tonsil carcinoma

tonsilinte carcinoma oru tharam schwamous sell carsinomayaanu. aurofaarinksile schwamous sell carsinomayude ettavum saadhaaranamaaya sthalamaanu tonsil. ooroofarinksinte ellah maarakathvangaludeyum <aii. dii. 1> ithil ulppedunnu. tumours palappozhum vipulamaaya ghattangalil kaanapedunnu, ekadesham 70 sathamaanam rogikalum servical lymph nodukalilekku metaastaasis kaanikkunnu.
. thondavedana, otaljiya allengil dysphagea ennivayaanu ettavum kooduthal report cheyyappedunna paraathikal. chila rogikalkku thondayil oru muzhayude saannidhyam anubhavappedunnathaayi paraathippedaam. ekadesham 20 sathamaanam rogikalkku kazhuthil oru nooad maathramaan rogalakshanamaayi kaanappedunnath.
pukayila pukavali, pathivayi uyarnna alavil madyam kazhikkal ennivayaanu carcinoma tonsil vikasippikkunnathinulla pradhana apakada gadakangal. human papilloma virusumaayi (echpivi tharam echpivi 16) ithu bandhappettirikkunnu. vaayile shuchithvathinte mosham paripalanam, thondayile cancer valarunnathilekku chaayvulla janithaka pravanatha, rogaprathirodha sheshi kuranja avasthakal (soolid oorgan traansplaant polullava), chila thozhilukalil aasbattos, perchloroethylene thudangiya ejantumaarude vittumaaraatha exposure, radiation therapy, bhakshana gadakangal enniva mattu apakada gadakangalil ulppedunnu.
adayaalangalum lakshanangalum.
aadyakaala shathangal saadhaaranayaayi lakshanangalillathavayaanu. rogathinte oru vipulamaaya ghattam ulla rogikal ekadesham <aii. dii. 1> kesukal ulkkollunnu.
ettavum pradhanappetta adayaalangalil hridayamidippu undaakumbol kazhuthil oru muzhayum sareerabhaaram kurayunnathum ulppedunnu.
aalukalkk ksheenavum oru lakshanamaayi prathyakshappedaam.
tonsillaar capsulinullil valarunnathinaal praadhamika tumourinu eluppathil thirichariyaan kazhiyunna adayaalangalo lakshanangalo illa. cheria valippam allengil pradeshathinu chuttumulla dridatha vikasippikkukayallathe tonsil parishodhikkumbol samshayaaspadamaaya onnum shradhikkaan prayaasamaan.
tonsillaar kripttukalkkullil onno athiladhikamo sthalangalil carcinoma sambhavikkam. ithu tonsilinte valarchayodoppam undakam. baadhithamaaya tonsil orofaarinchiyal sthalathekku valarunnu, ithu kooduthalum jugulodigastic mekhalayil kazhuthu pindatthinte roopathil rogikk shradheyamaakkunnu.
tonsilukalil lymphaticsinte sambannamaaya shringhala adangiyirikkunnathinaal, carcinoma kazhuthile lymph nodukalilekku metaastaasais cheythekkaam, avayil palathum sistik aanu.
thalayottiyilekko mediastinathilekko tumour vikasikkunnath sambhavikkam.
thondavedana, dysphagea, otaljiya (thalayotiyile naadi edapedal kaaranam), shareerathile baahya samvedanam, rakthasraavamundaakuka, naav urappikkal (aazhathilulla peshikalude nuzhanjukayattam), trismus (terrigoid peshi parafarinchiyal spacil ulppettittundengil) ennivayaanu adhika lakshanagal.
maruvashathu, tumour puratthekku valarunna aazhathilulla chuvapp allengil velutha fungus murivaayi prathyakshappedaam, ithu oru kendra alsar upayogichu charmmatthinte uparithalam thakarkkunnu. eee murivu polulla alsar sukhappeduthunnathil paraajayappedunnu (sukhappeduthaatha) ithu rakthasraavathilekkum thondavedanayilekkum mattu anubandha lakshanangalilekkum nayikkunnu.
biopsy samayat, murivu moonnu lakshanagal kaanichekkaam kerattinaiseshan, fibrosis, necrosis enniva moolamulla murivu, dridatha, systification enniva.
servical lymphodenopathy undakam.
kaaranam.
