Tonsil cancer is the most common form of oropharyngeal (throat) cancer. But among all types of cancer, tonsil cancer is still relatively rare, affecting a little more than eight out of 100,000 people.
Tonsil cancer treatment is usually successful if it is diagnosed early, before the cancer has spread elsewhere in the body, according to Peter T. Dziegielewski, MD, an otolaryngology-head and neck surgery doctor at UF Health in Gainesville, Florida, where he is also chief of head & neck oncologic and microvascular reconstructive surgery.
What Is Tonsil Cancer?
Tonsil cancer is cancer that starts in the tonsils, the two small glands in the back of the throat. Your tonsils are part of the body’s immune system, filtering out bacteria and other toxins from traveling down the throat.
Tonsil cancer can also spread quickly to other parts of the body, particularly the nearby lymph nodes.
Types of Tonsil Cancer
There are two main types of tonsil cancer: squamous cell carcinoma and lymphoma. Tonsil cancers may also be grouped by which part of the tonsil is first involved and what causes the cancer to form.
Lingual tonsil cancer
The lingual tonsils are at the base of the tongue, as opposed to the palatine tonsils, which are found on the sides of the throat. Lingual tonsil cancer happens when cancer cells first form in the lingual tonsils. It’s less common than palatine tonsil cancer.
Palatine tonsil cancer
Most tonsil cancer cases are palatine tonsil cancers. They are often marked by one tonsil appearing more swollen or much different than the other. If both palatine tonsils are swollen, it’s probably not tonsil cancer.
Squamous cell carcinoma
The majority of tonsil cancers are squamous cell carcinomas. Squamous cells are flat cells that line the surface of the skin, as well as the lining of the mouth, throat, and other parts of the body.
Tonsil lymphoma
Tonsil lymphomas are much less common than squamous cell carcinomas. Tonsil lymphoma, like other lymphomas, is a type of cancer that develops in the lymphocytes. These are white blood cells found in the lymph nodes and other tissue, such as the tonsils, that play a key role in the immune system.
Tonsil salivary gland tumor
When cancer cells form in a salivary gland, it’s called a salivary gland tumor. In very rare cases, these cancers can also involve the tonsils.
HPV-positive tonsil cancer
Human papillomavirus (HPV) is a sexually transmitted infection, and a leading cause of tonsil cancers. People with HPV-positive tonsil cancer generally have much better outcomes than those with HPV-negative tonsil cancer (cancer that happens when there is no HPV infection present).
"The prognosis for purely HPV-related, aka HPV-positive tonsil cancers, is excellent," Dziegielewski says. "Overall cure rates are around 90%. For hybrid cancers that are HPV positive in smokers, the cure rates are around 70%-80%."
HPV-negative tonsil cancer
HPV-negative tonsil cancer happens without an HPV infection. It’s usually the result of heavy smoking and/or alcohol abuse. "The prognosis for smoking-related, aka HPV-negative tonsil cancers, is much worse than it is for HPV-positive cancers," Dziegielewski says. "The cure rates are around 40%."
Tonsil Cancer Symptoms
Tonsil cancer can cause painful and uncomfortable symptoms. Typical tonsil cancer symptoms include a sore throat that doesn't go away and the feeling that something is caught in the back of your throat. You can also have trouble swallowing. Other symptoms can include neck pain and swelling, as well as an earache and jaw stiffness.
Tonsilitis vs. Tonsil Cancer
Tonsilitis refers to inflammation of the tonsils, usually caused by a bacterial or viral infection. Symptoms include a sore throat, swollen tonsils, trouble swallowing, and swollen lymph nodes on either side of the neck.
Tonsil cyst vs. cancer
Repeated throat infections and inflammation can sometimes cause cysts to form on the tonsils. A cyst or abscess that forms near a tonsil is sometimes a complication of tonsillitis. Symptoms include a very sore throat and, sometimes, a hard time opening your mouth.
Tonsil cancer vs. tonsil stones
Just like the kidneys and gallbladder, the tonsils are vulnerable to the formation of "stones," which are actually small, hardened pieces of minerals, such as calcium. The main symptom is bad breath, but you may also have a sore throat and cough.
Tonsil Cancer Causes
It’s not always clear what causes cells in the tonsils to become cancerous. But there are some common risk factors. "The most common risk factor today is the human papillomavirus (HPV)," Dziegielewski says. "It was once smoking/tobacco use and alcohol consumption. But this is now a distant number-two risk factor. For every one smoking-related tonsil cancer, we see about 50 HPV-related ones."
