What Is Tonsil Cancer

Overview

What is tonsil cancer?

Tonsil cancer is a type of head and neck cancer and it is when there is an abnormal and uncontrolled growth of cells that formed in the tonsils producing tumours or lesions. Over the years the incidence of tonsil cancer has increased rapidly, believed to be caused by the increasing prevalence of human papillomavirus (HPV) induced cancers. Since it is the most common type of head and neck cancer, studies have shown around 8.4 cases per 100,000, and from these 72.2% are believed to be HPV associated, which has shown to have increased in the last 40 years.^1,2

Anatomy and function of tonsils

The tonsils are part of the lymphatic system, a crucial component of the immune system of the body. Because of their location at the throat and the palate, they prevent harmful microbes or viruses from entering the body through the mouth and nose. Tonsils also have a lot of white blood cells, and these help to kill germs. 

All the different types and structures of the tonsils form Waldeyer’s ring. The ring refers to the circular shape these lymphoid tissues form around the beginning of the throat, from the mouth and the nose. ³

Types of tonsil cancer

The most common tonsil cancer type is squamous cell carcinoma. Other types include lymphoma and rarely small cell carcinoma. Additionally, in some extremely rare cases, they can be diagnosed as other cancers that have spread (metastasized) to the tonsils.¹

Causes and risk factors 

• Human papillomavirus (HPV)
• Smoking 
• Alcohol¹
• Genetics⁴

Symptoms 

• Ear pain
• Blood in saliva
• Mouth pain
• Difficulty in swallowing, chewing and speaking
• Halitosis (bad breath)
• Ulcers or sores in the back of the mouth that do not heal
• Sore throat that does not go away
• Lump in the neck
• One tonsil is inflamed and larger than the other^1,5 

Diagnosis and staging

To diagnose tonsil cancer a few steps have to be followed.

Physical examination

During the physical examination appointment, your doctor will first ask you some questions about your symptoms and medical history. They may also use their hands to touch and feel your neck to check for any lymph nodes that may have enlarged. The doctor may also perform a nasal endoscopy where a tube with a small camera attached is guided through your nose down to your throat to examine the tissues from the inside.¹

Use of imaging technology

In order to better understand the size of the tumour and to look for any signs of its progression to other neighbouring organs of the body (metastasis), the doctor will ask you to undergo a few tests. Some of these include: 

• Computerised tomography (CT) scan
• Positron emission tomography (PET) scan
• Magnetic resonance imaging scan (MRI) scan

Biopsy 

To confirm the diagnosis, your doctor will perform an incisional biopsy of the tonsil or a fine needle aspiration biopsy of the lump in the neck. During this time, any suspicious cells are carefully sampled from the mouth or cells are suctioned from the neck with a thin needle. These cells are then carefully examined by a professional under a microscope.⁶

Staging of tonsil cancer

Knowing the stage of your cancer will tell you the size of the cancer and how much your cancer has spread. It can also tell the doctor what treatment plan to take based on the staging. The staging depends on:

• If cancer has spread to the nearby lymph nodes
• If cancer has spread to other body parts
• How far cancer has grown into the nearby tissues

The stage of cancer also depends on the HPV, specifically if the cells contain HPV. This is  tested through the p16 test:

• P16 positive - has cells containing HPV
• P16 negative - cells do not contain HPV¹

Treatment options

There are several different options available, but the treatment will depend on the size of the tonsil cancer and the location, and if the cancer has spread to different parts of the body. These include: 

