What You Need to Know About Tonsil Cancer

There are three kinds of tonsils—the pharyngeal tonsils, or adenoids, which are behind the nose; the palatine tonsils, which are at the back of your throat and are probably what you think of when you hear the term "tonsils"; and the 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).

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. 

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.

• Sores in the back of the mouth or throat that do not heal
• Swollen tonsils that are not equal in size (one is particularly larger than the other)
• Mouth pain that does not go away
• Earaches
• Difficulty and/or pain when swallowing
• Pain when eating citrus fruits
• Lumps in the neck
• Neck pain
• Sore throat that does not go away
• Blood-tinged saliva
• Bad breath

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 virus HPV or HIV, or are more than 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 (human papilloma virus) 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 tripled. 

In 2004, seven out of 10 cases of head and neck cancers were 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.

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 tests
• X-rays
• MRI
• PET scan

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. This is 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.
  • The cancer has spread to other parts of the body.

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:

1. 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.
2. 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.
3. 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.

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. Unfortunately, tonsil cancer is more deadly than some of the other throat/mouth cancers. When caught in early stages, though, many people are able to beat tonsil cancer.