Cancer Head & Neck Cancer An Overview of Tonsil Cancer Symptoms, Risk Factors, and Treatments By Kristin Hayes, RN facebook twitter Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children. Learn about our editorial process Kristin Hayes, RN Medically reviewed by Medically reviewed by Doru Paul, MD on November 26, 2018 Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology Oncology at the New York Presbyterian Weill Cornell Medical Center. Learn about our Medical Review Board Doru Paul, MD Updated on August 14, 2019 Print Table of Contents View All Table of Contents Symptoms Causes and Risk Factors The HPV Connection Diagnosis Stages Treatment There are two types of cancer that affect the tonsils: squamous cell carcinoma and lymphoma. Tonsil cancer is considered a form of oropharyngeal (oral) cancer. Unfortunately, tonsil cancer is more deadly than some of the other throat/mouth cancers. When caught in early stages, though, many people coping with tonsil cancer are able to beat it. There are three kinds of tonsils: Pharyngeal tonsils, or adenoids, which are behind the nosePalatine tonsils, which are at the back of your throat and are probably what you think of when you hear the term "tonsils"Lingual tonsils, which are at the base of the tongue Of these three sets of tonsils, the palatine tonsils are the most likely to become malignant (cancerous). Illustration by JR Bee, Verywell Symptoms You will notice that some symptoms of tonsil cancer are very similar to symptoms of strep throat. However, strep throat is most common in people ages 5 to 15 years, while tonsil cancer most commonly affects people over the age of 50. Some common symptoms of tonsil cancer include: Sores in the back of the mouth or throat that do not healSwollen tonsils that are not equal in size (one is particularly larger than the other)Mouth pain that does not go awayEarachesDifficulty and/or pain when swallowingPain when eating citrus fruitsLumps in the neckNeck painSore throat that does not go awayBlood-tinged salivaBad breath Causes and Risk Factors Some individuals are more likely to get tonsil cancer because of lifestyle choices or other circumstances. You are more likely to get tonsil cancer if you drink alcohol or smoke, are infected with the human papillomavirus (HPV) or HIV, or are 50 years old or older (although tonsil cancer can occur at any age). You are also more likely to get tonsil cancer if you are a man or have had an organ transplant. The HPV Connection There has been an increase in head and neck cancer due to HPV infection. This is the same virus that causes cervical cancer. Historically, head and neck cancer was considered rare and typically caused by using chewing tobacco, excessive smoking, and consumption of alcoholic beverages. But, between 1984 and 2004, the number of head and neck cancers caused by HPV quadrupled. The CDC estimates that 70 percent of cases of head and neck cancers are caused by HPV. It is believed that the virus is usually transmitted through unprotected oral sex. The "silver lining" (so to speak) is that HPV-positive malignancies are much more responsive to treatment than other head and neck cancers. While HPV-positive cancers have increased, other types of head and neck cancers have decreased. There are HPV vaccines available and transmission can be prevented by using condoms. Diagnosis Doctors use different tools to help them diagnose cancer of the tonsils. The first step of this process is to obtain an accurate health history from you. Your physician will then examine you. After this, if necessary, your doctor will likely order one or more of the following tests: Fine needle aspiration (a small amount of tissue is taken out of the tonsils with a needle and the cells are examined under a microscope)Blood testsX-raysMRIPET scan Stages Classifying cancers into four stages allows health professionals to indicate how far the cancer has progressed in a clear and concise manner. However useful this may be for your doctor, it may be very confusing for you. Here's are what the different stages mean: Stage I: The cancer is small (less than 2 cm), is confined to one area, and has not spread to surrounding lymph nodes.Stage II: The cancer is between 2 to 4 cm, but has not spread.Stage III: The cancer is greater than 4 cm and has spread to one lymph node that is on the same side of the neck as the tumor. The lymph node measures 3 cm or less.Stage IV: This is the most complicated stage with the worst prognosis. For stage IV tonsil cancer, any of the following things might be true:The cancer has spread to surrounding areas of the throat or mouth and/or more than one lymph nodes.It has spread to one lymph node that measures over 6 cm.It has spread to one lymph node on the opposite side of the neck as the tumor.It has spread to other parts of the body. Treatment The amount of treatment you receive for your condition will depend on what stage of tonsil cancer you have, what type you have, and how aggressive you and your physician would like to be when it comes to treatment. In general, three types of treatments are used: Surgery: Most patients will need surgery to remove the cancerous tissue. Some individuals who have stage I or II cancer may not need any more treatment than this, although radiation may be recommended since a single remaining cancer cell could grow into another tumor.Radiation: After surgery, many patients undergo radiation to kill any remaining cancer tissue. There are several kinds of radiation and what is used will depend on your particular situation.Chemotherapy: If you have stage III or IV tonsil cancer, you will likely need chemotherapy. A new treatment called induction chemotherapy is being used to shrink tumors. To treat tonsil cancer, most doctors will recommend a minimum of surgical treatment followed by localized radiation. Some physicians also use hyperthermia (warming the body to a high temperature to kill cancer cells). Other investigational treatments are available, but your insurance company is not likely to pay for them. Investigational treatments are extremely expensive unless you are participating in a current study. There are also many holistic and scientifically unproven treatments offered around the world; these treatments have to be paid for out of pocket, can be quite expensive, and there is no guarantee that they will work (or that they are safe). Be sure to do your research and survey your doctors to ensure you're taking the best course of action for treating your tonsil cancer. Was this page helpful? Thanks for your feedback! Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Song S, Wu HG, Lee CG, et al. Chemoradiotherapy versus surgery followed by postoperative radiotherapy in tonsil cancer: Korean Radiation Oncology Group (KROG) study. BMC Cancer. 2017;17(1):598. doi:10.1186/s12885-017-3571-3 Bannister M, Ah-see KW. Is oropharyngeal cancer being misdiagnosed as acute tonsillitis? Br J Gen Pract. 2014;64(628):e742-4. doi:10.3399/bjgp14X682537 Genden EM, Ferlito A, Scully C, Shaha AR, Higgins K, Rinaldo A. Current management of tonsillar cancer. Oral Oncol. 2003;39(4):337-42. D'souza G, Dempsey A. The role of HPV in head and neck cancer and review of the HPV vaccine. Prev Med. 2011;53 Suppl 1:S5-S11. doi:10.1016/j.ypmed.2011.08.001 Mannina EM, Pejavar SM, Glastonbury CM, Van zante A, Wang SJ, Yom SS. Diagnosis of Bilateral Tonsil Cancers via Staging PET/CT: Case Report and Review. Int J Otolaryngol. 2011;2011:928240. doi:10.1155/2011/928240 Song S, Wu HG, Lee CG, et al. Chemoradiotherapy versus surgery followed by postoperative radiotherapy in tonsil cancer: Korean Radiation Oncology Group (KROG) study. BMC Cancer. 2017;17(1):598. doi:10.1186/s12885-017-3571-3 Additional Reading American Cancer Society. Rise in Rate of Throat Cancer Lined to HPV. https://www.cancer.org/ American Cancer Society. Survival Rates for Oral Cavity and Oropharyngeal Cancer by Stage. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/survival-rates.html Cedars-Sinai. Tonsil Cancer. http://www.cedars-sinai.edu/Patients/Health-Conditions/Tonsil-Cancer.aspx National Cancer Institute. (2011). Hyperthermia in Cancer Treatment. https://www.cancer.gov/about-cancer/treatment/types/surgery/hyperthermia-fact-sheet National Cancer Institute. (2015). Cancer Staging Fact Sheet. https://www.cancer.gov/about-cancer/diagnosis-staging/staging