Tonsil cancer

Overview

Tonsil cancer is a growth of cells that starts in a tonsil. The tonsils are two oval-shaped pads in the back of the mouth. They help the immune system fight germs.

Tonsil cancer can cause difficulty swallowing. It may make it feel like something is caught in the throat. Tonsil cancer is often diagnosed late in the disease. Often, the cancer has spread to nearby areas, such as the lymph nodes in the neck.

Tonsil cancer is considered a kind of throat cancer. Tonsil cancer happens in the part of the throat that's behind the mouth, called the oropharynx. Cancer that starts in this part of the throat is sometimes called oropharyngeal cancer.

Treatments for tonsil cancer include surgery, radiation therapy and chemotherapy.

Symptoms

Signs and symptoms of tonsil cancer include:

• Difficulty swallowing.
• A sensation that something is caught in the back of the throat.
• Swelling and pain in the neck.
• Earache.
• Jaw stiffness.

When to see a doctor

Make an appointment with a doctor, dentist or other healthcare professional if you have any symptoms that worry you.

Causes

Tonsil cancer happens when cells in the tonsils develop changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

It's not always clear what causes the DNA changes that lead to tonsil cancer. For many tonsil cancers, human papillomavirus is thought to have a part. Human papillomavirus, also called HPV, is a common virus that's passed through sexual contact. For most people, HPV doesn't cause any problems. For others, it causes changes in the cells that may one day lead to cancer. Tonsil cancer caused by HPV tends to occur at a younger age and is more likely to respond well to available treatments.

Risk factors

Factors that may increase the risk of tonsil cancer include:

Using tobacco

All forms of tobacco increase the risk of tonsil cancer. This includes cigarettes, cigars, pipes, chewing tobacco and snuff.

Drinking alcohol

Frequent and heavy drinking increases the risk of tonsil cancer. Using alcohol and tobacco together increases the risk even more.

Being exposed to human papillomavirus

Human papillomavirus, also called HPV, is a common virus that's passed through sexual contact. For most people, it causes no problems and goes away on its own. For others, it causes changes in the cells that can lead to many types of cancer, including tonsil cancer.

Prevention

Things that can help lower the risk of tonsil cancer include making healthy choices and having regular checkups. To lower your risk of tonsil cancer:

Don't use tobacco

If you don't use tobacco, don't start. If you currently use tobacco of any kind, talk with your healthcare professional about strategies to help you quit.

Limit alcohol if you choose to drink

If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.

Have regular health and dental exams

During your appointments, your dentist, doctor or other healthcare professional can check your mouth for signs of cancer and precancerous changes.

Consider the HPV vaccine

A vaccine can help prevent infection with human papillomavirus, also called HPV. HPV infection raises the risk of tonsil cancer and other cancers. Receiving a vaccination to prevent HPV infection may reduce the risk of HPV-related cancers. Ask your healthcare professional whether the HPV vaccine is right for you.

Diagnosis

To diagnose tonsil cancer, a healthcare professional might start by looking closely at your mouth and throat. Other tests and procedures might include imaging tests and a procedure to remove some cells for testing.

Examining the throat and neck

A healthcare professional may use a mirror or tiny camera to examine your mouth and throat. The health professional may feel your neck to check for swollen lymph nodes.

Removing a tissue sample for testing

Your healthcare professional may recommend a biopsy to get some tonsil cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab. To get the sample, a healthcare professional may cut away some cells from the tonsil. Or the health professional may use a needle to draw some cells out from a swollen lymph node in the neck.

In the lab, doctors called pathologists look for signs of cancer in the tissue sample. The tissue sample also will be tested for human papillomavirus, also called HPV. If your cancer cells show signs of HPV, this greatly impacts your prognosis and your treatment options.

Taking imaging tests

Imaging tests make pictures of the body. They may help your healthcare team better understand the size of your cancer. Imaging tests also can look for signs that cancer may have spread beyond your tonsils.

Imaging tests used for tonsil cancer may include:

• Computerized tomography, also called CT.
• Magnetic resonance imaging, also called MRI.
• Positron emission tomography, also called PET.

Tonsil cancer staging

Your healthcare team uses information from these procedures to assign your cancer a stage. The stage tells your healthcare team about the extent of your cancer and about your prognosis.

The stages of tonsil cancer range from 0 to 4. The lowest numbers indicate a small cancer that may only be in the tonsil or may have spread to a few nearby lymph nodes. As the cancer gets bigger or spreads to more lymph nodes, the stages get higher. A stage 4 tonsil cancer is one that has grown beyond the tonsil or has spread to many lymph nodes. A stage 4 tonsil cancer also may have spread to other parts of the body.

The stages of tonsil cancer are different for cancers that show signs of HPV infection and those that don't. Talk with your healthcare team about your tonsil cancer stage and what it means for your outlook.

Treatment

Treatments for tonsil cancer include surgery, radiation therapy and chemotherapy. Other treatments include targeted therapy and immunotherapy.

