Tonsil Cancer

Tonsil cancer is a malignant tumor on your tonsils, the fleshy masses in the back of your throat (pharynx). It’s the most common form of oropharyngeal cancer. The most common presenting symptom is a painless neck mass or an enlarged lymph node that won’t go away. Sometimes, it can also present as a sore throat that doesn’t go away.

In the past, the biggest risk factor was smoking cigarettes. Tobacco use can still lead to tonsil cancer. But now, most of these cancers are linked to human papillomavirus (HPV). While most HPV infections clear on their own, some — like the strains of HPV that cause cervical cancer — are active in people with this disease.

Often, healthcare providers can treat tonsil cancer if they find it before it spreads. But lots of things can affect your prognosis, including whether it relates to an HPV infection or not.

Types

There are two types:

• HPV-independent (HPV-): The disease isn’t linked to HPV infection. This type is more common in men over 55 who smoke. It often involves a worse outlook (prognosis) than HPV-associated types.
• HPV-associated (HPV+): The disease is linked to HPV infection. Usually, it’s a strain called HPV16. The risk is the same no matter your sex. But people diagnosed tend to be younger than those who have HPV-independent disease.

Symptoms of tonsil cancer

The most common symptom is a painless neck mass or enlarged lymph node that won’t go away. Another is a sore throat that won’t go away, or when one tonsil is swollen and larger than the other tonsil. Other symptoms are:

• Bad breath
• Blood in your saliva (spit)
• Difficulty swallowing, speaking or chewing
• Ear pain
• Mouth pain
• Sores in the back of your mouth that don’t heal

Having these symptoms doesn’t mean you have tonsil cancer. Tonsil cancer symptoms can look and feel like other less serious conditions, like tonsillitis.

But you should talk to a healthcare provider if your symptoms last longer than a few days.

Tonsil cancer causes and risk factors

Tonsil cancer develops when healthy cells mutate (change) and become cancer cells. Without treatment, it can spread to other places in your body.

Experts don’t know exactly why this happens. But having cancer-causing strains of the human papillomavirus (HPV) increases your risk. HPV is a sexually transmitted infection, which means you get it through sexual contact with an infected person. Most people in the U.S. are exposed to the virus when they first become sexually active. Nine out of ten people clear the virus from their system naturally with their immune system. However, the persistent presence of HPV can lead to cancer development 20 to 30 or more years after.

Other risk factors are:

• Tobacco use: This includes smoking tobacco and using e-cigarettes (vaping).
• Heavy alcohol use: Drinking too many alcoholic drinks can increase your risk.
• Weakened immune system: People who have human immunodeficiency virus (HIV) or who take immunosuppressants for organ transplants have increased risk.

How doctors diagnose this condition

A healthcare provider will examine your throat and tonsils. They may do a throat culture to rule out bacterial infections as a cause. They’ll look for changes in your tonsils, like sores that could be cancer.

If they suspect tonsil cancer, they’ll refer you to an otolaryngologist (an ear, nose and throat specialist or ENT). They may order tests, including biopsies and imaging tests.

Biopsy

Your provider may do a biopsy to collect samples of cells and tissue. Lab tests will check the samples for cancer cells and the HPV virus. Possible types of biopsy are:

• Incisional biopsy: This test uses surgery to get cell and tissue samples.
• Fine-needle aspiration (FNA) or core-needle biopsies: If you have a suspicious lump on your neck, they may insert a tiny needle that removes cells or tissue to get a sample.

Imaging tests

If biopsy results show signs of tonsil cancer, your healthcare provider may order imaging tests to see if the cancer has spread to other parts of your body. Tests may include:

• Computed tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Positron emission tomography (PET) scans

How is tonsil cancer staged?

