My son was seen by his doctor, and he seemed concerned about his tonsils. Only one of them is swollen. The doctor said to watch it. Why?

T.C.

The significance of asymmetric tonsils depends on many factors. How old is your son? I do not know whether he is six years old, or if he is 66 and has been smoking and drinking for the last 50 years!

In the case of a young child, an asymmetrically enlarged tonsil is usually due to infection, and it is not a particularly significant finding. Nevertheless, in the back of the doctor's mind is probably the "L word." Lymphoma, a cancer of the lymph nodes, can involve the tonsils, causing one to grow out of proportion to the other. The symptoms of lymphoma vary from patient to patient. Some patients only note one or more enlarged lymph nodes (in the neck, armpits, groin and so forth), while others have enlarged lymph nodes AND flulike symptoms such as fever, chills, malaise (general ill feeling), loss of appetite, night sweats and muscle aches. Absence of flulike symptoms provides encouragement (albeit weak) that lymphoma is not present, but the physician must still have a high level of suspicion so as to avoid missing the diagnosis.

If your son is young, has had a recent cold or sore throat and has no other suspicious neck masses or other unusual symptoms (as described above), his doctor's advice to "watch it" is an abbreviation for the following: "Please tell me if your son starts noticing any other odd symptoms..." such as those of lymphoma. The doctor may not want to unnecessarily worry your son (or you), since lymphoma is unlikely in this situation. Still, it hardly helps to tell you to "watch it" without telling you what, exactly, you need to look out for.

If your son is older, the situation is somewhat different. Lymphoma remains a concern at any age, but with increasing age and increasing exposure to nasty habits (smoking and drinking, in particular), one also has to worry about a cancer called squamous cell carcinoma. I wouldn't think more than a microsecond about this diagnosis in a six-year-old, but in the 66-year-old described above, it would dominate my thoughts. With a 66-year-old, I would NOT "watch it" but would instead strongly recommend that the patient have the tonsil removed as soon as possible, to see if it harbored a cancer.

Without knowing more about your son, I do not know whether this answer will frighten you or reassure you. It should enable you (or your son, if he is an adult) to ask the doctor some very pointed questions. If these questions are not answered to your (or his) satisfaction, consultation with an ear, nose and throat specialist would be my next step.