pukavaliyum madyathinte durupayogavumaanu pradhana apakada gadakangal. vairal kaaranagal aduthide apakadasaadhyatha gadakangalilonnaayi pariganichittundu. epsteen-baar vairas (iii. bii. vii) (nasopharinchial carcinoma undakkunnathil pradhaanamaayum ulppedunna), human papilloma vairas thudangiya vairasukale eee vibhaagathil ulppeduthiyittundu. vettila chavaykkunnathu ("arakka kaattechu") vaayile arbudathinu kaaranamaakunnathumaayi nerittu bandhappettirikkunnu. fda visha sasya daattaabesin keezhilum yuu ithu prasthaavichittundu.phudu aandu drugg administration 
santhulithamallaatha bhakshanakramam, pazhangaludeyum pachakkarikaludeyum kuravu enniva cancerinulla saadhyatha vardhippikkunnuvennu thelinjittundu.
pathophysiology.
tumour koshangalkk mattu lymph nodukalilekku (saadhaaranayaayi kazhuthile lymph nodukal) metaastaasisilekku vazhi nalkukayum lymphydenopathic kaaranamaakukayum cheiyunna lymphaticsinte sambannamaaya vitharanam tonsilil ullathinaal praadeshika lymphnodukalilekkulla metaastaasis saadhaaranamaanu. servical lifedinopathy ipsilettaral (70 shathamaanamo athil kooduthalo rogikal) allengil ubhaykakshi (30 shathamaanamo athil kuravo rogikal) aakam. tonsilinte carcinoma saadhaaranayaayi servical lymph nooad level II, III, IV, V, retrofarrinchial lymph nodukaliloodeyaanu vyaapikkunnath.
thalayudeyum kazhuthileyum tumourukalude naalam pathipp tonsilinte schwamous sell carsinoma rund tharangalayi vibhajikkunnu echpivi positteev allengil negatteevu. tonsillaar kripttukalude aazhathilulla lymphoid tissuevil ninnu echpivi positteev tumours undaakukayum avaa keratinising allathavayumaanu. maruvashathu, tonsillar uparithala eppitheeliyathil ninnu echpivi negatteevu tumours vikasikkunnu, athinaal keratinising displassiayundu.
mettaastaasisinte vazhikal.
tonsillaar carsinomayil metaastaasis saadhaaranamaanu. ithu pradhaanamaayum kaansarinte ghattatheyum cancer koshangalude metaastaasais vazhiyeyum aasrayichirikkunnu.
cancer koshangal aduthulla gadanakalilekkum lymphattikkukalilekkum allengil shareerathile vidoora sthalangalilekkum secondary tumours uthpaadippikkunnathilum vyaapikkam.
praadeshika.
tumour praadeshikamaayi mriduvaaya annaakkilekkum thoonukalilekkum naavinte adithattilekkum faarinchiyal mathil, hypopharynx ennivayilekkum vyaapikkam. ithu terrigoid peshikaleyum mandible peshikaleyum akramikkukayum vedanaykkum trismassin kaaranamaakukayum cheyyum. parafarinchiyal sthalavum aakramichekkaam.
lymphatic.
50 sathamaanam rogikalkkum avatharana samayat prarambha servical nooad edapedal undu. jugulardigastric nodukalaanu aadyam ulppedunnathu.
vidoora metaastaasis.
klinikkal padanangalil vidoora mettaastaasisinte saannidhyam 4-31% vare vyathyaasappedunnu.
vidoora metaastaasis sambhavangale swaadheenikkunna gadakangal ivayaanu
illinoyisile hainsile vettarans administration medical sentaril kaanapetta tonsillaar carcinoma baadhicha 471 purusha rogikalude rekhakal vidoora mettaastaasisinte sambhavavum sthalavum sthaapikkunnathinaayi avalokanam cheythittundu. ellah rogikalum hystological roganirnayavum tonsillaar carsinomayude theliyikkapetta kesukalumaanu. 471 rogikalil 72 perkkum (15 sathamaanam) postmortem cheytha 155 rogikalil 33 perkkum (29 sathamaanam) vidoora metaastaasis undennu report cheyyappettu.
schwamous sell carsinomayaanu ettavum saadhaaranamaaya report cheyyappetta kosha tharam (88 sathamaanam); lymphoapiteleomayulla kesukalil vidoora mettaastaasisinte ettavum uyarnna sambhavam undaayirunnu. vidoora metaastaasis undaakunna ettavum saadhaaranamaaya shareeraghadana kendrangalil shwaasakosham, karal, ellukal enniva ulppedunnu.
chikilsaykku munbum thudarnadapadikalkkum munbu eee avayavangalude samagramaya anweshanam valare shupaarsha cheiyunnu.
roganirnayam.
