Tonsil Cancer

Diagnosis

To diagnose tonsil cancer, a healthcare professional will typically begin with a close examination of your mouth and throat. Additional tests and procedures may be needed to confirm the diagnosis and assess the extent of the cancer.

Examining the throat and neck
A healthcare professional may use a mirror or a small camera to inspect the mouth and throat. They may also feel the neck to check for swollen lymph nodes.

Removing a tissue sample for testing
A biopsy may be recommended to collect tissue from the tonsil or a swollen lymph node. The sample is analyzed in a lab to detect cancerous cells. Tests also check for human papillomavirus (HPV), which can affect prognosis and treatment options.

Imaging tests
Imaging tests create pictures of the body to help determine the size of the cancer and whether it has spread beyond the tonsils. Common imaging tests include:

• Computerized tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)

Tonsil cancer staging
Information from these tests helps your healthcare team assign a cancer stage. Stages range from 0 to 4, with higher numbers indicating larger cancers or greater spread. Stage 4 cancers may extend beyond the tonsil, involve multiple lymph nodes, or spread to other body parts. Staging may differ depending on whether HPV is present. Discuss your cancer stage and prognosis with your healthcare team.

Treatment

Treatment options for tonsil cancer include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Your care team considers factors such as tumor location, growth rate, spread, test results, overall health, and personal preferences. Treatment may also differ based on HPV status, and clinical trials for less intensive therapy may be an option.

Surgery
Surgery aims to remove as much cancer as possible and may be used at any stage.

Transoral surgery
Most surgeries are done through the mouth. Surgeons use cutting tools or lasers to remove the tumor.

Neck surgery
For larger cancers or those involving lymph nodes, an incision in the neck may be required. Reconstructive surgery and rehabilitation may follow to restore speech, swallowing, and eating.

Radiation therapy
Radiation uses energy beams, such as X-rays or protons, to destroy cancer cells.

Radiation may be used:
• Alone for small cancers confined to the tonsil
• After surgery if the tumor cannot be fully removed
• After surgery if there is a risk of lymph node involvement
• Alongside chemotherapy to enhance effectiveness, either as initial therapy or post-surgery

Chemotherapy
Chemotherapy uses strong medicines to kill cancer cells. It is often combined with radiation therapy or used alone for cancers that recur or spread.

Targeted therapy
Targeted medicines attack specific parts of cancer cells, causing them to die. This may be used for recurrent or metastatic tonsil cancer.

Immunotherapy
Immunotherapy enhances the immune system’s ability to detect and destroy cancer cells. It may be used when other treatments are insufficient or the cancer has spread.

Rehabilitation services
Treatment may affect speech, swallowing, and eating. Rehabilitation specialists, including speech and swallowing therapists, dietitians, physical therapists, and occupational therapists, can assist in recovery and improve quality of life after treatment.