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About tonsil cancer

Cancer of the tonsil is a type of head and neck cancer. Symptoms often include a painless neck lump and a sore throat. The main risk factors for tonsil cancer are smoking, drinking alcohol and infection with the HPV virus.

The tonsils

The tonsils are 2 glands at the back of your throat. They are 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
Diagram showing the parts of the oropharynx

Types

Most tonsil cancers are a type called squamous cell carcinoma. A small number of tonsil cancers are lymphomas.

The information in this section is about squamous cell carcinoma. The treatment for lymphomas is different.

Symptoms

Symptoms can include:

  • a sore throat
  • ear pain
  • a painless lump in your neck
  • difficulty swallowing

Risk factors

The main risk factors for developing this type of cancer are

  • smoking
  • regularly drinking a lot of alcohol
  • infection with a virus called human papilloma virus (HPV)

If you smoke and drink a lot together, you increase your risk even further.

Human papilloma virus (HPV)

There are many types of HPV. Tonsil cancer is especially linked to type 16. HPV is a sexually transmitted infection. It is very common. For many people, HPV causes no harm and goes away without treatment. Only a very small number of people with HPV develop tonsil cancer.

Tests

Your doctor will examine you. They might look at the back of your throat using a small mirror that they put into your mouth. They will check for swollen lymph nodes in your neck.

The only way to confirm a diagnosis of cancer is to take a small amount of tissue (biopsy) from the abnormal area. A specialist doctor examines it under a microscope. They also test your cancer cells to check for HPV infection.

You might have an examination and biopsy under a general anaesthetic. The doctor uses a tube and camera called a panendoscope to look into your throat.

You will also have one or more of the following tests:

  • MRI scan
  • CT scan
  • ultrasound
  • PET-CT scan

Stages

The stage of your cancer tells you how big it is and whether it has spread. It helps your doctor decide what treatment you need.

The stage of your cancer depends on:

  • 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

The stage of tonsil cancer also depends on whether your cancer cells contain the HPV virus. The doctors test your cancer cells. This is called the p16 test. Your cancer is either called:

  • P16 positive - it contains HPV
  • P16 negative – it doesn’t contain HPV

Tonsil cancers that contain HPV tend to do better than tonsil cancers that don’t contain HPV.

Treatment

Treatment for tonsil cancer could include:

  • surgery
  • radiotherapy
  • chemotherapy
Last reviewed: 
18 Jul 2018
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    VT DeVita, TS Lawrence, SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

  • Head and Neck Cancer: Multidisciplinary Management Guidelines
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    A Balderas-Loaeza and others

    International Journal of Cancer, 2007

    Volume 120, Issue 10

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    Accessed June 2018

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