From the Research
Tonsillar squamous cell carcinoma most commonly metastasizes to the cervical lymph nodes, particularly levels II and III of the neck, with distant metastatic sites including the lungs, bone, liver, and mediastinum. The pattern of metastasis is influenced by various factors, including the human papillomavirus (HPV) status of the tumor 1. Key points to consider in the management of tonsillar squamous cell carcinoma include:
- The high probability of nodal metastasis, with up to 70% of patients presenting with nodal involvement at diagnosis 2
- The importance of thorough ipsilateral neck treatment due to the high probability of nodal metastasis 2
- The potential for distant metastasis, with the lungs being the most common site of distant spread, followed by bone, liver, and mediastinum 3
- The influence of HPV status on the pattern of metastasis, with HPV-positive tumors showing a somewhat different metastatic profile than HPV-negative tumors 1
- The importance of early detection of metastatic disease for proper staging and treatment planning, typically requiring imaging studies such as CT, MRI, or PET scans to identify both regional and distant spread 4. In terms of treatment, both primary surgery and radiotherapy/chemoradiotherapy (RT/CRT) are effective treatments for tonsillar squamous cell carcinoma, with single modality treatment typically provided for stage I-II diseases 4. However, the management of retropharyngeal lymph nodes (RPLNs) is an important consideration, with elective irradiation of RPLNs potentially being an indication for adjuvant radiation therapy after transoral surgery for tonsil cancer 1.