Parapharyngeal space may also get invaded. Lymphatic
50% of patients have initial cervical node involvement at the time of presentation. Jugulardigastric nodes are the first to be involved. Distant metastasis
The occurrence of distant metastasis varies extensively, ranging between 4–31% in clinical studies. Factors influencing the incidence of distant metastasis are:
Location of primary tumor. Initial staging
Histological differentiation
Loco-regional control of the primary tumor.The records of 471 male patients with tonsillar carcinoma seen at the Veterans Administration Medical Center, Hines, Illinois, have been reviewed to establish the incidence and site of distant metastasis. All the patients were histological diagnosed and proven cases of tonsillar carcinoma. 72 (15%) out of 471 patients and 33 (29%) of 155 autopsied patients were reported to have distant metastasis. Squamous cell carcinoma was the most common reported cell type (88%); cases with Lymphoepithelioma had the highest incidence of distant metastasis. The most common anatomical sites of incidence of distant metastasis include lung, liver and bones. Thorough investigation of these organs is highly recommended before treatment as well as during follow ups. Diagnosis
The first step to diagnosing tonsil carcinoma is to obtain an accurate history from the patient. The physician will also examine the patient for any indicative physical signs. A few tests then, maybe conducted depending on the progress of the disease or if the doctor feels the need for. The tests include:
Fine needle aspiration, blood tests, MRI, x-rays and PET scan. Staging
The staging of a tumor mass is based on TNM staging.T staging is the based on the tumor mass.
See also
Cholestasis
Cholestatic pruritus
List of cutaneous conditions
Pruritic urticarial papules and plaques of pregnancy (PUPPP) an itchy condition of pregnancy that is associated with a rash. References
External links
E A Fagan "Intrahepatic cholestasis of pregnancy"