Many patients with tonsil cancer have a history of heavy drinking and may have significantly altered hepatic function. Chest x-ray is necessary to exclude pulmonary metastasis. CT scans or MRI studies allow assessment of nodal status and depth of invasion. Biopsy of tonsil lesions Large bulky masses can be adequately anesthetized topically in the office, allowing for a simple transoral biopsy in that setting. Perform a tonsillectomy in the operating room if smaller tumors are present or if malignancy is suspected in apparently normal tonsils.
Lymphoma is the second most common type of tonsil malignancy.
Lymphoma of the tonsil usually presents with a submucosal mass in an asymmetrically enlarged tonsil. When lymphadenopathy is present, multiple enlarged lymph nodes commonly are observed on 1 side of the neck. Lymphoepithelioma is a term used to describe an undifferentiated carcinoma. Sarcomas, salivary gland malignancies, and adenocarcinomas are very rare tonsil malignancies. The diagnostic and therapeutic approaches for these tumors are similar to those used for squamous cell carcinoma.