Tonsil cancer develops when there is abnormal cell growth in a person’s tonsils. Tonsil cancer is often diagnosed late, and the diagnosis can be surprising, especially if you haven’t really noticed any symptoms. As such, it is crucial to be aware of the signs. Treatments for tonsil cancer include chemotherapy, surgery, and radiation therapy.
What is a tonsil?
The tonsils sit towards the back of the throat, one on either side. They consist of lymphoid tissue, which contains lymphocytes – cells that help combat disease.
The tonsils trap and destroy bacteria and viruses. They can change in size and often swell with blood to help trap bacteria and viruses, such as when a person has a cold.
What is tonsil cancer?
Tonsil cancer is a common form of oropharyngeal malignancy. Its incidence is sharply rising due to the increasing prevalence of human papillomavirus (HPV)-induced cancers. The presence of HPV can dramatically alter the prognosis of tonsillar cancer.
Tonsil cancer is relatively rare and living with a rare form of cancer can be challenging. Tonsil cancer is often diagnosed late in the disease, when cancer has spread to nearby areas, such as the tongue and the lymph nodes.
Tonsil cancer begins when cancerous cells develop in the tonsils. It can occur in people who have had their tonsils removed, as some tonsil tissue may remain after surgery. Drinking alcohol, smoking, and carrying HPV appear to increase the risk of getting tonsil cancer.
Tonsil cancer symptoms
Many people with tonsil cancer may not notice any symptoms even after they are diagnosed. The major symptom of tonsil cancer is having one tonsil larger than the other. Another common symptom is a persistent sore throat. It is not uncommon for the first symptom to be a lump in the neck.
Other symptoms may include:
- Change in speaking voice quality
- Fatigue
- Unexplained weight loss
- Ear pain, especially on only one side, the same side as the affected tonsil
- Difficulty swallowing, chewing, or opening the mouth
- Red or white patch on the tonsil
- Bleeding from the mouth – very rare
Having one or more of these symptoms doesn’t mean you have tonsil cancer. Several non-cancerous problems cause the same symptoms.
It’s important to see a specialist if you have a tonsil infection that doesn’t get better with antibiotics or unexplained ear pain that doesn’t go away.
Early-stage tonsil cancer
Early-stage tonsil cancer can be hard to recognise as symptoms may be similar to illnesses such as tonsillitis or strep throat.
Thus, to catch this disease in the early stages, head to the doctor if you have asymmetrical tonsils (one larger than the other) or a persistent sore throat that doesn’t seem to get better even with medication.
Causes and risks factors of tonsil cancer
In the past, the known risk factors for tonsil cancer were being older and using tobacco or alcohol. People who both smoke and drink heavily have double the chances of developing cancers in their throat.
However, now there seems to be an increased rate of tonsil cancer in patients who don't smoke or drink. There is some evidence that it's related to the human papillomavirus (HPV). HPV is a common virus associated with sexual contact. Tonsil cancer caused from HPV is a type of squamous cell carcinoma.
As with all cancers, tonsil cancer results from a combination of factors, including genetics, lifestyle, and environment.
Tonsil cancer diagnosis
The diagnosis for tonsil cancer would start with an examination of your mouth and throat. The doctor might feel your neck for lumps and perform a laryngoscopy, where a thin tube with a camera and light is passed down your throat to check if there is anything out of the ordinary.
If any abnormal areas are found, a sample of cells might be biopsied for lab testing. You may also have imaging tests like CT, MRI, or PET scans done.
If cancer is found, your doctor will further evaluate the abnormalities to determine type and grade of the cancer to determine its growth rate and which stage of cancer you are in. This will help your doctor chart the best treatment plan to fight the cancer.
Stages of tonsil cancer
Stage Zero
There are precancerous cells present. Although they are not cancerous, changes have taken place in cells.
Localised cancer
There are cancer cells present in the tonsils. However, these cells have not spread to other areas. Tumours in this stage are smaller than 2cm diameter. This is also referred to as stage 1 cancer.
Regional cancer
The cancer has spread from the tonsils to nearby tissues. Tumours in this stage can be as large as 4cm diameter. Your lymph nodes or the epiglottis may be affected.
Distant cancer
Cancer has progressed and spread to other areas such as the mouth. It may start to affect other parts of the body as well, such as the lungs.
Tonsil cancer treatment
Treatment for tonsil cancer might involve surgery to remove the cancer cells. Surgeons might be able to access small cancers through your mouth. Larger cancers might require opening up the neck. Other treatment options might include radiation therapy and chemotherapy.
Radiation therapy may be needed to shrink a tumour or stop its growth especially inoperable cancers. Radiation therapy is also used after surgery if the cancer can't be removed completely or if there's a risk that the cancer may have spread to the lymph nodes.
Radiation can also be combined with chemotherapy as an initial treatment or as an additional treatment after surgery. The chemotherapy makes the cancer cells more vulnerable to the radiation and may increase the effectiveness.
Tonsil cancer prevention
1. The best way to prevent cancer in the tonsils is to quit smoking, avoid tobacco products or marijuana. Not chewing tobacco or using snuff also helps. Smoking is the largest cause of cancers in the head and neck region.
2. Avoid being around smokers and in areas where smoking is common because second-hand smoke may also increase the chances of developing cancers in the head and neck.
3. Protect yourself from HPV by limiting the number of sexual partners. Using a condom doesn’t protect you from HPV as it can also spread during oral sex.
4. Get HPV vaccinations to prevent HPV infection before your first-time sexual contact. The Centre for Disease Control and Prevention recommends that all pre-teen girls and boys to have HPV vaccination.
5. See your doctor and dentist routinely. By examining your mouth, they can help detect tonsil cancer early.
Survival rate of tonsil cancer
Similar to other cancers, treatment success depends on when the disease is detected. The earlier treatment starts, the better chances of survival. HPV-related tonsil cancer has about 85% five-year survival rate.
Do remember that survival rates are estimates based on others who have been diagnosed and treated for this condition. You can estimate how long you will live or how successful your treatment will be based on survival rates. For a more accurate picture, talk to your doctor about your condition.
How fast does tonsil cancer grow?
This depends on the type of cancer. High-grade tumours spread faster compared to low-grade tumours. Again, speak to your doctor about your condition for an accurate prognosis.
How do you get checked for tonsil cancer?
While symptoms such as a persistent sore throat and asymmetrical tonsils may indicate tonsil cancer, the only way to know for sure is to have a biopsy. Make an appointment with your healthcare provider for this procedure.
Reach out to our Ear, Nose and Throat surgeons and oncologists at Gleneagles Hospital if you are experiencing symptoms to get checked for tonsil cancer. The experienced team of specialists are able to tailor treatment plans for your condition, address your concerns and journey with you, if it is indeed cancer.
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