Tonsil cancer

This page was reviewed under our medical and editorial policy by

Beomjune B. Kim, DMD, MD, FACS, Head and Neck and Microvascular Reconstructive Surgeon

This page was updated on May 26, 2023.

Most people probably think of their tonsils only in the context of having them removed as a kid or having them swell up from a cold or flu. But cancer of the tonsils is one of the more common cancers that occur in the mouth and throat—and it’s most often caused by a virus that may be prevented with a vaccine.

The tonsils are masses of lymphoid tissue in the throat, behind the mouth and teeth. The lymphoid tissue in the tonsils is similar to the tissue inside of lymph nodes. These tissues filter out white blood cells from the lymph, a clear liquid that runs throughout the body.

In the throat, the tonsils are the first part of the lymphatic system to be exposed to viruses and bacteria that enter the digestive and respiratory tracts. They form an important part of the immune system, preparing the body to fight off germy invaders.

Tonsil cancer is considered an oropharyngeal cancer. It’s the most common oropharyngeal cancer, making up about 23 percent of mouth and throat cases, according to a 2021 study published in StatPearls Publishing. It’s also a head and neck cancer, since these tissues are located in that part of the body.

Causes and risk factors for tonsil cancer

A virus called the human papillomavirus (HPV) causes this cancer. However, tonsil cancer has also been linked to specific lifestyle factors.

Risk factors for tonsil cancer include:

  • Tobacco use
  • Alcohol consumption
  • HPV type 16 infection

Having several of these risk factors—for example, smoking and drinking heavily—further increases the risk of developing tonsil cancer.

HPV is a common infection, but some types of the virus are more dangerous than others. Not all types of HPV cause cancer. Some types of HPV are called “high-risk” because they put those infected at high risk of developing tumors. Infection with these high-risk strains (including type 16, which is associated with tonsil cancer) is preventable with the HPV vaccine.

Getting the HPV vaccine, quitting smoking and reducing excessive drinking are all steps that may help decrease the risk of developing tonsil cancer. Types of tonsil cancer

Types of tonsil cancer

Because the tonsils are made up of a mucosal layer and a lymphatic layer, they contain two types of cells that may turn cancerous.

Most frequently, tonsil cancers are squamous cell carcinomas. These tumors are derived from the squamous cells in the mucous layer of the tonsil. Less frequently, tumors may arise from the lymph tissue itself, which is called lymphoma.

This article is focused primarily on squamous cell carcinomas of the tonsils.

Another important designation for tonsil cancer is the presence of HPV in the tumor. Because HPV is integral in the formation of some of these cancers, the presence of HPV type 16 (called p16 positive) in the tumor has an impact on the tonsil cancer stage. Conversely, if the tumor doesn’t have HPV, it’ll be marked as p16 negative.

Cancers linked to an HPV infection have better outcomes than those not linked to an infection. Those not linked to HPV are more likely to appear in older male smokers with other illnesses, which may be why they have a worse survival rate.

Symptoms of tonsil cancer

The symptoms of tonsil cancer include:

  • Painless neck lump
  • Sore throat or persistent hoarseness
  • Ear or jaw pain
  • Swallowing pain or problems
  • Weight loss

Anyone worried about these symptoms should schedule an appointment with a doctor.

Diagnosis of tonsil cancer

To diagnose tonsil cancer, a specialist doctor called an otolaryngologist or a head and neck surgeon examines the patient’s head and neck, feeling with the hands, and inspects the throat using a small mirror.

An otolaryngologist or a head and neck surgeon may take a tonsil sample, called a biopsy, and examine the area further. This may require sedating the patient with an anesthetic and using a tube with a camera (called a panendoscope). Then, a specialist examines the biopsied tissue sample under a microscope to see whether the growth is cancerous and test for HPV.

Other imaging tests that a care team may use to further examine the area include:

These painless tests give the doctor a better view of the area around the tonsils.

Treatment of tonsil cancer

Tonsil cancer is treated with a combination of surgery, radiotherapy, chemotherapy and immunotherapy, depending on the patient’s diagnosed stage and HPV status.

  • During surgery, a doctor cuts out the tonsil, the growth, close-by lymph nodes in the neck, and possibly part of the throat. The extent of the surgery depends on the tumor’s size. A specialist later checks the lymph nodes for signs of cancer. If the tonsil cancer is small and caught early, surgery may be the only treatment needed.
  • Radiotherapy kills the cancer cells with radiation (invisible, high-energy waves). Radiation treatment is done once a day for a few weeks to shrink the tumor. It may be used after surgery, alongside chemotherapy treatments or on its own, depending on the cancer’s stage.
  • Chemotherapy involves treatment with drugs that kill fast-growing cells. The most common chemotherapy drug for tonsil cancer is cisplatin. It’s often given along with the chemotherapy drug fluorouracil (5FU). However, some patients may receive carboplatin instead.
  • Immunotherapies are drugs that turn the body’s immune system against cancer. One example is the use of the monoclonal antibody treatment Erbitux® (cetuximab). These proteins are naturally made by the body but may also be administered as an anti-cancer treatment to help the body find and attack the tumor.

Survival rates for tonsil cancer

Survival rates for tonsil cancer are highly dependent on the type of cancer and the patient’s health and lifestyle.

Tonsil cancer that is positive for HPV is less dangerous. About 71 percent of people diagnosed with p16 positive tonsil cancer are alive five years later, according to StatPearls Publishing. Tonsil cancer that isn’t related to HPV is more troublesome. About 46 percent of people diagnosed with HPV-negative cancer in their tonsils are alive five years after diagnosis.

Part of this difference may come from a smoking history—smokers with tonsil cancer are less likely to survive than their nonsmoking counterparts, regardless of their cancer’s HPV status.

Patients diagnosed with tonsil cancer should ask their doctor about evidence-informed treatment options.

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