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Tuesday, May 21, 2013
Head and Neck Cancer
What are the Symptoms of Tonsillar Carcinoma?
My 17 year old has always had very large tonsils. She is in college a year early and has been reporting several puzzling symptoms. Yesterday she went to urgent care because her tonsil was bleeding and they swolen and touching. Last month they swelled together and she had difficutly breathing. Three weeks ago she had strep throat but that resolved. She reported syncope about 1-2 months ago with no reason other than she was standing washing dishes. She reports a swolen tongue and I think she said it was tingly, but cannot remember. She has ear pain without infection. She has nausea and lack of appetite, fatigue, and chest pain. She also reports diarrhea for several months. We took her to an ENT yesterday who did the camera in the nose and saw normal tissue, except said her adnoids and tonsils were very large. Then when he looked in her mouth he saw the blood vessel that was close to the surface. His recommendation was to wait and see if it continued to bleed and perhaps a tonsillectomy later this summer. After reading some about tonsilar carcinoma, I am now concerned we might be dealing with that. He has never heard of a tonsil bleeding without infection and doesn`t seem to know about symptoms of carcinoma and I would like to present them to him with a full history of these other symptoms that we didn`t realize could be related and ask for immediate tonsilectomy and testing but I would like a reliable source other than just an article on the internet. Thank you.
I cannot say that all the symptoms that your daughter has are related to her tonsils. Having said that it seems as though her tonsils are too large and she may have airway compromise. At night especially she may have sleep apnea....she may stop breathing. Does she snore? Does she look sleepy during the day. Does she fall asleep easily?, in front of the TV for example. It would be highly uncommon for her to have cancer, and I do not believe she does.
The bleeding is probably because the tonsils are big and are easily traumatized especially with food. I would question her ENT about the possibility of sleep apnea. Removal of the tonsils and possibly the adenoids would remedy this situation. Her ENT is familiar with the warning signs and symptoms of throat cancer and does not need to be reminded. You could ask to be reassured that she does not have cancer.
Pierre Lavertu, MD, FRCS(C), FACS
Professor of Otolaryngology-Head and Neck Surgery
School of Medicine
Case Western Reserve University