What Is Tonsil Cancer?

Tonsil cancer is a type of oropharyngeal cancer. When it's diagnosed in the early stages, many people who have tonsil cancer can have good outcomes.

You have three sets of tonsils:

• Pharyngeal tonsils are the adenoids, which are behind the nose.
• Palatine tonsils are at the back of your throat and are probably what you think of when you hear the term "tonsils."
• Lingual tonsils are located at the base of the tongue.

Of these three sets of tonsils, the palatine tonsils are the most likely to become malignant (cancerous). 

Symptoms

The symptoms of tonsil cancer are similar to symptoms of common upper respiratory infections, such as strep throat or tonsillitis. However, while infections tend to worsen quickly and then resolve, cancer symptoms generally linger or slowly worsen.

An enlarged tonsil, which can be seen with a routine physical or dental exam, may be an indication of tonsil cancer.

Symptoms of tonsil cancer can include:

• Non-healing, persistent sores in the back of the mouth or throat
• Swollen tonsils that are not equal in size (one is particularly larger than the other)
• Mouth pain that does not go away
• Earaches
• Difficulty swallowing and/or pain when swallowing
• Pain when eating citrus fruits
• Lumps in the neck
• Neck pain
• Sore throat that does not go away
• Blood-tinged saliva
• Bad breath

Causes

Several risk factors can predispose a person to tonsil cancer, including alcohol use, smoking, and/or infection with human papillomavirus (HPV).

This cancer is more common among men than women, people over age 50 (although tonsil cancer can occur at any age), and those who have had an organ transplant.

The HPV Connection

The incidence of head and neck cancers has been increasing. Between 1984 and 2004, the number of head and neck cancers caused by HPV, the same virus that causes cervical cancer, quadrupled.

While HPV-positive cancers have increased, other types of head and neck cancers have decreased. Historically, head and neck cancer was considered rare and was typically caused by using chewing tobacco, smoking, and consumption of alcoholic beverages.

HPV-positive malignancies are much more responsive to treatment than other head and neck cancers. 

HPV prevention strategies include getting an HPV vaccine and using condoms.

Diagnosis

Healthcare providers use different tools to help diagnose cancer of the tonsils. The first step of this process is your medical history and physical examination.

If necessary, your healthcare provider may order one or more of the following tests:

• Tissue biopsy (a small amount of tissue is taken from the tonsils, and the cells are examined under a microscope)
• Blood tests
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan

Staging

If you are diagnosed with cancer, it is classified into a stage, which defines how far the disease has progressed.

Typically, there are four different cancer stages:

• Stage I: The cancer is smaller than 2 centimeters (cm), is confined to one area, and has not spread to surrounding lymph nodes.
• Stage II: The cancer is between 2 to 4 cm, but has not spread.
• Stage III: The cancer is larger than 4 cm and has spread to one lymph node that is on the same side of the neck as the tumor. The lymph node measures 3 cm or less.
• Stage IV: Stage IV tonsil cancer criteria include any of the following:
• Cancer has spread to surrounding areas of the throat or mouth and/or more than one lymph node on the same side of the neck as the tumor.
• It has spread to one large lymph node (larger than 3 cm) on the same side of the neck as the tumor.
• It has spread to one lymph node on the opposite side of the neck as the tumor.
• It has spread to other parts of the body.

Treatment

The treatment you receive for your condition will depend on what type and stage of tonsil cancer you have. You and your healthcare provider will discuss the treatment plan that is best for you. The treatments chosen may vary depending on the characteristics of the tumor and whether it developed due to HPV.

Early stage tonsil cancer, when the tumor is small and only present in the tonsil, may be treated by surgery to remove the tonsil and some of the neck lymph nodes. Or, you may have radiation therapy to the head and neck.

If you have a higher risk of cancer coming back and are treated with surgery, you may be given radiation therapy or radiation therapy plus chemotherapy.

Locally advanced and advanced tonsil cancer, in which the cancer has spread to nearby tissue or other parts of the body, is treated in various ways. Chemotherapy and radiation therapy may be given together (chemoradiotherapy). You may be treated with radiation therapy alone. Or, you may have surgery to remove the cancer, lymph nodes, and adjacent tissues, followed by radiation therapy or chemoradiotherapy.

Immunotherapy has also been approved for use alone or in combination with chemotherapy for the treatment of metastatic tonsillar cancer. Keytruda (pembrolizumab) may be used in combination with chemotherapy agents.

Targeted therapy may be used if the tumor has certain characteristics. Erbitux (cetuximab) is a targeted therapy that may be used in combination with radiation therapy.

Frequently Asked Questions

Can I still get tonsil cancer if I previously had my tonsils removed?

Yes, tonsil cancer can still develop in any tonsil tissue that wasn't removed in the surgery.

What is the tonsil cancer survival rate?

The five-year survival rate for oropharynx cancers, which includes tonsil cancer, is 62% for localized cancer (cancer that has not spread beyond where it started). For regional spread (where it has grown into nearby lymph nodes or structures) the rate is 57%, and for distant metastasis (cancer that has spread to a different area in the body) the rate is 29%.

How can I prevent tonsil cancer?

Avoid smoking and smokeless tobacco products, limit alcohol intake, get the HPV vaccine, and use protection during sexual activities. Also, be sure to visit the dentist regularly as many head and neck cancers are first detected by the dentist.

Summary

Many cancers are most treatable when caught early, and tonsil cancer is no exception. If you notice symptoms such as sores in your mouth, pain, or a sore throat that won't go away, or if you have blood in your saliva or lumps in your neck, talk with your healthcare provider right away.