new cases develop in young patients without these risk factors. Recent investigation suggests that human papilloma virus (HPV) may serve as an etiology in such cases and represent a unique risk factor in a sub-set of patients. Irrespective of the etiology, in the majority of cases early carcinoma of the tonsil can effectively be treated using single modality therapy. While local-regional control and survival are similar following surgery or radiotherapy, primary surgery can be accomplished with minimal functional morbidity while reserving radiation for recurrent disease. In contrast, surgical salvage following external beam radiotherapy can be technically challenging and is often associated with a significant increase in surgical complications and functional morbidity. In contrast to early tonsillar disease, advanced tonsil cancer represents a clinical challenge that requires multimodality therapy. While advanced lesions are often treated with a combination of radiation, chemotherapy, and surgical ablation, management of the neck and distant metastases continues to present a therapeutic dilemma.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
authors.forename: Crispian
authors.initials: C
authors.lastname: Scully
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
authors.forename: Kevin
authors.initials: K
authors.lastname: Higgins
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
mesh_terms: D002277:Carcinoma / Q000532:radiotherapy* / Q000601:surgery / Q000821:virology; D003131:Combined Modality Therapy; D006801:Humans; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications; D011879:Radiotherapy Dosage; D014067:Tonsillar Neoplasms / Q000532:radiotherapy* / Q000601:surgery / Q000821:virology; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000150:complications