Hostname: page-component-745bb68f8f-d8cs5 Total loading time: 0 Render date: 2025-01-13T06:04:49.074Z Has data issue: false hasContentIssue false
  • English
  • Français

The isolated symptom of unilateral tonsillar enlargement has limited value in adults with a suspected head and neck cancer pathway

Published online by Cambridge University Press:  12 December 2022

K L Lau Open the ORCID record for K L Lau [Opens in a new window] ,
A Rajgor ,
A Muzammil ,
R Scurrah ,
H Cocks  and
N Oozeer
K L Lau*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Sunderland Royal Hospital, UK
A Rajgor
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Sunderland Royal Hospital, UK National Institute for Health Research, London, UK Applied Cancer Therapeutics and Outcomes, Newcastle University, UK
A Muzammil
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Sunderland Royal Hospital, UK
R Scurrah
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Sunderland Royal Hospital, UK
H Cocks
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Sunderland Royal Hospital, UK
N Oozeer
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Sunderland Royal Hospital, UK
*
Author for correspondence: Dr K L Lau, Department of Otolaryngology-Head and Neck Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Given the uncertainty regarding the predictive value of unilateral tonsillar enlargement and/or lesion in malignancies, this study aimed to evaluate the efficacy of unilateral tonsillar enlargement and/or lesion referral criterion in the adult suspected head and neck cancer pathway.

Methods

All two-week wait referrals received in 2018–2019 were reviewed. All patients referred with unilateral tonsillar enlargement and/or lesion were included and analysed for patient demographic data, presenting symptoms, initial clinic outcomes and final diagnoses.

Results

A total of 4934 urgent head and neck cancer referrals were analysed, and 1.9 per cent of these had unilateral tonsillar enlargement and/or lesion. Only 10 patients were diagnosed with tonsil cancer. All the positive tonsil cancer cases had at least one additional head and neck red flag symptom.

Conclusion

The referral criterion for unilateral tonsillar enlargement and/or lesion may be of limited benefit in an already economically challenged National Health Service. Further multicentre studies should be undertaken to refine conclusions on the value of unilateral tonsillar enlargement and/or lesion alone as a criterion for the head and neck cancer two-week wait pathway.

Keywords

Head And Neck NeoplasmsTonsillar Neoplasms
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 8 , August 2023 , pp. 902 - 905
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr K L Lau and Mr A Rajgor take responsibility for the integrity of the content of the paper

References

Weatherspoon, DJ, Chattopadhyay, A, Boroumand, S, Garcia, I. Oral cavity and oropharyngeal cancer incidence trends and disparities in the United States: 2000–2010. Cancer Epidemiol 2015;39:497–504CrossRefGoogle ScholarPubMed
Olaleye, O, Moorthy, R, Lyne, O, Black, M, Mitchell, D, Wiseberg, J. A 20-year retrospective study of tonsil cancer incidence and survival trends in South East England: 1987–2006. Clin Otolaryngol 2011;36:325–35CrossRefGoogle Scholar
Marur, S, D'Souza, G, Westra, WH, Forastiere, AA. HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol 2010;11:781–9CrossRefGoogle ScholarPubMed
Sehdev, A, Zhao, Y, Singh, AK, Sharma, N. Primary small cell carcinoma of the tonsil: a case report and review of the literature. Case Rep Oncol 2012;5:537–41CrossRefGoogle ScholarPubMed
Rokkjaer, MS, Klug, TE. Malignancy in routine tonsillectomy specimens: a systematic literature review. Eur Arch Otorhinolaryngol 2014;271:2851–61CrossRefGoogle ScholarPubMed
Papouliakos, S, Karkos, PD, Korres, G, Karatzias, G, Sastry, A, Riga, M. Comparison of clinical and histopathological evaluation of tonsils in pediatric and adult patients. Eur Arch Otorhinolaryngol 2009;266:1309–13CrossRefGoogle ScholarPubMed
National Cancer Registration and Analysis Service. Cancer Waiting Times (CWT) urgent suspected cancer referrals: referral, conversion and detection rates Cancer Data. http://www.ncin.org.uk/cancer_type_and_topic_specific_work/topic_specific_work/tww_conversion_and_detection [6 October 2021]Google Scholar
Round, T, Gildea, C, Ashworth, M, Møller, H. Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort study. Br J Gen Pract 2020;70:e389–98CrossRefGoogle ScholarPubMed
Northern Cancer Alliance. Two week wait referral guidance. In: https://northerncanceralliance.nhs.uk/pathway/early-diagnosis/supporting-primary-care/two-week-wait-referral-forms/ [20 October 2021]Google Scholar
Hong, B, Shaikh, Z, Adcock, S, Aldallal, SN. Two-week wait false alarms? A prospective investigation of 2WW head and neck cancer referrals. Br Dent J 2016;220:521–6CrossRefGoogle ScholarPubMed
Roy, S, Anjum, K. The two-week wait–a qualitative analysis of suspected head and neck cancer referrals. Br Dent J 2018;225:159–63CrossRefGoogle Scholar
Rimmer, J, Watson, J, O'Flynn, P, Vaz, F. A head and neck ‘two-week wait’ clinic: cancer referrals or the worried well? Bull R Coll Surg Engl 2012;94:1–4CrossRefGoogle Scholar
Randall, DA, Martin, PJ, Thompson, LD. Routine histologic examination is unnecessary for tonsillectomy or adenoidectomy. Laryngoscope 2007;117:1600–4CrossRefGoogle ScholarPubMed
Sunkaraneni, VS, Jones, SEM, Prasai, A, Fish, BM. Is unilateral tonsillar enlargement alone an indication for tonsillectomy? J Laryngol Otol 2006;120:1–4CrossRefGoogle ScholarPubMed