Treating tonsil cancer

Treatment for tonsil cancer includes surgery, radiotherapy, and chemotherapy. You might have one treatment type or a combination. The tonsils are in the part of the throat called the oropharynx.

Treatment for tonsil cancer is similar to other oropharyngeal cancers . 

Treatment decisions

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on several factors including:

• the stage of your cancer
• your general health

The stage of your cancer tells you how big it is and whether it has spread. 

Some tonsil cancers contain a virus called human papilloma virus (HPV ).  The doctor tests your cancer cells for HPV:

• HPV positive cancers contain HPV 
• HPV negative cancers don’t contain HPV 

Doctors stage HPV positive tonsil cancer in a different way to HPV negative tonsil cancers. Your treatment options depend on the stage of your cancer. 

Treatment by stage

Below, we have information about treatment for early stage cancer and advanced stage cancer. Your specialist doctor will tell you more about the stage of your cancer and the treatment you will have.

Early stage tonsil cancer

Early tonsil cancer means your cancer is smaller than 4cm. It hasn't spread into nearby tissues or to other parts of the body. 

If your cancer has spread to nearby lymph nodes , your cancer might still be early stage. This depends on your situation. Your doctor can tell you more about your stage. 

To treat early stage tonsil cancer, you might have either:

• surgery to remove the cancer and some of the lymph nodes in your neck or
• radiotherapy to the throat and neck

If your doctor thinks there is a high risk that your cancer will come back after surgery, you might need:

• radiotherapy
• chemoradiotherapy  

Locally advanced and advanced tonsil cancer

Locally advanced tonsil cancer means the cancer has grown outside the tonsils to nearby tissue or lymph nodes. Advanced tonsil cancer means it has spread to other parts of the body.

Your doctor will explain your cancer stage.

Treatment options include:

• chemoradiotherapy to your throat and neck
• surgery to remove the part of the throat affected by cancer and some of the lymph nodes in your neck, followed by radiotherapy or chemoradiotherapy
• radiotherapy on its own

You might have chemotherapy before surgery if your cancer is very large. Although this isn't very common.

You usually have a PET CT scan around 12 weeks after chemoradiotherapy. This is to check if your lymph nodes contain cancer. If there are signs of cancer, you usually have surgery to remove the lymph nodes.

You might have radiotherapy, chemotherapy or surgery to control symptoms of advanced cancer.

Surgery

You might have an operation to remove the part of the throat that contains the cancer. There are different types of operation. The type of surgery depends on where exactly the cancer is and the size of your cancer.

Early cancers

You might only need a simple operation if your cancer is very small. You can sometimes have this using local anaesthetic or with laser surgery. So, you don't need to stay overnight in hospital. 

Usually, surgery for early stage cancer is through your mouth (endoscopic surgery). This is also called:

• transoral laser microsurgery (TLM) 
• transoral robotic surgery (TORS)

The surgeon might also suggest a selective neck dissection. This is when they remove lymph nodes in some areas of your neck. They send the nodes to the laboratory to check them for cancer cells. 

If there is cancer in the lymph nodes you might need to have more surgery to remove more nodes.

Larger cancers

For larger cancers, you may need a more complicated operation and need to stay in hospital for a while.

For the most complicated surgery, you might have part of your soft palate or the back of your tongue removed. Your surgeon rebuilds this with tissue taken from another part of the body. 

Possible problems after surgery

You will have some pain after most types of surgery, but this is usually well controlled. Your doctors and nurses give you painkillers by drip, tablets, or liquids if you need them.

Having an operation to your mouth may affect eating and drinking for a while afterwards. 

Talk to your doctor or specialist nurse before your operation. You can ask them how it will affect you and what support there is.

Radiotherapy

Radiotherapy uses high energy waves similar to x-rays to kill cancer cells. You might have radiotherapy:

• on its own as your main treatment

• after surgery

• combined with chemotherapy (chemoradiotherapy) as your main treatment or after surgery

• to help relieve the symptoms of advanced tonsil cancer

You have radiotherapy to the part of the throat affected by cancer. And the doctor might also treat the lymph nodes in your neck.

You usually have radiotherapy treatment once a day, between 4 to 7 weeks.

Radiotherapy to the head and neck area can cause several side effects. These include a dry, sore mouth and taste changes.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer.

You might have chemotherapy combined with radiotherapy (chemoradiotherapy). The chemotherapy helps the radiotherapy work better. You might have this:

• after surgery if there is a high risk of your cancer coming back
• as your main treatment

Some people have chemotherapy to shrink the cancer before the main treatment. Although, this isn’t very common. This is called neo adjuvant treatment. 

The most commonly used drug is cisplatin. You might have this with fluorouracil (5FU). Some people have carboplatin instead of cisplatin.

The side effects of chemotherapy include feeling sick and lower resistance to infections. Your side effects also depend on the drug you have and whether you have it with other treatments.

Targeted and immunotherapy cancer drugs

Cetuximab (Erbitux)

Cetuximab is a type of targeted cancer drug called a monoclonal antibody .

You might have cetuximab:

• with radiotherapy for locally advanced squamous cell mouth and oropharyngeal cancer
• with platinum chemotherapy for squamous cell mouth cancer that has come back or has spread to other parts of the body

Nivolumab  (Opdivo)

Nivolumab is a type of immunotherapy. This type of treatment stimulates the body’s immune system to fight cancer cells.

You have nivolumab if you have squamous cell cancer and:

• your cancer has come back or has spread to other parts of the body

• you had platinum based chemotherapy, and your cancer has started to grow within 6 months of having chemotherapy

In Scotland, you can have nivolumab if your cancer continues to grow. This is while you are on or after having platinum based chemotherapy.

You can have it for up to 2 years.

Pembrolizumab (Keytruda)

Pembrolizumab is also a type of immunotherapy.

You might have pembrolizumab if you have squamous cell cancer and:

• you haven’t had any treatment for an advanced cancer

• your cancer has come back and you can’t have surgery to remove the cancer

• the cancer shows a type of protein called programmed cell death ligand 1 (PD-L1)

Research

Researchers are always interested in finding new ways to treat head and neck cancer.

They are looking at different treatment combinations for people with tonsil cancer. They want to compare how well the different treatments work. And learn more about the side effects. For example, they are looking at giving chemoradiotherapy and immunotherapy drugs together.

Coping

Coping with a diagnosis of cancer can be difficult. Being well informed about your cancer and its treatment can help. It can make it easier to make decisions and cope with what happens.

Talking to other people who have the same thing can also help.

Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people.

You can call our nurse freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.