Cancer of the tonsil is one of the head and neck cancers. It develops in the part of the throat just behind your mouth, called the oropharynx, pronounced oar-o-far-rinks. The oropharynx includes
- The back third of your tongue
- The soft area at the back of the roof of the mouth (the soft palate)
- The tonsils and two ridges of tissue in front of and behind the tonsils
- The back wall of your throat
The main risk factors for developing this type of cancer are smoking and regularly drinking a lot of alcohol. If you smoke and drink a lot together, you increase your risk even further.
Cancer of the tonsil has been linked to a virus called human papilloma virus (HPV). There are a number of different types of HPV. Some cause warts on the genital area or skin. Other types increase the risk of some types of cancer including cancer of the cervix, vagina, vulva, penis and anus. Researchers have found that the type of HPV that increases the risk of these cancers also increases the risk of oropharynx cancers including cancer of the tonsil. This type of HPV is called HPV16.
Researchers are looking into how HPV of the mouth is passed on. There is some evidence to show that it is passed on through sexual contact through oral sex but it may also be passed on through mouth to mouth contact or in other ways.
You may be offered any of these treatments for oropharyngeal cancer
You may have either surgery or radiotherapy to treat early tonsil cancer. Early means a small tumour that is still contained within the tonsil. If you have a cancer that is larger, has grown throughout the tonsil, or has started to grow outside it, you may have surgery followed by radiotherapy. More advanced cancers that have grown outside the tonsil may need shrinking before they can be removed. You may have chemotherapy or radiotherapy or both to try to shrink the cancer. This is called down staging. If the cancer does shrink, you may then be able to have an operation to remove it.
Advanced cancers cause symptoms such as pain, bleeding and difficulty swallowing. You may have radiotherapy or chemotherapy or both to help control symptoms.
There are other experimental treatments being investigated, for example, photodynamic therapy (PDT). For this treatment, you have to take a drug that concentrates in the cancer cells. The drug is harmless until a bright light is shone onto the cells. It is then switched on and kills the cells.
As you can see, treatment depends on how far the cancer has grown. So the first step for your specialist is to find out
- How far your cancer has grown into local tissues
- Whether it has spread to nearby lymph glands
- Whether it has spread to any other part of the body
This is called staging the cancer. Your doctor will be able to tell you more about which treatment is best for you once your cancer has been staged.
You may be able to have an operation to remove the part of the throat that contains the cancer. There are different types of operation. The part of your throat removed depends on the exact site of the tumour. If your cancer is very small, you may only need a very simple operation. This can be done using local anaesthetic or with laser surgery and you don't need to stay overnight in hospital.
For larger more extensive cancers you may need a more complicated operation and need to stay in hospital for a while. For the most complicated surgery, you may have to have part of your soft palate or the back of your tongue removed. Your surgeon will rebuild this with tissue taken from another part of the body. There is more information about this surgery in the treating mouth and oropharyngeal cancer section.
All types of treatments have side effects. Sometimes surgery to the throat causes a lot of swelling in the area and makes it difficult to breathe normally. If this is the case then your surgeon may need to make a hole in your windpipe, at the base of your neck. This hole is called a tracheostomy and will allow you to breathe while the swelling is there. It is usually only temporary and will be removed once your wound has healed. There is information about having a tracheostomy and how it may affect you in the section about living with mouth and oropharyngeal cancer.
Some operations on the throat can affect your speech. We take it for granted that it is easy to speak, but it is actually a very complicated process. To produce sound we use our throat, soft palate, lips, nose, mouth and tongue. If you have surgery to any of these, your speech may change. This may not be very noticeable and may only be temporary. But sometimes the change is permanent. If you have any speech difficulties at all, a speech and language therapist can help you manage. We have information about speech loss and how to cope with it.
You may have radiotherapy
- On its own to treat a small tonsil cancer
- Either before or after surgery to treat a larger cancer
- To help relieve the symptoms of advanced tonsil cancer
External radiotherapy and internal radiotherapy (brachytherapy) may both be used to treat tonsil cancer. You usually have external radiotherapy treatment once a day for a few weeks. Brachytherapy is most likely to be used for small cancers. You may have brachytherapy if your cancer has come back after earlier treatment with external beam radiotherapy.
There is information about the general side effects of radiotherapy and specific side effects to the head and neck area in the radiotherapy section.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer. Chemotherapy has not always been a treatment of choice for tonsil cancer. But recent research has suggested that combining chemotherapy with radiotherapy may help as much as surgery for large cancers of the head and neck, including tonsil cancer. We need further research in this area.
If you have tonsil cancer you may be given chemotherapy before your main treatment to help shrink the cancer. This is called neoadjuvant treatment. When a cancer is shrunk before further treatment, this is called down staging. The drugs most commonly used to treat cancer of the tonsil are
Click on the links above to find out the specific side effects of each drug.
It has been found that using these two drugs together is more effective in shrinking the cancer than using one of them alone. Other chemotherapy drugs and combinations have been tested but none has yet produced results as good as cisplatin and fluorouracil.
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