Endoscopic examination of Mr. Van's ear, nose, and throat at Tam Anh General Hospital Ho Chi Minh City revealed a tumor on the left tonsil and pharyngeal congestion. Professor Doctor Tran Phan Chung Thuy, Director of the Ear, Nose, and Throat Center, stated that the one-sided swollen inflammation was not typical tonsillitis due to its firm consistency, ulcerative surface, and infiltration, necessitating a biopsy.

The results confirmed basaloid squamous cell carcinoma of the tonsil. Immunohistochemical staining showed the tumor was positive for HPV.

MRI results indicated the malignant tumor had invaded multiple structures in the oropharynx, extending to the soft palate, retromolar area, and peridental soft tissues. Doppler ultrasound of the cervical lymph nodes and fine-needle aspiration cytology (FNAC) confirmed the presence of cancer cells in the cervical lymph nodes.

Professor Chung Thuy explained that doctors prescribed pre-operative radiation therapy to shrink the tumor for the patient's HPV-related tonsil cancer, which had invaded and metastasized to the cervical lymph nodes (T4N3 stage). Subsequently, they would consider appropriate surgery based on an individualized treatment regimen. Mr. Van also has underlying conditions of hypertension and diabetes.

Professor Chung Thuy consults Mr. Van on his treatment. *Photo: Tam Anh General Hospital*

"Among non-genital cancers, HPV-related tonsil cancer has the highest incidence, especially HPV type 16," Professor Chung Thuy stated. Other types, such as HPV 18, can also cause the disease but are less common. Early-stage tonsil cancer often presents with few symptoms, typically painful or difficult swallowing, similar to having a bone stuck in the throat, leading patients to confuse it with common tonsillitis. As the disease progresses, patients experience prolonged sore throat, difficulty swallowing, pain radiating to the ear, uneven tonsils, swollen cervical lymph nodes, or weight loss, indicating advanced-stage cancer.

When detected early, HPV-related tonsil cancer generally responds better to treatment than non-HPV-related cancer. Professor Chung Thuy cited information published in the US National Library of Medicine, indicating that the incidence of tonsil cancer is about 8,4/100,000 people, typically occurring on one side and rarely on both.

Human Papillomavirus (HPV) is a virus that causes human papillomas and is associated with various cancers. Currently, the mechanism by which HPV invades and persists in tonsil tissue is not clearly understood. Tonsillar crypts are capable of trapping and processing antigens, which may provide conditions for the virus to access basal cells, persist in the tissue, and increase cancer risk.

Most HPV infections in healthy immune systems resolve spontaneously within one to two years without causing symptoms. However, prolonged infection with high-risk types like HPV 16 and 18 carries a high risk of developing cervical, tonsil, base of tongue, anal, or penile cancers. Factors that increase the risk of HPV infection include unsafe sexual practices, multiple partners, immunosuppression, or sexually transmitted diseases.

Doctors advise individuals to get the HPV vaccine at the appropriate age, practice safe sex, undergo regular health check-ups, maintain oral hygiene, and boost immunity to help reduce the risk of HPV infection and related complications. Those in high-risk groups should undergo regular ear, nose, and throat screenings for early detection of abnormalities.

If experiencing prolonged sore throat, one-sided ear pain, or difficulty swallowing, patients should seek early examination at an Ear, Nose, and Throat specialist for timely diagnosis and treatment, which increases treatment effectiveness.

Uyen Trinh

*Patient's name has been changed