Tonsil Cancer: What You Need to Know

What is Tonsil Cancer?

Tonsil cancer is a type of head and neck cancer that originates in the tissues of the tonsils, which are two small glands located at the back of the throat on either side. These glands are part of the lymphatic system and play a crucial role in immune defense by filtering out bacteria and harmful invaders before they enter the body.

Tonsil cancer occurs when the cells that make up the tonsils grow and divide uncontrollably, forming tumors or lesions. There are three types of tonsils in the human body:

• Pharyngeal tonsils (adenoids): Located at the back of the throat
• Palatine tonsils: Found on either side of the throat
• Lingual tonsils: Situated at the base of the tongue

Most cases of tonsil cancer develop in the palatine tonsils, but it can also arise in the lingual or pharyngeal tonsils. The prevalence of this cancer has significantly increased in recent years, making it one of the most common forms of oropharyngeal cancer. This rise has been linked to lifestyle factors such as smoking and alcohol consumption, along with other risk factors that contribute to its development.¹Williamson AJ, Mullangi S, Gajra A. Tonsil Cancer. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537238/

Tonsil Cancer Causes

Tonsil cancer, also known as tonsil carcinoma, can develop due to various factors. While the exact cause of tonsil cancer is often not known, certain risk factors have been associated with its development. Here are some potential causes and risk factors:²National Cancer Institute. (n.d.). Head and Neck Cancers. Retrieved from https://www.cancer.gov/types/head-and-neck.

• Human papillomavirus (HPV) infection: In recent years, HPV infection has been identified as a significant risk factor for tonsil cancer, particularly in the oropharynx (the back of the throat, including the tonsils). HPV, especially the high-risk strains HPV-16 and HPV-18, can lead to cellular changes that contribute to cancer development.³Näsman A, Attner P, Hammarstedt L, Du J, Eriksson M, Giraud G, Ahrlund-Richter S, Marklund L, Romanitan M, Lindquist D, Ramqvist T, Lindholm J, Sparén P, Ye W, Dahlstrand H, Munck-Wikland E, Dalianis T. Incidence of human papillomavirus (HPV) positive tonsillar carcinoma in Stockholm, Sweden: an epidemic of viral-induced carcinoma? Int J Cancer. 2009 Jul 15;125(2):362-6.
• Tobacco use: Long-term tobacco use, including smoking cigarettes, cigars, or pipes, increases the risk of developing tonsil cancer. The carcinogenic substances in tobacco can damage the DNA in cells, leading to the formation of cancerous cells.⁴Jethwa AR, Khariwala SS. Tobacco-related carcinogenesis in head and neck cancer. Cancer Metastasis Rev. 2017 Sep;36(3):411-423. doi: 10.1007/s10555-017-9689-6. PMID: 28801840; PMCID: PMC5709040.
• Alcohol consumption: Regular and heavy alcohol consumption is associated with an increased risk of tonsil cancer. Alcohol can cause cellular damage and weaken the immune system, making it more susceptible to the effects of other carcinogens. The combination of tobacco and alcohol can have a synergistic effect, further increasing the risk.
• Family history and genetic factors: Some individuals may have an increased risk of developing tonsil cancer due to inherited genetic mutations that affect cell growth and DNA repair. Additionally, a family history of certain cancers, including tonsil cancer, may also contribute to an increased risk.

It’s important to note that having one or more of these risk factors does not guarantee the development of tonsil cancer. Many people without any known risk factors can still develop the disease, and not everyone exposed to risk factors will develop tonsil cancer.

