Squamous cell carcinoma of the tonsil in young adults

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Abstract
Squamous cell carcinoma of the tonsil is rare in people under 40 years of age. Only 11 cases have been treated at the M. D. Anderson Hospital since 1944. Their 5-year survival was decreased (14%) when compared to the total group of patients treated for squamous cell carcinoma of the tonsil (48%). Young adults had higher clinical staging than the total group. Ninety-one percent of the young patients had neck nodal metastasis, with 55% staged N3. Of the entire group, 76% had neck nodal metastasis with 23% staged N3. Case histories indicate a lack of suspicion of tonsillar cancer on the part of patients and physicians. The average total delay from symptoms to diagnosis was 11 months. Response rates to radiotherapy alone were excellent (no failures) in patients with staging T1, T2) T2, N0, and N1. However, five (45%) of the 11 young patients had T3 or T4 primaries and all died, four with regional failure. Six of the 11 young patients had N3 staging and five of these died, all with regional failure except one. Planned combined treatment should be used more frequently in young adults with high staging.