• Surgery - the aim would be to remove as much cancer as possible as it can be used as a treatment option at all stages of tonsil cancer. During the procedure, a surgeon passes specialised tools through the mouth and removes the tumour by incision or lasers
• Transoral robotic surgery (TORS) - uses a robotic system to treat cancer where it could be difficult to reach. Mostly used on early-stage tonsil cancer
• Radiation therapy - uses high-energy radiation beams to target and destroy cancer cells. For shrinking the cancer, this technique can be used at an early stage, but it can also be used after surgery to destroy the remaining cancer cells
• Chemotherapy - uses cancer-killing drugs that are given orally or intravenously. Used in combination with radiation therapy to help slow down the growth of the cancer¹
• Targeted therapy - a newer cancer treatment using drugs that stop or slow down the growth of cancer by targeting specific characteristics of the cancer’s biology. Given orally or intravenously and done along radiation or chemotherapies
• Immunotherapy - a new and very promising form of drug treatment that makes the body's own immune system attack and kill the cancer cells⁷ 

Prognosis and survival rates

There is a 5-year survival rate for people with tonsillar cancer. This refers to individuals who live for longer than 5 years after their diagnosis. The overall 5-year survival rate for tonsil cancer is 67%, which is based on where and how much your cancer has spread:

• Early-stage cancer which has not spread - 85%
• Cancer that has spread to nearby lymph nodes, tissues or organs - 65%
• Cancer which has spread to more than one part of the body - 40%

Be mindful that the survival rates do not predict what can happen in the future. Your prognosis will depend on the treatment that you are receiving and other factors, such as your age and your overall health.⁸

Management of side effects and complications

Most treatments will have side effects. Patients commonly experience these after radiation- or chemotherapy and they may include:

• Hoarseness
• Dry mouth
• Difficulty when swallowing
• Loss of taste
• Soreness and discolouration around mouth and throat
• Open sores in mouth or throat
• Fatigue
• Nausea

Doctors may provide you with some supplementary medication, such as painkillers to aid with some of the side effects.^9,10 

Prevention 

There are some steps that you can take to reduce the risk of having tonsil cancer:

• HPV vaccination - receiving vaccination to prevent HPV infection can reduce the risk of HPV-associated cancers
• Smoking - it is advised to stop smoking altogether. If you still use tobacco, then talking to a doctor can help, as they can advise strategies to help you quit
• Alcohol moderation - monitor your alcohol consumption. Generally, it is advised to have no more than 1 drink a day for individuals assigned female at birth, and 2 drinks a day for individuals assigned male at birth.
• Regular dental check-ups - an appointment with the dentist can help to check your mouth for any signs of cancer or presumed cancer or any changes in the mouth.⁸

Support and resources

Cancer can be a scary condition that can make you feel anxiety, fear and uncertainty.  Fortunately, there are treatment options available for you that have been shown to have successfully treated tonsil cancer when caught at early stages. If you have been diagnosed with cancer, do give a thought to joining a support group. Being able to talk with others who are going through the same difficulties as you, can give you emotional and mental support throughout your treatment journey. 

FAQs

Can you have tonsil cancer for years without knowing?

It is possible to have tonsil cancer without realising as some patients are asymptomatic. This is usually the case for individuals with HPV-positive cancer which can have no visible symptoms even at more advanced stages of the cancer. The diagnosis is often made accidentally during an unrelated physical examination.^1,11

What is the most common age for tonsil cancer?

The tonsil cancer is diagnosed mostly in older individuals, with those over 50 being more at risk. However, you can still be at risk of developing it at any age.²

Does tonsil cancer spread quickly?

The progression of tonsil cancer largely depends on whether you are HPV-positive or negative and your lifestyle. Individuals testing positive for HPV and individuals smoking tobacco products see faster cancer progression as well as recurrence.¹

Can you talk after tonsil cancer?

Most symptomatic patients will experience speech difficulties before and also after the cancer treatment. However, speech and language therapists can help them rehabilitate. There are also voice prosthetics available for more severe cases.¹²

Summary

Tonsils are one of the most important organs in the throat and mouth, as they can help to prevent any microbes from entering the body through the mouth. Consequently, having any problems, especially cancer, affecting them can have a serious impact on the body. Over time, tonsil cancer has become more common and has led to more researchers being interested in this type of tumour. Hence, with the use of traditional treatment and newer technology, a more suitable and tailored treatment can be given to you.