Healthcare providers stage the condition from I (1) to IV (4), where lower numbers mean early-stage cancer. Stage IV means advanced cancer that has spread. To assign the stage, providers consider:

• The tumor’s size and location
• Whether the cancer has spread to the lymph nodes in your neck
• Whether the cancer has spread to distant parts of your body

There are two different staging systems: one for HPV-associated cancers and one for HPV-independent cancers. This is because the two types behave differently. HPV-associated cancers tend to involve a better outlook than HPV-independent ones.

For instance, most HPV-associated tonsil cancers are diagnosed after the cancer has spread to neck lymph nodes. Usually, cancers with lymph node involvement are considered more advanced. But HPV-associated cancers are still often curable at this point.

Your healthcare provider can explain how the cancer stage impacts your treatment.

How is tonsil cancer treated?

Treatment depends on the size and location of the tumor and whether it’s spread to other parts of your body. The most common treatments for tonsil cancer include surgery, radiation therapy and chemotherapy.

Tonsil cancer surgery

Your otolaryngologist may do surgery to remove small tumors or affected lymph nodes, including:

• Cervical lymphadenectomy: You may need surgery to remove your neck lymph nodes to see if the cancer has spread there or to treat cancer that has spread. They may also call this surgery neck dissection.
• Transoral robotic surgery (TORS): This surgery treats hard-to-reach areas, like the back of your throat. TORS is a treatment option for early-stage tonsil cancer.

Radiation therapy and chemotherapy

You may receive radiation therapy or chemotherapy plus radiation therapy (chemoradiation) as an alternative to surgery or after surgery for tonsil cancer.

For example, your provider may recommend radiation therapy instead of surgery to cure small tumors. Or you may need it after surgery to get rid of any microscopic cancer cells that may remain. Your provider may give you chemotherapy at the same time as radiation to enhance its effects.

They may recommend chemotherapy when surgery or radiation therapy won’t cure tonsil cancer. Chemotherapy can slow down cancer growth and ease symptoms.

Immunotherapy and targeted therapy

These treatments shrink tumors or slow tumor growth. They can help manage symptoms.

Immunotherapy helps your immune system fight cancer better. You may get this treatment alone or in combination with chemotherapy. Targeted therapies block proteins cancer cells use to grow. Providers most often use them in advanced cancers that have spread or come back after remission. Remission means that there aren’t any signs or symptoms of cancer.

When should I see my healthcare provider?

You’ll need regular checkups to see if treatment is working. This may involve imaging scans or blood tests.

Even when treatments cure the cancer, they can still cause serious side effects that your healthcare provider will help you manage. Side effects can include trouble speaking or swallowing. You may need to work with a speech-language pathologist to help with these.

What is the survival rate for this condition?

Tonsil cancer survival rates vary based on several factors, including your HPV status and whether the tumor is spreading. The five-year survival rate for HPV-associated tonsil cancer is 90% to 95%. This means that 9 out of 10 people are alive at least five years after they’re diagnosed. The survival rate is lower for HPV-independent tonsil cancer, at around 55% to 60%.

When you think about cancer survival rates, it’s also important to remember:

• These rates are estimates based on the experiences of other people who had tonsil cancers. What was true for them may not be true for you.
• Experts update survival rates every five years, and it’s possible tonsil cancer survival rates are different now from what they were in the past.
• A survival rate isn’t an estimate for how long you’ll live, or your life expectancy if you have tonsil cancer.

Survival rate data can be complicated and confusing. If you have tonsil cancer, ask your oncologist about survival rate estimates and how they apply to your situation.

Can tonsil cancer be cured?

In some cases, yes. As with most cancers, treatment is most successful when healthcare providers diagnose and treat them in the early stages. The chance of a cure is highest with early-stage disease and HPV-associated tonsil cancers.

Can tonsil cancer be prevented?

You can greatly reduce your risk of tonsil cancer with these precautions:

• Take steps to prevent HPV, like getting the HPV vaccine.
• Don’t smoke or use tobacco products of any kind.
• Get routine oral cancer screenings, which help detect tonsil cancer early on.