Ms. Su experienced difficulty swallowing for about two weeks, initially thinking it was a lodged bone. Her tonsils were swollen, and medication brought no relief. Recently, her condition worsened, making eating difficult, prompting her to seek examination at Tam Anh General Hospital TP HCM.

Master of Medicine, Doctor of Clinical Oncology II, Tran Thi Thuy Hang, Head of the Otolaryngology Department at the Otolaryngology Center, performed an endoscopy. The examination revealed that the right tonsil was significantly larger than the left, felt firm, and adhered to surrounding tissues. MRI imaging identified group II cervical lymph nodes, suspected to be secondary metastases. A biopsy confirmed squamous cell carcinoma. Surgery revealed the tumor had spread to the patient's lateral pharyngeal wall. Post-operative histopathology and immunohistochemical staining confirmed squamous cell carcinoma, stage T3N1M0. This indicates locally advanced disease, with the tumor spreading to adjacent areas and metastasizing to cervical lymph nodes, but without distant metastasis. Following surgery, Ms. Su received adjuvant radiotherapy.

Tonsil cancer is a malignant tumor of the oropharynx, forming when tonsil cells develop DNA abnormalities. When DNA is damaged, cells multiply uncontrollably, failing to undergo normal programmed cell death, gradually accumulating into a tumor. This tumor grows, invades, and destroys surrounding healthy tissue.

Doctor Hang consulting Ms. Su. *Photo: Tam Anh General Hospital*

Unilateral difficulty or pain while swallowing is a typical early symptom of tonsil cancer. However, patients often mistake it for a lodged bone, especially when there is no fever or weight loss, as in Ms. Su's case. Unilateral tonsil swelling is also easily confused with common tonsillitis, a prevalent condition, particularly in individuals with a history of chronic pharyngitis or gastroesophageal reflux disease.

Common tonsillitis typically involves bilateral swelling, high fever, and significant pain upon swallowing, responding well to antibiotics or anti-inflammatory drugs within 5-7 days. In contrast, early-stage tonsil cancer usually presents with only unilateral swelling, little to no fever, and a mild but persistent sensation of obstruction that does not improve with anti-inflammatory medication.

Doctor Hang stated that the disease prognosis largely depends on the stage of detection. In the early stage, when the tumor is localized to the tonsil, the likelihood of disease control is higher. Advanced-stage tonsil cancer requires more extensive surgery combined with adjuvant radiotherapy to reduce the risk of recurrence. In late stages, when the cancer has metastasized distantly, treatment primarily focuses on disease control and improving the patient's quality of life.

Doctor Hang advises that if unusual symptoms such as persistent unilateral tonsil swelling, sore throat, or difficulty swallowing do not subside after two weeks of treatment, patients should consult an otolaryngologist for endoscopy, diagnosis, and appropriate treatment to avoid disease progression due to delay.

Uyen Trinh

*Patient's name has been changed.