Sue Yom, MD, PhD, a specialist in head and neck cancer radiation oncology at the University of California, San Francisco, also notes that the Epstein-Barr virus is another risk factor for tonsil cancer, particularly squamous cell carcinoma. Some rare genetic traits can also raise the risk of tonsil cancer, she says.
Tonsil Cancer Diagnosis
Diagnosing tonsil cancer usually starts with a physical exam and includes a throat culture to check for an infection. Someone on your health care team will rub a long cotton swab on the back of your throat. That collects some cells to send to the lab. The exam may also include a check of your ears, nose, and neck for signs that a cancer might have spread.
Other screenings may include:
- Fine-needle biopsy of tissue suspected of being cancerous
- Imaging tests, such as a magnetic resonance imaging (MRI) or positron emission tomography (PET) scan
- Blood tests
- Chest X-rays to see whether the cancer has spread to the lungs
Tonsil Cancer Treatment
Treatment decisions are based largely on the nature of the cancer and how far, if at all, it has spread beyond the tonsils. The main treatment options include surgery, chemotherapy, radiation therapy, and immunotherapy.
Dziegielewski points out that in recent years, doctors have come up with new ways to de-escalate certain treatments to lessen their duration and side effects. He adds that treatments are tailored to the individual. "It is not one size fits all," he says. "Some patients do better with surgery only, some with de-escalated radiation, and some with induction chemotherapy and radiation therapy."
Tonsil cancer surgery
Surgery is often recommended for early-stage cancer. One commonly used procedure is transoral robotic surgery (TORS). "In most cases, we recommend the treatment that will have the least long-term side effects," Dziegielewski says. "In many cases, it is surgery – transoral robotic surgery."
Yom adds that surgeons should look at the possible complications that might affect the health of a patient’s throat. "Surgery is a good first treatment for small, well-visualized, isolated tonsil cancers with minimal neck disease," she says. "It’s a good option in situations where the patient does not have a medical condition that makes anesthesia or surgery risky, and where the surgeon has confidence that all of the tumor can be removed without unacceptable impact on the throat and neck functions."
If your tonsil cancer has spread to nearby lymph nodes, you may need a lymphadenectomy, the surgical removal of lymph nodes in the neck.
Radiation for tonsil cancer
Early-stage tonsil cancer is also often treated with radiation therapy. Radiation may be used along with chemotherapy or surgery, Dziegielewski says. "If the surgery would cause major speech and swallowing deficits – for example, if a large part of the tongue needs to be removed – then radiation therapy would be the better treatment," he says.
Chemoradiation – a treatment that combines radiation and chemotherapy – is often used, not just for larger tumors, but also tumors with features that suggest they might grow and spread to nearby tissue, Yom says.
Chemotherapy for tonsil cancer
Chemotherapy is sometimes recommended when surgery and/or radiation therapy isn’t an option.
Chemo may also be the first-line option, depending on the type of cancer being treated, Yom explains. "Lymphomas are typically treated with chemotherapy as lymphoma is considered a hematologic or blood-based disease," she says.
But chemotherapy alone is often not enough to cure any type of tonsil cancer. The same is true for immunotherapy, Dziegielewski says. "Chemotherapy and immunotherapy by themselves are only 1%-5% effective at curing these cancers," he says. "They tend to be used with radiation therapy or in situations where a cancer recurs."
Immunotherapy for tonsil cancer
Immunotherapy is a treatment that uses medications to boost the body’s own immune system to destroy cancer cells and stop cancer from spreading. "Immunotherapy is not used in the curative setting for these tumors, although its integration alongside these other treatments is being investigated," Yom says.
Dziegielewski adds that some institutions are using chemo and/or immunotherapy before surgery, and omitting radiation altogether, in an effort to lessen long-term side effects of radiation therapy.
Takeaways
While tonsil cancer is often curable, your best defense is to try to avoid the condition in the first place. That means avoiding smoking, limiting alcohol use, and getting the HPV vaccine, while also practicing safe sex. Getting regular oral cancer screenings is also helpful.
It’s also important to have tonsil cancer symptoms evaluated quickly. If you have a sore throat that lingers, swollen tonsils or lymph nodes, or other signs of tonsil cancer, see your doctor as soon as possible.
Tonsil Cancer FAQs
What is the most aggressive tonsil cancer?
One of the most aggressive forms of tonsil cancer is called basaloid squamous cell carcinoma, an especially rare type of tonsil cancer.
Can tonsil cancer be cured?
Tonsil cancer can often be cured. Early detection gives you the best chance of beating this condition.
Is tonsil cancer a sexually transmitted disease (STD)?
HPV, a common sexually transmitted disease, is the cause of many cancer cases affecting the tonsils, mouth, and throat.
