Tonsil cancer is a type of oropharyngeal cancer. These cancers affect the mouth and throat.

Oral and oropharyngeal cancers, such as tonsil cancer, fall under the broader category of head and neck cancers.

Infection with human papillomavirus (HPV) seems to increase the risk and affect the prognosis of tonsil cancer.

According to the National Institutes of Health (NIH), the number of tonsil cancer cases appears to be rising, possibly due to an increase in HPV infections. The NIH note that up to 93% of people in Western Europe with newly diagnosed throat and mouth cancers also tested positive for HPV.

The tonsils are part of the immune system. They help defend the body against bacteria and viruses that enter the mouth and throat.

Like other cancers, tonsil cancer is more likely to respond to treatment that starts early. Getting a diagnosis at an early stage increases the chance of successful treatment and recovery.

Below, we describe tonsil cancer symptoms, treatment, and outlook.

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Treatment for tonsil cancer is more responsive with an early diagnosis.

Tonsil cancer begins when cancerous cells develop in the tonsils. It can occur in people who have had their tonsils removed, as some tonsil tissue often remains after surgery.

Drinking alcohol, smoking, and having HPV appear to increase the risk.

The tonsils sit toward the back of the throat, one on either side. They consist of lymphoid tissue, which contains lymphocytes, cells that fight off disease.

The tonsils catch and destroy bacteria and viruses. They can change in size and often swell with blood to help trap germs, such as when a person has a cold.

Throat cancer is another type of oropharyngeal cancer. Learn more here.

Some people do not notice any symptoms until tonsil cancer has started to spread.

When symptoms occur, they can resemble those of other illnesses, such as strep throat or tonsillitis.

Here are some symptoms that may indicate tonsil cancer:

  • a sore throat that lasts for a long time
  • difficulty chewing or swallowing
  • a white or red patch on the tonsil
  • a sore on the back of the throat
  • a persistent earache
  • difficulty consuming citric foods and drinks, such as orange juice
  • a lump in the neck or throat
  • unexplained weight loss
  • blood in the saliva

See a doctor if any of these symptoms last for more than 2 weeks.

A number of factors appear to increase the risk of tonsil cancer.

According to the American Head and Neck Society, risk factors include:

Environmental factors: These include using tobacco products and having a high alcohol intake.

Viruses: People with HPV or HIV may have a higher risk of tonsil cancer.

Age and sex: In the past, people who received a tonsil cancer diagnosis tended to be male and over 50 years of age. However, the relationship between age and tonsil cancer can vary, based on HPV status. HPV-positive cancers tend to appear in people with the infection who are younger and do not smoke.

Is there a link between HPV and HIV? Find out more here.

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A biopsy may be taken to diagnose tonsil cancer.

A doctor will ask a person about:

  • their medical history
  • symptoms
  • any known risk factors

They will look at the mouth and throat and feel for lumps and anything else unusual.

If the doctor thinks that there is a possibility of tonsil cancer, they will recommend seeing a specialist. The specialist may do other tests, including:

Lab tests: Blood and urine tests can show changes that may indicate cancer.

Laryngoscopy: This involves the doctor passing a thin tube containing a light and a camera down the throat to look for anything unusual.

Imaging tests: These may include a CT, MRI, PET scan, or X-ray. They can detect internal changes, including those that may indicate that the cancer has spread.

Biopsy: The doctor will take a small amount of tissue to examine under a microscope. This is the only way to confirm whether cancerous cells are present.

If cancer is present, the doctor will need to evaluate:

  • the cancer's stage, or how much of the body it has affected
  • its type and grade, which can indicate how fast it may grow

This information helps doctors determine the best course of treatment.

Stages

The stages of tonsil cancer are:

Stage 0: Changes have occurred in cells that increase their risk of becoming cancerous. These are precancerous cells, but they are not cancer. They have not spread.

