The main treatments for tonsil cancer are surgery, radiotherapy and chemotherapy, either combined or on their own. Your treatment depends on how far your cancer has grown and whether it has spread – this is called the stage of your cancer.
The stage of your cancer also depends on whether your cancer cells contain the HPV virus.
Treatment by stage
Early tonsil cancer
Early tonsil cancer means a tumour that is smaller than 4cm and is contained within the tonsil.
You might have either:
- surgery to remove the cancer and some of the lymph nodes in your neck
- radiotherapy to the throat and neck
You might need radiotherapy or chemoradiotherapy after surgery if your doctor thinks there is a high risk that your cancer will come back. Chemoradiotherapy means you have chemotherapy and radiotherapy together.
Advanced tonsil cancer
Advanced tonsil cancer means your cancer is larger than 4cm. Or it has grown outside the tonsil, invading other tissues or lymph nodes.
You might have:
- chemotherapy and radiotherapy together (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 a few months 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.
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 the site and size of your cancer.
You might only need a simple operation, if your cancer is very small. This can be done using local anaesthetic or with laser surgery, and 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 remove lymph nodes in some areas of your neck. They send the nodes to the laboratory to check them for cancer cells. This is called a selective neck dissection.
If there is cancer in the lymph nodes you might need to have more surgery to remove more nodes.
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 to 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.
Radiotherapy uses high energy waves similar to x-rays to kill cancer cells. You might have radiotherapy:
- on its own as your main treatment or 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 for a few weeks.
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 fluoracil (5FU). Some people have carboplatin instead of cisplatin.
Targeted cancer drugs
Cetuximab ( Erbitux) is a type of targeted cancer drug called a monoclonal antibody. You might have cetuximab together with radiotherapy if you can't have chemotherapy for any reason.
Nivolumab is a type of immunotherapy. This type of treatment stimulates the body’s immune system to fight cancer cells. You might be able to have nivolumab if your cancer has started to grow again within 6 months of stopping chemotherapy. To be able to have this, your doctor needs to make an individual application to a special fund called Cancer Drugs Fund.
Doctors and researchers are always interested in finding new ways to treat head and neck cancer.
Some tonsil cancers are caused by a virus called Human Papilloma Virus (HPV). Doctors know that HPV positive tonsil cancers respond well to treatment. They want to find out if these patients could have less intensive treatment.
Researchers 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.
They are also looking at different ways to give radiotherapy. And they are looking at drugs that might improve how well radiotherapy works.
Targeted cancer treatments are drugs that change the way that cells work and help the body control the growth of cancer. Doctors are looking at different targeted drugs for people with tonsil cancer.
Coping with a diagnosis of a more aggressive cancer can be especially difficult, both practically and emotionally. Being well informed about your cancer and its treatment 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 who know what you are going through.
The Rare Cancer Alliance offer support and information to people affected by rare cancers.