Signs & Symptoms

It is essential to pay attention to any unusual changes in your head and neck region to help with an early diagnosis and treatment of cancer, which will likely improve the prognosis and outcome.
The symptoms and signs of tonsil cancer can vary, but common indicators include:

• Sore Throat: Persistent or recurring sore throat that does not improve with time or usual treatments.
• Difficulty Swallowing: Pain or discomfort while swallowing, known as dysphagia, which may worsen over time.
• Ear Pain: Unexplained ear pain or discomfort that may be felt on one side unrelated to an ear infection.
• Lump or Swelling: A persistent lump or swelling on one side of the throat or neck. Trismus is a concerning sign of local invasion.⁵Kristensen, S., Tveterås, K. Trismus and carcinoma of the tonsil. Arch Otorhinolaryngol 241, 41–43 (1984). https://doi.org/10.1007/BF00457915
• Persistent or Recurring Tonsillitis: Frequent episodes of tonsillitis or persistent inflammation of the tonsils.
• Voice Changes: Hoarseness or changes in voice quality that persist for an extended period.
• Unexplained Weight Loss: Significant weight loss without any known cause or changes in diet or physical activity.

It is important to note that other non-cancerous conditions can also cause these symptoms. However, if any of these signs persist for an extended period or are accompanied by other concerning symptoms, it is recommended to consult a healthcare professional for further evaluation and appropriate testing. Early tonsil cancer detection and diagnosis are crucial for successful treatment and improved outcomes.

Diagnosis & Tests

The most common tests to diagnose tonsil cancer are physical examination, imaging tests, and biopsy.⁶Mehanna H, Evans M, Beasley M, Chatterjee S, Dilkes M, Homer J, O’Hara J, Robinson M, Shaw R, Sloan P. Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016 May;130(S2):S90-S96. doi: 10.1017/S0022215116000505. PMID: 27841123; PMCID: PMC4873902.

Physical Examination:

During the physical examination, your doctor will examine your oral cavity using a small mirror and a torch. Your doctor may assess for foul breath, enlarged tonsils, or white spots on the tonsils, which may increase the suspicion of tonsil cancer.

Imaging:

To make a diagnosis and understand the extent of cancer, the doctor often uses imaging techniques such as Orthopantomogram (OPG), Computed tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET).
CT scan is the investigation of choice when assessing the body for distal metastasis, which is the spread of cancer to different body parts through the bloodstream or lymphatics.⁷Lewis-Jones H, Colley S, Gibson D. Imaging in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016 May;130(S2):S28-S31.

Biopsy:

A biopsy involves taking a small tissue sample from the tonsil, which is then examined in the lab. Doctors can determine if cancer cells are present by taking a tissue sample with the help of a fine bore needle, referred to as Fine Needle Aspiration Cytology (FNAC), or by making an incision on the tonsils, referred to as an incisional biopsy.
These tests can help provide an accurate diagnosis and insight into the stages of tonsil cancer that may have developed. This will help doctors determine the appropriate treatment option.

How is the Tonsil Cancer Treated?

In treating tonsil cancer, a team of healthcare professionals, including an oncologist and other specialists, may recommend various medicinal and surgical options. The best choice for each case will be determined based on the case’s specifics.

Medical Treatment:

Medical treatment options for tonsil cancer usually include chemotherapy and radiation therapy.

• Chemotherapy uses drugs to target and kill cancer cells throughout the body.
• Radiation therapy or radiotherapy targets specific areas of the body using high-energy radiation beams.Charbonneau N, Gélinas M, del Vecchio P, Guertin L, Larochelle D, Tabet JC, Soulières D, Charpentier D, Nguyen-Tân PF. Primary radiotherapy for tonsillar carcinoma: a good alternative to a surgical approach. J Otolaryngol. 2006 Aug;35(4):227-34.
• In some cases, the doctors may use a combined treatment of chemotherapy and radiotherapy. However, this approach is associated with various side eff, acts such as fatigue, nausea, and hair loss.

Surgical Removal:

Surgical options for treating tonsil cancer involve removing the affected tissue or tumors from the tonsils. This can include partial removal (tonsillotomy) or complete removal of the tonsils (tonsillectomy) to eliminate all cancerous cells.
The most common approach for partial or complete tonsillectomy is transoral, in which the surgeon accesses the tonsils through the patient’s mouth.
Depending on the severity of the case, the surgeon may need to perform additional procedures like a neck dissection or laryngectomy.
In some cases, the doctor may use radiotherapy in combination with surgery to shrink the tumor and make its resection easier. Surgical treatment of Tonsil cancer has a favorable prognosis.⁸Galati LT, Myers EN, Johnson JT. Primary surgery as treatment for early squamous cell carcinoma of the tonsil. Head Neck. 2000 May;22(3):294-6. doi: 10.1002/(sici)1097-0347(200005)22:3<294::aid-hed13>3.0.co;2-9. PMID: 10748454.