tonsil carcinoma nirnnayikkunnathinulla aadyapadi rogiyil ninnu krithyamaaya charithram neduka ennathaanu. eathenkilum shaareerika lakshanagal undengil doctor rogiye parisodhikkum. rogathinte purogathi allengil doctorq aavasyamundennu thonnunnundo ennathine aashrayich kurachu parisodhanakal nadatthaam. parisodhanakalil iva ulppedunnu
phine soochi aaspireshan, rakthaparisodhana, emm. aarr. aii, ex-reey, valarthumrigangalude scan.
staging.
tumour maassinte staging tnm stejingine adisthaanamaakkiyullathaanu.
tumour maas adisthaanamaakkiyullathaanu tii staging. lymph nodukalilekku cancer vyaapikkunnathinte vyaapthiye adisthaanamaakkiyullathaanu enn staging. avasaanamaayi, emm ghattam soochippikkunnathu kyaansar thalaykkum kazhuthinum appurathekku vyaapichittundo illayo ennaanu.
tii staging.
tii ghattam nirnnayikkunnathinulla adisthaanam tumourinte shaareerika parisodhanayeyum imajingineyum aasrayichirikkunnu.
enn staging.
lymph nodukalude vilayiruthaliloodeyaanu eee ghattam theerumaanikkunnathu.
emm staging.
shareeram muzhuvan parishodhikkunnathine adisthaanamaakki.
oduvil, melpparanja phalangal avasanippikkukayum inipparayunna chart paraamarsikkukayum cheythaanu ghattam theerumaanikkunnathu
chikitsa.
tonsil carsinomaykkulla chikilsayil inipparayunna reethikal ulppedunnu
radio therapy.
aadyakaala radio sensitiivu tumours servical nodukalude vikiranathodoppam radio therapy vazhi chikilsikkunnu. cancer koshangale nasippikkaan uyarnna oorjja ex-reey, electron beam allengil radio active isotopukal enniva vikiranangal upayogikkunnu.
chemotherapy.
tonsil tumour churukkunnathinulla chikilsayaanu induction chemotherapy. mattu chikilsakalkku munbaanu ithu nalkunnathu, athinaal induction enna padam. chikitsa poortthiyaaya sesham, rogiyodu vishramikkaan aavasyappedukayum oru nischitha kaalayalavil vilayiruthappedukayum cheiyunnu. thudarnnu tumour koshangale poornnamaayum nasippikkunnathinaayi rogikk keemo-radiation therapy (chemotherapy radiation samyojippichu) nalkunnu.
sasthrakriya.
radiation chemotherapy tumourine nasippikkaan kazhiyunnillengil, sasthrakriya pariganikkum. aadyakaala upariplavamaaya shathangalkku tonsil verthirichedukkaam. valia shathangalkkum asthikale aakramikkunnavaykkum hemimandibulectomy, kazhuthu vichedanam (commando ooppareshan) ennivayiloode vishalamaaya sasthrakriya aavasyamaanu.
kompineshan therapy.
shasthrakriyaykk munbo sheshamo ulla vikiranavumaayi sasthrakriya samyojippikkaam.
shasthrakriyaykko vikiranathino anubandhamaayi chemotherapy nalkaam.
pravachanam.
ghattam, human papilloma vairas (echpivi) nila, cancer koshangalude lymph nuzhanjukayattam, lymph nooad capsulinu appurathulla cancer koshangalude vyaapanam, tumourinte arikukal, mettaastaasisinte vyaapthi thudangiya vividha gadakangalaanu roganirnayam nirnnayikkunnath.
oro rogikkum savisheshamaaya niravadhi gadakangal chikilsayude vijayasaadhyathaye baadhichekkaam.
tonsillaar carsinomayude roganirnayam nirnnayikkunna gadakangal inipparayunnavayaanu
echpivi staattas.
tonsillaar carcinoma echpivi sambandhiyaayatho allengil echpivi bandhamillaathatho aakam. echpivi negatteevu orofaarinchiyal cancer ullavarekkaal echpivi positteev kesukalkku mikacha roganirnayam undennu kaanikkunnu.
steju.
cancer svayam avatharippikkunna ghattam krithyamaaya chikilsayude tharam, rogashaanthiyude saadhyatha, kaansarinte aavarthanam, rogiyude athijeevana nirakk ennivaye badhikkunnu. rogathinte aadyaghattangalil krithyamaaya lakshanangalude abhavam kaaranam saadhaaranayaayi rogi valare vaikiyaan prathyakshappedunnathu. rogikalil naalil moonnu bhaagavum moonnaam ghattathilo athinusheshamo ullavaraan.
orofaarinchiyal kaansarinte gattangal thaazhepparayunnavayaanu
• ghattam 0 (carcinoma inn sittu): ghattam 0 ulla mikka rogikalum theevramaaya chikilsayude aavasyamillaathe deerghakaalam nilanilkkunnathinaal eee ghattam oru nalla roganirnayathe soochippikkunnu. ennirunnaalum, rogi pukavali nirtthanam, kaaranam ithu oru puthiya cancer varaanulla saadhyatha vardhippikkum.