Your healthcare team considers many factors when creating a treatment plan. These factors might include the cancer's location and how fast it's growing. The care team also may look at whether the cancer has spread to other parts of the body and the results of tests on the cancer cells. Your care team also considers your overall health and your preferences.

Your treatment also may depend on whether your cancer cells show signs of human papillomavirus, also called HPV. Researchers are studying whether people with HPV-related tonsil cancer can be treated with lower doses of radiation and chemotherapy. This less intense treatment causes fewer side effects. Studies have found that it seems to be as effective as higher doses. If your tonsil cancer is found to be HPV-related, you and your healthcare team might consider a clinical trial studying less intense treatments.

Surgery

The goal of surgery for tonsil cancer is to remove as much of the cancer as possible. Surgery can be used to treat all stages of tonsil cancer.

Surgery is most often done through the mouth. Doing surgery in this way is called transoral surgery. Surgeons pass tools through the mouth to access the cancer. The surgeons remove the cancer with cutting tools or lasers.

In certain situations, it may be necessary to make a large incision in the neck. This approach lets surgeons remove larger cancers and cancers that have spread to the lymph nodes. Reconstructive surgery and rehabilitation may be needed to restore your ability to eat, speak and swallow.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, a machine directs beams of energy to specific points on the body to kill the cancer cells.

Radiation therapy might be used alone to treat small cancers that haven't grown beyond the tonsil. Sometimes radiation therapy is used after surgery if the cancer can't be removed completely. It also may be used after surgery if there's a risk that the cancer may have spread to the lymph nodes.

Radiation also can be combined with chemotherapy. The chemotherapy makes the radiation work better. Radiation and chemotherapy together is sometimes used as the first treatment for tonsil cancer. Or radiation and chemotherapy might be used as extra treatment after surgery.

Chemotherapy

Chemotherapy treats cancer with strong medicines. For tonsil cancer, chemotherapy is usually combined with radiation therapy. It also can be used alone to slow the growth of tonsil cancer that has come back or has spread to other areas of the body.

Targeted therapy

Targeted therapy uses medicines that attack specific parts of cancer cells. By blocking these parts, targeted treatments can cause cancer cells to die. Targeted therapy might be used to treat tonsil cancer that spreads to other parts of the body or comes back after treatment.

Immunotherapy

Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Immunotherapy might be used when tonsil cancer spreads to other parts of the body and other treatments haven't helped.

Rehabilitation services

If treatment affects your ability to speak and eat, you might need rehabilitation services. Rehabilitation specialists who work with people with tonsil cancer include those in speech therapy, swallowing therapy, dietetics, physical therapy and occupational therapy. These services can help with your recovery after tonsil cancer treatment.

Coping and support

People who are facing a serious illness often say they feel worried about the future. With time, you'll find ways to cope with the feelings brought on by a tonsil cancer diagnosis. Until you find what works for you, you may find comfort in these strategies:

Ask questions about tonsil cancer

Write down questions you have about your cancer. Ask these questions at your next appointment. Also ask your healthcare team for reliable sources where you can get more information.

Knowing more about your cancer and your treatment options may help you feel more confident in making decisions about your care.

Stay connected to friends and family

Your cancer diagnosis can be stressful for friends and family too. Try to keep them involved in your life.

Your friends and family will likely ask if there's anything they can do to help you. Think of tasks you might like help with, such as caring for your home if you have to stay in the hospital or just being there when you want to talk.

You may find comfort in the support of a caring group of your friends and family.

Find someone to talk with

Find someone you can talk to who has experience helping people facing a life-threatening illness. Ask your healthcare team to suggest a counselor or medical social worker you can talk with. You might find it helpful to talk with other cancer survivors through support groups. Contact the American Cancer Society or ask your healthcare team about local or online support groups.

Preparing for an appointment

Start by making an appointment with your doctor, dentist or other healthcare professional if you have symptoms that worry you.

If your healthcare professional is concerned that you may have tonsil cancer, you may be referred to:

• A surgeon who operates on the head and neck.
• A doctor who uses medicine to treat cancer, called a medical oncologist.
• A doctor who uses radiation to treat cancer, called a radiation oncologist.

Because appointments can be brief it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as change your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements you're taking and the doses.
• Consider taking a family member or friend along. Sometimes it can be hard to remember all the information provided during an appointment. Someone who comes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For tonsil cancer, some basic questions to ask your doctor include:

• What is my stage of tonsil cancer?
• Can you explain the pathology report to me? Can I have a copy of my pathology report?
• Will I need more tests?
• What are the treatment options for my tonsil cancer?
• What are the benefits and risks of each option?
• Is there one treatment option you recommend over the others?
• What would you recommend to a loved one in my same situation?
• Should I get a second opinion from a specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

You are likely to be asked a number of questions. Being ready to answer them may allow time later to cover points you want to address. You may be asked:

• When did you first begin experiencing symptoms?
• Are your symptoms ongoing or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, seems to worsen your symptoms?