Tonsillectomy as a Prevention Strategy in the Light of Increasing Incidence of Oropharyngeal Cancer - a Research of Current Literature.

BACKGROUND/AIM: While in many Western countries the number of tonsillectomies decreases significantly, there is an increasing incidence of oropharyngeal carcinomas. For, obviously, removal of the tonsils will reduce individual risk for tonsil cancer, the question of tonsillectomy as a prevention strategy is suggested. This study focused on this question by carrying out a literature research. MATERIALS AND METHODS: A literature research was performed (www.pubmed.gov; Search words: tonsillectomy, oropharyngeal cancer, tonsil cancer, prevention) without applying additional filters. RESULTS: Out of the 16 identified studies, three population-based studies were evaluated. Individual incidence of tonsil cancer is significantly lower after removal of tonsils; however, risk elimination by tonsillectomy has not been proven. One of the studies revealed increasing numbers of base of the tongue cancer after previous tonsillectomy. CONCLUSION: The increase in oropharynx carcinomas can currently be attributed not to the decreasing tonsillectomy rates, but to the increase in HPV infections. A previous tonsillectomy reduces the individual risk of developing tonsil carcer. Tonsillectomy as prevention for oropharyngeal cancer cannot be recommended and may even be a disadvantage concerning base of the tongue cancers.

A global epidemic increase of an HPV-induced tonsil and tongue base cancer - potential benefit from a pan-gender use of HPV vaccine.

In 2007, human papillomavirus (HPV) type 16 was finally recognized as a risk factor, besides smoking and alcohol, for oropharyngeal squamous cell carcinoma (OPSCC), including tonsillar squamous cell carcinoma (TSCC), by the International Agency for Research against Cancer. Just before, in 2006, the Food and Drug Administration had approved Gardasil, the first vaccine against HPV16, 18, 6 and 11, for preventive vaccination women against cervical cancer. Concurrently, some Western countries, where smoking was decreasing, disclosed an epidemic increase in the incidence of OPSCC, especially of TSCC and base of tongue cancer (BOTSCC), together accounting for 80-90% of all OPSCCs, and mainly affecting men. The epidemic was later revealed to be due to a rise in HPV-positive cases, and scientists in the field suggested HPV vaccination also of boys. Globally, there are roughly 96 000 incident OPSCC cases/year of which 20-24% are caused by HPV, thereby accounting for around 22 000 OPSCC cases annually. Of these cases, 80-90% are due to HPV16 infection and would be prevented with the presently registered HPV vaccines. In Western countries, such as Sweden (with almost 400 TSCC and BOTSCC cases per year) and the United States, HPV prevalence in OPSCC is higher and around 70%. HPV vaccination of girls has been initiated in many countries, and the vaccines have been efficient and their side effects limited. HPV vaccination of boys has, however, been the exception, but should definitely not be delayed any further. It would benefit both girls and boys directly, and result in better and more robust herd immunity. Today, we have the possibility to eliminate several high-risk HPV types in the younger generations and avoid more than 600 000 cancer cases annually worldwide, and this possibility should be embraced by offering global pan-gender HPV vaccination.

Caracterización epidemiológica, clínica e histopatológica de la amigdalectmía, Hospital Escuela Universitario, Honduras / Tonsillectomy: epidemiological, clinical and histopathological characterization, Hospital Escuela Universitario, Honduras

Se define amigdalectomía a la disección de la amígdala palatina, unilateral o bilateral. La amigdalectomía es la cirugía más frecuente realizada en otorrinolaringología, en el año 2006, en Estados Unidos de América se realizaron 737 000 procedimientos. Objetivo: identificar las características epidemiológicas, clínicas, e histopatológicas de niños y adultos sometidos a amigdalectomía, para la detección precoz y manejo oportuno de patologías malignas. Material y Métodos: estudio no experimental, descriptivo transversal, realizado en salas quirúrgicas del Bloque Materno Infantil y Otorrinolaringología del Bloque Médico Quirúrgico del Hospital Escuela Universitario, del periodo junio 2016 a marzo 2017; el universo fue igual a la muestra 100 pacientes, mayores de 3 años, sometidos a amigdalectomía. Las técnicas utilizadas fueron la observación y la entrevista; se recolectó la información a través de un instrumento estructurado con preguntas abiertas y cerradas. Los resultados fueron procesados en el programa estadístico EPI-INFO 7.0, aplicando frecuencias, porcentajes y medidas de tendencia central. El estudio se realizó previa aprobación del Comité de Ética. Resultados: en 100 pacientes, la edad media fue de 13 años; el mayor factor de riesgo relacionado a malignidad identificado, correspondió a la halitosis 84%, la manifestación clínica frecuente fue la roncopatía 100%, el diagnóstico histopatológico frecuente de las biopsias obtenidas fue la hiperplasia folicular 99%, se encontró un caso de linfoma, neoplasia maligna 1%. Conclusiones: La incidencia de malignidad fue baja, el análisis histopatológico obtenido de muestras de pacientes amigdalectomizados, es necesario para la detección oportuna y manejo precoz de patologías malignas, se recomienda realizar el estudio histopatológico.