一名67歲陳小姐,因為喉嚨痛前往診所看診,卻遲遲沒有改善,後來輾轉到臺中榮總看診,確診為扁桃腺癌合併頸部淋巴腺轉移第四期,當下陳小姐一滴眼淚都沒流,連遺囑都寫好,所幸配合醫師接受達文西手術切除扁桃腺癌後,治療過程十分順利,她開始慢慢走出來,和朋友到處出遊、去跳舞等,陳小姐呼籲:「如果不幸罹癌,千萬要勇敢面對並積極接受治療。」 前言 每個人的扁桃體有3組,分別是顎扁桃體(palatine tonsils)、咽扁桃體(pharyngeal tonsils,又稱腺樣體)、舌扁桃體(lingual tonsils)等。扁桃體惡性腫瘤(tonsils cancer)的發病率低於喉癌及鼻咽部惡性腫瘤,最常見發生在顎扁桃體(It most commonly occurs in the palatine tonsils),多發於40歲以上者,而扁桃體肉瘤多發生在青年,也可見於兒童,發病率男多於女,可能是因為男性吸煙、過度飲酒人數佔多數,研究指出,吸煙是最常見的危險因數,可能是吸煙、過度飲酒對粘膜刺激有關,55%患者每天吸煙在20支以上,38%~50%以上患者是大量飲酒者(Smoking is the most common risk factor for squamous cell carcinomas of the tonsils. Alcohol is also a risk factor; the combination of smoking and alcohol use yields an even greater risk than using either substance alone)。此外,扁桃體粘膜角化症與白斑症等也可能發生癌變。 病理分類 扁桃體惡性腫瘤根據組織來源不同,可以分為鱗狀細胞癌(最常見)、淋巴上皮癌、未分化癌、移行上皮癌和腺癌(Most tonsil cancers are squamous cell carcinomas)。 臨床分類與分期 最主要的影響預後因素為癌症的種類及臨床分期。臨床分類與分期如下:
腫瘤擴散 扁桃體惡性腫瘤轉移早,以淋巴道轉移及血行轉移最常見。
臨床表現
診斷 結合患者 Symptoms、Signs 及超音波等輔助檢查大多可以輔助診斷,做穿刺細胞學檢查可以確診(在潰瘍邊緣塗片或活檢,也可在腫大頸淋巴結穿刺作細胞學檢查,也可切除扁桃體後送檢)。 鑒別診斷 常被誤診為扁桃體炎、扁桃體周圍膿腫、咽後膿腫、頸淋巴結炎,必須仔細進行鑒別。
併發症 併發症有時是非常嚴狀而致命的,如無法控制的大出血;另外,可造成靜息下或勞累性呼吸困難、喘鳴、甚至窒息而死亡(Some complications of tonsil cancer can be serious, such as uncontrolled or heavy bleeding or respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking)。整理如下:Decreased ability to eat, drink, talk or breathe、Recurring cancer after treatment、Spread of cancer into nearby structures、Hemorrhage、Spread of cancer to distant areas of the body、Spread of cancer to lymph nodes in the neck。 治療 治療的目的是永久的治癒以達到完全緩解;所謂緩解是不再出現任何症候,但有可能日後會復發,所以不可輕心(The goal of tonsil cancer treatment is to permanently cure the cancer or to bring about a complete remission of the disease)Remission means that there is no longer any sign of the disease in the body, although it may recur or relapse later)。扁桃體屬於淋巴器官,惡性淋巴瘤的發生率極高,但對放射線敏感,所以對多數人是作為首選的治療方式。
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