Tonsil Cancer

What is tonsil cancer?

Tonsil cancer is a cancerous tumor on your tonsils, which are in the back of your throat (pharynx). Tonsil cancer is the most common form of oropharyngeal cancer. A sore throat that doesn’t go away is a common early symptom. Often, healthcare providers can successfully treat tonsil cancer if they detect it before it spreads.

How common is tonsil cancer?

It’s not common. The American Cancer Society (ACS) estimates that in 2024, more than 21,000 people in the U.S. will develop a type of oropharyngeal cancer, including tonsil cancer. For comparison, the ACS estimates more than 2 million people in the U.S. will develop some type of cancer.

What are the symptoms of tonsil cancer?

The most common symptom of tonsil cancer is a sore throat that won’t go away. Another symptom is when one tonsil is swollen and larger than the other tonsil. Other common symptoms are:

• Bad breath (halitosis).
• Blood in your saliva.
• Difficulty swallowing, speaking or chewing.
• Ear pain.
• Mouth pain.
• Sores in the back of your mouth that don’t heal.
• Swollen lymph nodes in your neck (cervical lymphadenopathy).

Having these symptoms doesn’t mean you have tonsil cancer. But you should talk to a healthcare provider if your symptoms last longer than a few days.

What can be mistaken for tonsil cancer?

Tonsil cancer symptoms can look and feel like other less serious conditions. For example, viral and bacterial infections can cause tonsillitis. Tonsillitis symptoms include a sudden sore throat and tonsils that look swollen, red and/or have white spots.

What causes tonsil cancer?

Experts know that tonsil cancer develops when healthy cells mutate (change) and become cancerous cells. They don’t know exactly why this happens. But recent research shows that having the human papillomavirus (HPV) increases your risk of developing tonsil cancer. Other risk factors are:

• Tobacco use: This includes smoking tobacco and using e-cigarettes (vaping).
• Alcohol: Heavy use of beverages that have alcohol.
• Weakened immune system: People who have human immunodeficiency virus (HIV) or who take immunosuppressants for organ transplants have increased risk.

What are the complications of tonsil cancer?

Tonsil cancer can be aggressive, meaning it can spread (metastasize) very quickly from your tonsils to other areas of your body.

How is tonsil cancer diagnosed?

A healthcare provider will do a physical examination, focusing on your throat and tonsils. They may do a throat culture to rule out infections as a possible cause. They’ll look for changes in your tonsils like sores that could be cancer.

If they suspect tonsil cancer, they’ll refer you to an otolaryngologist (an ear, nose and throat specialist or ENT). This is a healthcare provider who specializes in conditions that affect your ear, nose and throat. They may order tests, including biopsies and imaging tests.

Biopsy

Your provider may do a biopsy to obtain cells and tissue. A medical pathologist will examine the cells and tissue for signs of tonsil cancer. Possible types of biopsy are:

• Incisional biopsy: This test involves surgery to obtain a sample of tonsil tissue.
• Fine-needle aspiration (FNA): If you have a suspicious lump on your neck, they may do a fine needle aspiration to obtain cells.

Imaging tests

If biopsy results show signs of tonsil cancer, your oncologist may order imaging tests to see if the cancer is spreading to other areas of your body. Tests may include:

• Computed tomography (CT) scans.
• Magnetic resonance imaging (MRI) scans.
• Positron emission tomography (PET) scans.

Tonsil cancer staging

Your provider will use test results to set the tonsil cancer stage. Healthcare providers use cancer staging systems to develop treatment plans. They base tonsil cancer stages on factors like the tumor location and size, whether cancerous cells are in nearby lymph nodes and if the tumor in your tonsils is spreading to another part of your body.

For example, an early-stage tonsil cancer is one that’s only on your tonsils. Advanced or late-stage tonsil cancer means there’s tonsil cancer in lymph nodes and other areas of your body.

How is tonsil cancer treated?

There are a few different options. Treatment depends on the size and location of the tumor and whether it has spread to other parts of your body. Possible treatments for tonsil cancer include surgery, radiation therapy and chemotherapy.