Localized: There are cancerous cells in the tonsils, but they have not spread. The tumor is smaller than 2 centimeters (cm) in diameter at this stage, which is also called stage 1.

Regional: The cancer has spread to nearby tissues. The tumor is larger than 2 cm —and may be more than 4 cm — across. It may also have spread to a nearby lymph node or the epiglottis.

Distant: The cancer has spread to other structures, such as the mouth or jawbone. As it progresses, it will affect other parts of the body, such as the lungs and liver.

Treatment for tonsil cancer depends on the stage and extent of the cancer.

Surgery

A surgeon usually removes the precancerous cells or tumor. They may need to remove the tonsils and additional tissue around the tumor to reduce the risk of leaving cancerous tissue behind.

Depending on the extent of the treatment, a person may need further surgery to restore their teeth, as well as their voice and other functions.

Radiation therapy

A doctor may recommend this to shrink a tumor before surgery or to help kill any remaining cancerous cells after the operation. Radiation therapy can stop the growth of a tumor or destroy cancerous cells.

Chemotherapy

This uses powerful medication to kill cancerous cells, slow their spread, or shrink the size of a tumor to make it easier to remove. A person may need chemotherapy alongside radiation therapy for cancers of the mouth and throat.

Chemotherapy kills cancerous cells, but it also damages healthy cells. For this reason, it can have severe adverse effects.

If diagnosis occurs at a later stage, a doctor may recommend a combination of chemotherapy and radiation therapy without extensive surgery.

Targeted therapy

Emerging drugs can target cancerous cells in a precise and selective way. For this reason, targeted therapy may have fewer side effects than chemotherapy.

Complications

Depending on the extent of the procedure, surgery in the mouth and throat can cause a number of complications.

Organs in this region are responsible for key functions, including breathing, digestion, and speech. A person may need help to perform these functions after treatment.

They may need:

  • a feeding tube to supply nutrition
  • a tracheotomy, which involves making a hole in the front of the throat to enable a person to breathe
  • dental implants
  • jaw reconstruction
  • esthetic surgery
  • speech and language therapy
  • dietary and other counseling

Palliative care

A person with advanced cancer will need additional support. If removing the cancer is not an option, and the cancer has spread to other parts of the body, a person will receive palliative care.

Treatment at this stage will focus on relieving symptoms and improving the person's quality of life. It will involve pain relief medication.

Counseling and other types of support may also be available.

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The outlook for tonsil cancer depends on the tumor type, a person's age, and any other health conditions.

Tonsil cancer is relatively rare, and living with a rare form of cancer can be challenging. Understanding what is happening and what to expect from treatment can make the process easier.

Doctors use statistics to calculate the average chance that a person will survive for 5 or more years after a diagnosis of cancer.

For tonsil cancer, the survival rate appears to depend on the person's HPV status. Accordingly, one study determined the following overall 5-year survival rates for people with tonsil cancer:

  • 71% for people with HPV-positive cancer
  • 36% for people with HPV-negative cancer

However, smokers appear to have a worse prognosis than nonsmokers, regardless of their HPV status.

Other factors that impact the outlook include:

  • the type of tumor
  • the person's age
  • other health conditions

Anyone who notices persistent swelling or other changes in or around their tonsils should see a doctor. Finding cancer in its early stages often means that it is easier to treat. This improves the chances of recovery.

Some risk factors for tonsil cancer are avoidable. People can lower their risk by:

  • quitting or avoiding smoking and tobacco use
  • limiting their alcohol intake
  • having a vaccination to protect them from HPV

Products developed to help people quit smoking are available for purchase online.

Learn more about HPV and how to prevent it.

Q:

I have had tonsil stones in the past. Does this increase the risk of tonsil cancer?

A:

While some symptoms of tonsil stones may be similar to those of tonsil cancer, tonsil stones are not a known risk factor for tonsil cancer.

Yamini Ranchod, PhD, MS Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.