_--The _tonsil_ is frequently the primary seat of
_lympho-sarcoma_, a very malignant form of round-celled sarcoma. The
tumour is at first confined to the tonsil, which differs in appearance
from simple hypertrophy only in being paler and more nodular. The
growth rapidly infiltrates the peritonsillar connective tissue and
adjacent palatal mucous membrane, which becomes pale and oedematous,
and the condition at this stage may simulate a suppurative
tonsillitis. As it increases, the tumour encroaches upon the cavity of
the pharynx, causing interference with swallowing and breathing; the
mucous membrane soon gives way, and widespread ulceration and
sloughing of the tumour substance occurs, sometimes leading to serious
and even fatal haemorrhage. The patient emaciates rapidly. The adjacent
lymph glands are early infected.

Removal by operation is seldom practicable, but the introduction of a
tube containing radium for several days has in some cases proved
beneficial.

_Carcinoma_ is more common than sarcoma. It may take the form of
_squamous epithelioma_ or of _medullary cancer_, and may originate in
the tonsil, in the groove between the tonsil and the tongue, or in the
soft palate. By the time the patient seeks advice it has usually
implicated the fauces, soft palate, and pharyngeal wall as well as the
tonsil.

Males suffer more frequently than females. The disease may exist for a
considerable time before giving rise to marked symptoms, and attention
may first be drawn to it by pain and difficulty in swallowing, or by
pain shooting towards the ear. In some cases enlargement of the glands
behind the angle of the jaw is the first thing to attract the
patient's attention. The other symptoms are very like those of cancer
of the tongue--pain during eating or drinking, salivation and foetid
breath. Sometimes fluids regurgitate through the nose, and the voice
may become nasal and indistinct. As the patient is usually unable to
open the mouth widely, it is seldom possible to learn much by
inspection, but a digital examination may reveal an irregular, hard,
and ulcerated growth. The swelling is sometimes palpable from the
outside, filling up the hollow behind the angle of the jaw, and in
this situation also the enlarged lymph glands may be felt. These are
often enlarged out of all proportion to the size of the primary
growth. The disease tends to spread locally, causing increasing
difficulty in swallowing and breathing. The pati