Tonsil cancer

Tonsil cancer is an abnormal growth of cells that forms in a tonsil. Your tonsils are two oval-shaped pads in the back of your mouth that are part of your body's germ-fighting immune system.

Tonsil cancer can cause difficulty swallowing and a sensation that something is caught in your throat. Tonsil cancer is often diagnosed late in the disease, when cancer has spread to nearby areas, such as the lymph nodes in the neck.

Treatments for tonsil cancer include surgery, radiation therapy and chemotherapy.

Symptoms

Signs and symptoms of tonsil cancer include:

• Difficulty swallowing
• A sensation that something is caught in the back of your throat
• Swelling and pain in the neck
• Earache
• Jaw stiffness

When to see a doctor

Make an appointment with your doctor or dentist if you experience any persistent signs and symptoms that worry you.

Causes

Tonsil cancer forms when healthy cells in the tonsils develop changes in their DNA. A cell's DNA contains the instructions that tell a cell what to do. The changes tell the cells to grow out of control and to continue living when healthy cells would normally die. The accumulating cells form a tumor that can grow beyond the tonsils and spread to other areas of the body.

It's not clear what causes tonsil cancer, but doctors are finding that human papillomavirus (HPV) is increasingly playing a role. This common sexually transmitted infection is detected in most tonsil cancers in the United States. Tonsil cancer caused by HPV tends to occur at a younger age and is more likely to respond well to available treatments.

Risk factors

Factors that may increase the risk of tonsil cancer include:

• Using tobacco
• Drinking alcohol
• Being infected with human papillomavirus (HPV)

Prevention

To reduce your risk of tonsil cancer:

• Don't use tobacco. If you don't use tobacco, don't start. If you currently use tobacco of any kind, talk with your doctor about strategies to help you quit.
• Limit alcohol if you choose to drink. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
• Get regular dental care. During your appointment, your dentist will check your mouth for signs of cancer and precancerous changes.
• Consider the HPV vaccine. Receiving a vaccination to prevent HPV infection may reduce your risk of HPV-related cancers, such as tonsil cancer. Ask your doctor whether an HPV vaccine is appropriate for you.

Diagnosis

Tests and procedures used to diagnose tonsil cancer include:

• Examining your throat and neck. Your doctor will use a mirror or tiny camera to examine your mouth and throat. The doctor may use his or her hands to feel your neck to check for enlarged lymph nodes.
• Removing a tissue sample for testing. Your doctor will remove an area of suspicious tissue and send it to a lab for testing. In the lab, specially trained doctors (pathologists) will look for signs of cancer. The tissue sample will also be tested for HPV, since the presence of this virus greatly impacts your prognosis and your treatment options.
• Taking imaging tests. To better understand the size of your cancer and to look for signs that cancer may have spread beyond your tonsils, your doctor may recommend imaging tests, such as computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET).

Your doctor uses information from these procedures to assign your cancer a stage. The stages of tonsil cancer range from 0 to IV. The earliest stages indicate a small cancer that may be confined to the tonsil or may have spread to a few nearby lymph nodes. Later stages indicate more-advanced cancer that has grown to involve many lymph nodes or has spread to other areas of the body.

Treatment

Which tonsil cancer treatments are best for you will depend on the size, stage and HPV status of your cancer, as well as your overall health and your preferences. Tonsil cancer treatment options may include surgery, radiation therapy, or a combination of chemotherapy and radiation therapy.

Researchers are studying whether people with HPV-related tonsil cancer can be treated with lower doses of radiation and chemotherapy. This less intense treatment causes fewer side effects and, in early studies, seems to be as effective as higher doses. If your tonsil cancer is found to be HPV-related, you and your doctor might consider a clinical trial studying less intense treatments.

Surgery

The goal of surgery for tonsil cancer is to remove as much of the cancer as possible. Surgery can be used to treat all stages of tonsil cancer.

Surgery is most often done through the mouth (transoral surgery). Surgeons pass specialized tools through the mouth to access the cancer and remove it with cutting tools or lasers.

In certain situations, it may be necessary to make a large incision in the neck to remove larger cancers and cancers that have spread to the lymph nodes. Reconstructive surgery and rehabilitation may be needed to restore your ability to eat, speak and swallow.

Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays or protons, to kill cancer cells.

Radiation therapy might be used alone to treat small cancers that haven't grown beyond the tonsil. Sometimes radiation therapy is used after surgery if the cancer can't be removed completely or if there's a risk that the cancer may have spread to the lymph nodes.

Radiation can also be combined with chemotherapy as an initial treatment or as an additional treatment after surgery. The chemotherapy makes the cancer cells more vulnerable to the radiation and may increase the effectiveness.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. For tonsil cancer, chemotherapy is usually combined with radiation therapy. It can also be used alone to slow the growth of tonsil cancer that has recurred or has spread to other areas of the body.

Rehabilitative services

Rehabilitation specialists in speech therapy, swallowing therapy, dietetics, physical therapy and occupational therapy help with rehabilitation that may be necessary after surgery or radiation therapy.

Coping and support

Learning you have any life-threatening illness can be devastating. With time you'll find ways to cope with your feelings, but you may find comfort in these strategies:

• Ask questions about tonsil cancer. Write down questions you have about your cancer. Ask these questions at your next appointment. Also ask your doctor for reliable sources where you can get more information.

  Knowing more about your cancer and your treatment options may make you more comfortable when it comes to making decisions about your care.

• Stay connected to friends and family. Your cancer diagnosis can be stressful for friends and family, too. Try to keep them involved in your life.

  Your friends and family will likely ask if there's anything they can do to help you. Think of tasks you might like help with, such as caring for your home if you have to stay in the hospital or just being there when you want to talk.

  You may find comfort in the support of a caring group of your friends and family.

• Find someone to talk with. Find someone you can talk to who has experience with people facing a life-threatening illness. Consult a counselor, medical social worker, clergy member or a support group for people with cancer.

Preparing for an appointment

Start by making an appointment with your dentist or family doctor if you have signs or symptoms that worry you.

If your doctor or dentist is concerned that you may have tonsil cancer, you may be referred to:

• A surgeon who specializes in procedures involving the head and neck
• A doctor who uses drugs to treat cancer (medical oncologist)
• A doctor who uses radiation to treat cancer (radiation oncologist)

Because appointments can be short, and because there's a lot of information to discuss, it's a good idea to be prepared. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For tonsil cancer, some basic questions to ask your doctor include:

• What is my stage of tonsil cancer?
• Can you explain the pathology report to me? Can I have a copy of my pathology report?
• Will I need more tests?
• What are the treatment options for my tonsil cancer?
• What are the benefits and risks of each option?
• Is there one treatment option you recommend over the others?
• What would you recommend to a loved one in my same situation?
• Should I get a second opinion from a specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

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