Tonsil cancer surgery

Your otolaryngologist may do surgery to remove small tumors or affected lymph nodes, including:

• Lymphadenectomy: You may need this surgery if tonsil cancer is in your neck lymph nodes. In this case, a surgeon will remove lymph nodes from your neck. They may call this surgery cervical lymphadenectomy or neck dissection.
• Transoral robotic surgery (TORS): This is a type of robotic surgery that surgeons use to treat hard-to-reach areas like the back of your throat. TORS is a treatment option for early-stage tonsil cancer.

Radiation therapy and chemotherapy

You may receive radiation therapy or chemotherapy as an alternative to surgery or after surgery for tonsil cancer. Your healthcare provider will base your treatment plan on factors like treatment response rate and treatment side effects.

For example, your provider may recommend radiation therapy as an alternative to surgery to cure tonsil cancer tumors, or after surgery to eliminate any potential remaining cancerous cells. Radiation may be given simultaneously with chemotherapy to enhance its effects, depending on the cancer stage.

They may recommend chemotherapy when surgery or radiation therapy isn’t an option for tonsil cancer. Chemotherapy can slow down tonsil cancer growth and ease its symptoms.

Side effects and complications of tonsil cancer treatment

Side effects and complications will be different depending on the treatment type. For example, TORS and lymphadenectomy surgery have different side effects. Radiation therapy and chemotherapy often cause similar side effects.

TORS may cause the following side effects or complications:

• Abnormal bleeding (hemorrhage).
• Aspiration: Food or liquid gets into your lungs.
• Respiratory compromise: Your lungs can’t take in enough oxygen.
• Dysphagia: You have difficulty swallowing.
• Difficulty breathing: You can’t breathe using your airway, and you may need a tracheostomy.

Possible lymphadenectomy side effects are:

• Abnormal bleeding.
• Bruising.
• Infection at the surgery site.
• Lymphedema.
• Nerve weakness.
• Pain.

Common chemotherapy and radiation therapy side effects include:

• Fatigue.
• Hair loss.
• Nausea and vomiting.

Can tonsil cancer be prevented?

You may not be able to prevent tonsil cancer, but you can reduce your risk with these precautions:

• Don’t smoke or use tobacco products of any kind.
• Take steps to protect yourself from HPV. This includes getting tested, practicing safe sex and getting an HPV vaccine.
• Undergo routine oral cancer screenings, which help detect tonsil cancer early on.

What are tonsil cancer survival rates?

Overall, 85% of people with tonsil cancer and HPV were alive five years after their diagnosis. Tonsil cancer survival rates may vary based on several factors, including whether the tonsil cancer is HPV-positive or negative or if the tumor is spreading.

When you think about cancer survival rates, it’s also important to remember:

• These rates are estimates based on the experiences of other people who had tonsil cancers. What was true for them may not be true for you.
• Experts update survival rates every five years, and it’s possible tonsil cancer survival rates are different.
• A survival rate isn’t an estimate for how long you’ll live, or your life expectancy if you have tonsil cancer.

Survival rate data can be complicated and confusing. If you have tonsil cancer, ask your oncologist about survival rate estimates and how they apply to your situation.

Is cancer of the tonsils curable?

Statistically, tonsil cancer isn't likely to be fatal. As with most cancers, treatment is most successful when the condition is detected and treated in the early stages.

How do I take care of myself?

It can be challenging to manage tonsil cancer symptoms and treatment. Here are some suggestions:

• Consider palliative care: This is a supportive treatment that can help you manage cancer symptoms, cancer treatment side effects and other challenges that come with having a serious illness.
• Eat well: Tonsil cancer symptoms and treatment may affect your ability to eat during and after treatment. If you’re having difficulty eating, talk to a nutritionist. They’ll have recommendations on ways you can get the nutrition you need.

When should I see my healthcare provider?

If you had tonsil cancer surgery, contact your surgeon right away if:

• Your surgery site is bleeding more than you expect or that you can’t control.
• You have signs of infection like fever, pus or fluid oozing from the site or the site looks red or is warm to the touch.

If you didn’t have surgery, contact a provider if you have symptoms like:

• New sore throat symptoms.
• Blood in your saliva.
• Your tonsils look different, like red, swollen or white spots.