Tonsil Cancer

What is tonsil cancer?

The throat has three types of tonsils: the pharyngeal tonsil (adenoids) in the back of the throat, the palatine tonsils on the sides of the throat, and the lingual tonsils on the base of the tongue.

Cancer of the tonsils usually involves the palatine tonsils.

Most tonsil cancers are squamous cell carcinomas, but some are lymphomas.

Related: Salivary gland diseases and tumors

What causes tonsil cancer?

Men are diagnosed with tonsil cancer three to four times more often than women. People are generally diagnosed at age 50 or older, but it can develop at any age. The most significant risk factors for tonsil cancers are tobacco and alcohol use, including smokeless tobacco (snuff and betel nut).

Other potential causes include people with certain infections or decreased immunity, such as:

  • Exposure to the human papilloma virus, especially strains 16 and 18.
  • Organ transplant recipients
  • People with human immunodeficiency virus disease

There are no accepted general risk factors or causes for lymphoma.

What are the symptoms of tonsil cancer?

The symptoms of tonsil cancer include:

  • A sore in the back of the mouth that will not heal
  • A tonsil that is larger on one side
  • Blood in the saliva
  • Mouth pain
  • Difficulty chewing, swallowing or speaking
  • Persistent sore throat
  • Intolerance to eating or drinking citrus foods
  • Severe ear pain
  • Lump or pain in the neck
  • Pain when swallowing
  • Bad breath

How is tonsil cancer diagnosed?

A doctor will examine the inside of your mouth and back of your throat to check the location and size of the tumor. Examination of the ears, nose, throat and neck are needed to help determine if the tumor has spread.

The doctor may also order tests including:

  • Blood tests.
  • X-rays to determine if the tumor has spread to the lung.
  • Fine needle aspiration biopsy. A thin needle is placed in the mouth. The cells are aspirated (suctioned) and then examined under a microscope to determine if the lump is cancerous.
  • Imaging studies to determine if the tumor has invaded nearby tissues or other organs of the body. These may include:
    • Orthopantomography (Panorex). This is a panoramic X-ray of the upper and lower jaw. It shows a view from ear-to-ear and helps determine if a tumor has grown into the jaw bone.
    • Computerized tomography scan.
    • Magnetic resonance imaging.
    • Positron emission tomography (PET) scan. During a PET scan, a small amount of radioactive glucose (sugar) is injected into a vein. The scanner creates computerized pictures of the areas inside the body. Cancer cells absorb more radioactive glucose than normal cells so the tumor is highlighted on the pictures.

How is tonsil cancer treated?

Early-stage tonsil cancer is often treated with radiation therapy. A promising treatment called induction chemotherapy is also used to shrink the tonsil tumor. Advanced cancer cases usually require a combination of surgery, radiation and chemotherapy.

Surgery is used if chemotherapy and radiation do not destroy the tumor. If the lymph nodes in the neck are affected, a neck dissection may be needed to remove the nodes.

Radiation therapy frequently follows surgery. Chemotherapy may be used for palliative therapy (to help relieve symptoms and slow the tumor growth) if surgery is not possible.

Key points

  • Cancer of the tonsils usually involves the palatine tonsils on the sides of the throat.
  • Men are diagnosed with tonsil cancer three to four times more often than women.
  • People are generally diagnosed at age 50 or older but it can develop at any age. The most significant risk factors for tonsil cancers are tobacco and alcohol use.
  • Tonsil cancer may be treated by a combination of surgery, radiation and chemotherapy.
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