Patients studied:
• 476 consecutive adult patients who had a tonsillectomy at the University of Iowa Hospitals over a 10 year period.
• 25 patients had a malignancy involving the tonsil.
• Squamous cell carcinoma and malignant lymphoma were the most common neoplasms.
Key risk factors:
(1) prior history of head and neck cancer (odds ratio 14.9, with 95% CL 1.3 to 50.4)
(2) asymmetry between tonsils (odds ratio 86.7, with 95% CL 9.7 to 776.1)
(3) firmness and/or visible lesion involving tonsil
(4) neck mass (odds ratio 31.4, with 95% CL 2.5 to 395.2)
(5) unexplained weight loss
(6) unexplained constitutional symptoms (fatigue, night sweats, fevers, anorexia)
Other factors associated with tonsillar malignancies:
(1) older age (odds ratio 8.2 if 40-54 years old; 18.1 if >= 55 years old)
(2) tobacco smoking
(3) alcohol abuse
Interpretation:
• All 25 patients in the Iowa series with malignancy had one or more key risk factors, with 23 patients having 2 or more key risk factors.
• All patient with 3 or more key risk factors had a malignancy.
