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When surgery is used to treat cancer of the tonsil, the procedure is often quite extensive, sometimes leading to severe side effects and disfigurement of the face and/or neck. Now, researchers report that radiation therapy alone or in combination with a less extensive surgery may allow effective treatment with less severe side effects and disfigurement.

Treatment options for cancer of the tonsil vary depending on a number of factors, including the stage of disease (extent of cancer at diagnosis).

Stage I cancer of the tonsil is characterized by cancer that is smaller than 1 inch and has not spread to the lymph nodes.

Stage II disease is described as cancer that is 1 to 1.5 inches in size (or that occurs in multiple sites) and has not spread to the lymph nodes.

Stage III disease is cancer that is 2 inches or larger in size and has spread to the lymph nodes.

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Stage IVa disease is cancer that began in the tonsil and spread to other parts of the throat or lymph nodes, while

stage IVb disease has spread to other parts of the body. Often, persons with earlier stage cancer of the tonsil receive radiation therapy and/or surgery to remove the cancer. Persons with more advanced disease may receive chemotherapy before or after surgery. Because surgery to remove cancer of the tonsil is often extensive, researchers continue to study new strategies to provide effective treatment, but with fewer side effects and less disfigurement. It has been proposed that earlier, smaller cancers of the tonsil be treated with radiation therapy alone; more advanced cancers with a less extensive surgery to remove the lymph nodes only, followed by radiation therapy to the tonsil area.

Researchers in Florida treated 400 patients with stage I to IVb cancer of the tonsil with radiation therapy to the tonsil area. One hundred forty-one patients first underwent surgery to remove any affected lymph nodes in the neck, and 18 received chemotherapy. After 5 years, 100% of persons with stage I disease, 86% of persons with stage II disease, 82% with stage III disease, 63% with stage IVa disease, and 22% with stage IVb disease were alive. Control of the cancer in the tonsil area was achieved in more than 80% of persons with stage I and II disease, 74% of those with stage III disease, and 60% of those with stage IV disease.

These researchers concluded that the use of radiation therapy alone or with surgery to remove affected lymph nodes only, afforded cure rates as good as those achieved with more extensive surgery, but with less severe complications. Persons who have cancer of the tonsil may wish to talk with their doctor about the risks and benefits of undergoing this treatment regimen or of participating in a clinical trial (research study) in which promising new treatments are being studied.(Journal of Clinical Oncology, Vol 18, No 11, pp 2219-2225, 2000)

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