• ghattam I umm II umm eee ghattathil pankedukkunna mikka rogikalkkum vijayakaramaya chikitsa labhikkunnu, ithu oru nalla roganirnayam kaanikkunnu. chemotherapy, sasthrakriya, radiation therapy allengil chemoradiation ennivayaanu eee ghattatthile chikilsaareethikal. eee ghattatthile pradhana chikitsa tumourineyum servical lymph nodukaleyum lakshyamidunna vikiranamaanu. tumour neekkam cheiyunnathum servical (kazhuthu) lymph nodukalude lymphodenectomy cheiyunnathum radiation pakaram pradhana chikitsa reethiyilaan edukkunnathu. shasthrakriyaykk sheshamulla bakkiyulla cancer koshangal chemoradiation upayogichu chikilsikkunnu.
• ghattam III umm aii. vii. eyum eee ghattathil cancer koshangal praadeshika tissuekalilekkum servical lymph nodukalilekkum mettaastais cheiyunnu. eee kesukalil upayogikkunna chikitsa keemo radiationaanu. chemoradiationushesham sheshikkunna cancer koshangal shasthrakriyayiloode neekkam cheiyunnu. cancer koshangal servical lymph nodukalilekku nuzhanjukayariyenkil chemoradiation chikilsaykku sheshavum lymphodenectomy nadatthaam. chikilsayude mattoru reethiyil, aadyam, tumour, servical lymph nodukal enniva shasthrakriyayiloode neekkam cheiyunnathum thudarnnu aavarthanathinulla saadhyatha kuraykkunnathinu chemoradiation allengil radiation ulppedunnu.
• ghattam IVB: eee ghattathil cancer ithinakam vidoora metaastaasisinu vidheyamaayittundu, athinaal mosham roganirnayam kaanikkunnu. chikilsayil chemotherapy, settaksimaab allengil randum ulppedunnu. kyaansaril ninnu undaakunna lakshanagal laghookarikkunnathinum sankeernathakal kooduthal vikasikkunnath thadayunnathinum radiation upayogikkaam.
lymphatic nuzhanjukayattam.
munpile sthambhathile shathangalulla rogikalil pakuthiyolam perkkum tonsillaar phosa shathamulla rogikalil naalil moonnu perkkum avatharana samayat thanne nodel metaastaasis undu. servical lymph nodukalilekkulla cancer koshangalude metaastaasis rogashanthikkulla saadhyatha kuraykkunnu. prathyekichu, lymph nooad capsulinu appurathulla cancer koshangalude mettaastaasisinte thelivukal undengil. ennirunnaalum, lymph nooad capsulinu purathulla cancer koshangalude metaastaasis echpivi-anubandha auroferinksinekkaal echpivi-anubandha auroferinks cancerinu oru "mosham roganirnayamaanu" ennu chila daatta soochippikkunnu.
tumour ekstenshan.
naavinte adithattilekku tumour neettuka rogashanthikkulla saadhyatha ganyamaayi kuraykkunnu. chikilsaykku sesham ithu aavarthikkaanulla saadhyathayum vardhippikkunnu.
metaastaasis.
tissukal, naalangal, valia njarambukal, lymphatics thudangiya praadeshika gadanakalilekku cancer koshangal vyaapikkunnath rogiyude roganirnayam vashalaakkunnu.
echpivi-anubandha auropharinx carsinomayile athijeevana nirakk vishakalanam cheytha oru patanam echpivi-anubandhamallaatha auropharinx carsinomayil. rogiyude echpivi nilaye adisthaanamaakki, moonnaam ghattathinum naalam ghattathinum auropharinx carsinomayil, moonnu varshathinu sesham athijeevanathil oru poruthakkedundennu patanam velippeduthi.
echpivi positteev aayavaril athijeevanam 82 sathamaanavum pinneedu echpivi negatteevu kaansarukalil 57 sathamaanavum aayirunnu.

