Are throat cancers on the rise because we’ve stopped taking out tonsils?
Anthony Syke S wasn’t overly concerned when he first noticed a slight swelling on the right side of his neck. there was no pain or discomfort, his general health was excellent for a man in his mid-50s and he was relaxed and refreshed after a family holiday in the U.S. But, as a precaution, Anthony decided to visit his doctor.
‘My GP took one look and said it was some kind of viral infection that was affecting the lymph nodes in the neck and would probably go away of its own accord,’ recalls Anthony, now 65, a retired banker.
Lymph nodes are tiny, bean- shaped glands dotted throughout the body; they are part of the lymph system, which transports fluids, nutrients and waste material to and from the tissues into the bloodstream.
If there is an infection, the lymph nodes trap bacteria and viruses until infectionfighting white blood cells arrive to destroy the bugs before they get into the bloodstream, and these collect in the glands. the lymph nodes become swollen in the process and this is what your doctor is feeling for when he checks under your neck.
‘the thought had occurred to me that it might be something more sinister like a tumour, but when my doctor said it was nothing to worry about, that put my mind at rest,’ says Anthony, who lives in Chelsea, West London, with his wife nancy, 66, and their children Catherine, 28, and Christopher, 25.
however, the grape-sized swelling, just to the right of his Adam’s apple, did not subside, and after three weeks nancy insisted Anthony seek expert advice at the nearby private Lister hospital.
After examining Anthony, the consultant said the swelling was almost certainly due to a tumour on his right tonsil.
he was referred to the Royal Marsden hospital for a biopsy. this confirmed that Anthony had a squamous cell carcinoma, a malignant growth which can affect the cells in the soft tissue that lines the mouth, throat and tonsils. ‘I was really shocked,’ says Anthony. ‘I thought that was the beginning of the end of my life.
‘I started to talk to nancy and t he children about getting my will in order in case the worst happened.’
After surgery to remove his cancerous right tonsil and a small patch of surrounding tissue to make sure no cancer cells were left, Anthony underwent a month of daily radiotherapy sessions and two bouts of chemotherapy, and was given the all-clear.
Annual check-ups followed and after five years without the tumour DOCTORS returning, he was declared cured.
stressed that his cancer was a random event, not something linked to lifestyle. Mouth cancer of all types is most commonly linked to lifestyle factors such as smoking and heavy drinking and, more recently, the human papillomavirus (HPV), the same organism that causes cervical cancer in women (the virus can also be passed on via oral sex).
these factors have led to a rise in oral cancers, but the rise in tonsil cancer may have another cause — the drop in childhood surgery to remove the tonsils.
the tonsils are made of lymphoid tissue, which makes proteins to fight infections. Fortunately, other tissues around the body also make these proteins, so having the tonsils out does not detrimentally affect general health.
there are two main reasons for removing them. the first is recurrent tonsillitis, where the tonsils become inflamed due to an infection; if this causes a child to need lots of time off school or multiple courses of antibiotics, they may be offered the surgery.
the other reason is if the tonsils are so big (naturally or as a result of i nfection) t hat t hey are obstructing breathing at night.
Removal involves a tonsillectomy, where the fibrous white capsule containing the tonsil is cut away from the muscle bed at the back of the throat using forceps.
Back i n the Fifties, almost 250,000 tonsillectomies a year were done on the NHS. today the figure is nearer 40,000.
this is largely because in recent years tonsillectomies have been classed as ‘procedures of limited clinical effectiveness’ under NHS commissioning rules. this means many NHS managers refuse to fund the surgery because recurrent tonsillitis is viewed as a relatively minor condition that can be treated with painkillers and antibiotics if it becomes very severe.
As a result, clinical commissioning groups — the bodies that pay for NHS treatments — have been funding fewer of them. But now there is evidence that these cuts in surgery may be linked to a surge in Uk tonsil cancer cases, which have doubled to more than 1,000 a year since the late nineties.
A major new study suggests tonsillectomy can slash the risk of a cancer in the tonsil area later in life by up to 85 per cent — the risk is not reduced by 100 per cent because rogue cancer cells can still settle in the soft tissue where the tonsils sat.
Scientists from Johns hopkins School of Medicine in the U.S. studied medical records of nearly four million people, looking at how many had their tonsils out early in life and how many later developed cancers of the tonsils or throat.
the results showed that people who had tonsillectomies were significantly less likely to suffer malignant tumours in the tonsil area when they got older.
But it’s not just cancer that appears to be on the increase as a result of fewer tonsil removals.
Last year, a study by Aintree hospital, Liverpool, found that between 1991 and 2011, when tonsillectomy rates in the Uk dropped by 44 per cent, there was a 300 per cent rise in hospital admissions for acute tonsillitis.
the number of cases where patients needed emergency treatment for potentially life-threatening tonsil abscesses — that needed to be drained, treated with powerful antibiotics or even surgically removed — leapt by 30 per cent.
the researchers described the increase in the number of abscesses as ‘most alarming’.
‘over the past decade, commissioning bodies have been restricting access to this type of surgery to save money, although they will never say that on the record,’ says tony narula, a surgeon and president of ent Uk, a body representing ear, nose and throat specialists.
‘yet we are seeing more and more adults admitted to hospital with severe tonsillitis and abscesses in the throat and neck. the cost of treating them is huge, so there are no savings to be made by reducing tonsil removals.’
But do the new studies on tonsil cancer suggest more tonsillectomies should be performed?
Professor hisham Mehanna, an expert in head and neck surgery at the University of Birmingham, said specialists i n ent had speculated about a possible link between tonsil removal and reduced cancer risk — but until now it was not proven.
But he added: ‘this does not mean we are going to do thousands more tonsillectomies to prevent cancer. We would have to do an awful lot of operations to have a positive effect on quite a small number of people.
‘But if there was a test to show someone has persistent infection with HPV, then it is something doctors might consider as a ROUGHLY preventive measure.’
half of us will contract HPV at some point in our lives, though in most cases it causes no symptoms or complications.
But if preventive surgery on a massive scale is not really an option for halting the rise in oral cancers, what is?
the most effective measure the Government could take, says tony narula, is to routinely vaccinate boys against HPV as well as girls, to halt the spread of the cancer- causing virus. ‘ Immunising hundreds of thousands of boys each year might only save one life from cancer — but imagine if that one person was your own son.’
the charity HPV Action plans to lobby at the house of Commons to drum up support for an extension of the vaccine programme.
After his close shave with tonsil cancer in 2005, Anthony now campaigns for greater awareness of the signs and symptoms with the oracle Cancer trust.
‘If a GP spots a lump in the neck area, they should refer the patient immediately,’ he warns. ‘It never even crossed my mind that I could get cancer in my tonsils.’