Rehabilitative Services:

Tonsil cancer can lead to severe complications if left untreated.
However, timely management and rehabilitation lead to excellent survival rates and positive outcomes.
The post-treatment rehabilitation services are essential for individuals recovering from tonsil cancer to help them regain strength, improve functioning, and return to their daily activities. Common rehab services after tonsil cancer include physical therapy to improve range of motion and muscle function, speech therapy to address difficulties with speaking or swallowing, occupational therapy to help patients learn new ways of doing tasks, and nutritional therapy to ensure proper nutrition.

What are the Potential Side Effects of Tonsil Cancer Treatment?

Treatments for tonsil cancer, like any other type of cancer, come with potential side effects. Common side effects include nausea, vomiting, fatigue, hair loss, pain when swallowing, sore throat, and mouth sores. Less common side effects may include dry mouth, hoarseness, difficulty speaking, and shortness of breath. Additionally, more severe complications can arise, such as infection or damage to nearby organs. Discussing potential benefits and side effects with your doctor beforehand is best.

What can you do to Prevent Tonsil Cancer?

It is essential to be aware of the risk factors and take steps to reduce your risk of developing them. These include:

• Avoid the use of tobacco products.
• Limit your exposure to ultraviolet radiation from the sun or tanning lamps.
• Decrease alcohol consumption.
• Get vaccinated against the human papillomavirus (HPV).
• Visits to your doctor for check-ups can help detect any early signs of tonsil cancer.

Tonsil cancer is no joke – it’s serious and can lead to severe complications if not caught early. By recognizing the signs and symptoms, knowing the diagnosis and tests, and understanding the treatment options, we can better equip ourselves to prevent and fight against it. We must view it as a serious issue before it becomes too late.

Refrences

• 1
  Williamson AJ, Mullangi S, Gajra A. Tonsil Cancer. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537238/
• 2
  National Cancer Institute. (n.d.). Head and Neck Cancers. Retrieved from https://www.cancer.gov/types/head-and-neck.
• 3
  Näsman A, Attner P, Hammarstedt L, Du J, Eriksson M, Giraud G, Ahrlund-Richter S, Marklund L, Romanitan M, Lindquist D, Ramqvist T, Lindholm J, Sparén P, Ye W, Dahlstrand H, Munck-Wikland E, Dalianis T. Incidence of human papillomavirus (HPV) positive tonsillar carcinoma in Stockholm, Sweden: an epidemic of viral-induced carcinoma? Int J Cancer. 2009 Jul 15;125(2):362-6.
• 4
  Jethwa AR, Khariwala SS. Tobacco-related carcinogenesis in head and neck cancer. Cancer Metastasis Rev. 2017 Sep;36(3):411-423. doi: 10.1007/s10555-017-9689-6. PMID: 28801840; PMCID: PMC5709040.
• 5
  Kristensen, S., Tveterås, K. Trismus and carcinoma of the tonsil. Arch Otorhinolaryngol 241, 41–43 (1984). https://doi.org/10.1007/BF00457915
• 6
  Mehanna H, Evans M, Beasley M, Chatterjee S, Dilkes M, Homer J, O’Hara J, Robinson M, Shaw R, Sloan P. Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016 May;130(S2):S90-S96. doi: 10.1017/S0022215116000505. PMID: 27841123; PMCID: PMC4873902.
• 7
  Lewis-Jones H, Colley S, Gibson D. Imaging in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016 May;130(S2):S28-S31.
• 8
  Galati LT, Myers EN, Johnson JT. Primary surgery as treatment for early squamous cell carcinoma of the tonsil. Head Neck. 2000 May;22(3):294-6. doi: 10.1002/(sici)1097-0347(200005)22:3<294::aid-hed13>3.0.co;2-9. PMID: 10748454.