What Is Tonsil Cancer?

Tonsil cancer is a type of oropharyngeal or oral cancer. There are two types of cancer that affect the tonsils: squamous cell carcinoma and lymphoma. However, when caught in the early stages, many people who are diagnosed with tonsil cancer can have good outcomes.

There are three kinds of tonsils:

• Pharyngeal tonsils are the adenoids, which are behind the nose.
• Palatine tonsils are at the back of your throat and are probably what you think of when you hear the term "tonsils."
• Lingual tonsils are located at the base of the tongue.

Of these three sets of tonsils, the palatine tonsils are the most likely to become malignant (cancerous). 

Symptoms

The symptoms of tonsil cancer are very similar to symptoms of common upper respiratory infections, such as strep throat or tonsillitis. However, while infections tend to worsen quickly and then resolve, if cancer is present, the symptoms generally linger or slowly worsen.

Symptoms of tonsil cancer can include:

• Non-healing, persistent sores in the back of the mouth or throat
• Swollen tonsils that are not equal in size (one is particularly larger than the other)
• Mouth pain that does not go away
• Earaches
• Difficulty swallowing 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

Causes

Several risk factors can predispose a person to tonsil cancer, including alcohol use, smoking, and/or infection with HIV or human papillomavirus (HPV).

This cancer is also more common among men than women, people over age 50 (although tonsil cancer can occur at any age), and those who have had an organ transplant.

The HPV Connection

There has been an increase in head and neck cancers due to increases in HPV infection. This is the same virus that causes cervical cancer. 

Historically, head and neck cancer was considered rare and was typically caused by using chewing tobacco, smoking, and consumption of alcoholic beverages. But, between 1984 and 2004, the number of head and neck cancers caused by HPV quadrupled.

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 also be prevented by using condoms.

Diagnosis

Doctors use different tools to help diagnose cancer of the tonsils. The first step of this process is to obtain an accurate health history. Your physician will then examine you.

If necessary, your doctor may 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
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan

Staging

Once a cancer is diagnosed, it is classified into a stage, which clearly defines how far the disease has progressed. However useful this may be for your doctor, it may be very confusing for you.

Typically, there are four different cancer stages:

• Stage I: The cancer is smaller than 2 centimeters (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 larger 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:
• Cancer has spread to surrounding areas of the throat or mouth and/or more than one lymph node on the same side of the neck as the tumor.
• It has spread to one large lymph node (larger than 3 cm) on the same side of the neck as the tumor.
• 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 treatment you receive for your condition will depend on what type and stage of tonsil cancer you have. Talk with your doctor about what treatments will be best for you.

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 additional treatment; however, radiation may be recommended to destroy any remaining cancer cells that could grow into another tumor.
• Radiation: After surgery, many patients undergo radiation to kill any remaining cancer tissue.
• Chemotherapy: If you have stage III or IV tonsil cancer, you may need chemotherapy. Chemotherapy is usually given in combination with radiotherapy unless cancer has spread to distant sites. Immunotherapy has also been approved for use alone or in combination with chemotherapy for the treatment of metastatic tonsillar cancer.

A Word from Verywell

A cancer diagnosis can be scary. If you have received a diagnosis of tonsil cancer, it's important to understand that treatments are available and that the disease can be managed.

Many cancers are most treatable when caught early, and tonsil cancer is no exception. If you notice symptoms such as sores in your mouth, pain, or a sore throat that won't go away, or if you have blood in your saliva or lumps in your neck, talk with your doctor right away.