Head & Neck Cancer
Tonsil Cancer
The tonsils and tonsil cancer
Tonsils work as part of the body’s immune system. The throat has three types of tonsils, the pharyngeal tonsil (adenoids), the palatine tonsil and the lingual tonsils.
Tonsil cancer is a type of oropharyngeal or oral cancer, and usually involves the palatine tonsils, which are small organs shaped like oval pads that are located on the sides of the throat just behind the mouth in the oropharynx.
The oropharynx structure includes:
- The back third of the tongue
- The soft palate (the soft area at the rear of the roof of the mouth)
- The tonsils and the ridges of tissue in front and behind them
- The back wall of the throat
Tonsil cancer occurs from changes in the DNA that result in an abnormal growth of cells forming in a tonsil. It is more common amongst men with three to four times more men diagnosed than women. Generally, those diagnosed with tonsil cancer are aged 50 years or older, but it can develop at any age.
Most tonsil cancers are squamous cell carcinomas, but a small number are lymphomas, and the treatment for each type is different.
Tonsil cancer occurs from changes in the DNA that result in an abnormal growth of cells forming in a tonsil. It is more common amongst men with three to four times more men diagnosed than women. Generally, those diagnosed with tonsil cancer are aged 50 years or older, but it can develop at any age.
Most tonsil cancers are squamous cell carcinomas, but a small number are lymphomas, and the treatment for each type is different.
Tonsil cancer and HPV
It is unknown what causes tonsil cancer, but it is now recognised that human papillomavirus (HPV) (a common sexually transmitted infection), can play a significant role in the development of tonsil cancer and this now accounts for a rise in the number of cases diagnosed worldwide.
Tonsil cancer caused by HPV tends to occur in a younger population and has proven to be more responsive to the current available treatments.
Clinical Presentation
Tonsil cancer can result in difficult in swallowing and can feel like there is something caught in the throat. It is often not diagnosed until late in the disease, when the cancer has spread to other nearby areas in the neck. Other presentations can include:
- Swelling and pain the neck
- Earache
- Stiffness of the jaw
- A sore in the back of the mouth that does not heal
- The tonsil is larger on one side
- Pain in the mouth
- A persistent sore throat
- Difficulty chewing, speaking, or swallowing
- Bad breath
- Blood in the saliva
Risk factors and prevention
Factors believed to be linked to an increased risk of tonsil cancer include:
- HPV infections (particularly strains 16 and 18)
- Tobacco usage (include snuff and chewing beatle nut)
- Alcohol consumption
Note: the risk is increased if you smoke and drink.
Other less common but potential causes of tonsil cancer include people who have certain infections or decreased immunity such as those who have had organ transplants or immunodeficiency virus disease.
To reduce the risk of developing tonsil cancer:
- Don’t use tobacco
- Limit alcohol consumption (drink only in moderation)
- Have regular dental checks
- Consider an HPV vaccination to prevent HPV infection
How is tonsil cancer diagnosed?
If your doctor suspects tonsil cancer, they will likely refer you to Dr McGuinness for an examination, tests, and diagnosis. At your consultation, Dr McGuinness will examine the inside of your mouth and the back of the throat to identify the presence of a tumour and check the location and size. Your ears, nose and neck are also examined to determine if the tumour has spread to other areas.
A fine needle aspiration biopsy is performed. This can be done in rooms or under general anaesthetic, and involves a thin needle being placed in the mouth which then aspirates cells from the lump for laboratory testing.
There are a number of other tests that may also be undertaken which will be determined at the time of your examination. These can include:
- Blood tests
- X-rays to check if the tumour has spread to the lungs
- MRI
- CT-Scan
- Ultrasound
- PET scan
What are the stages of tonsil cancer?
The treatment for tonsil cancer is determined by the stage of the cancer and its size, and depends on:
- How far the cancer has grown into local tissues
- Whether is has spread to other parts of the body
- Whether it has spread to the lymph nodes
The stages of tonsil cancer are:
Early tonsil cancer
This means the tumour is smaller than 4cm and is contained within the tonsil.
Advanced tonsil cancer
In advanced tonsil cancer, the tumour is either larger than 4cm or has grown outside the tonsil and has invaded other tissues or the lymph nodes.
How is tonsil cancer treated?
Early tonsil cancer may need surgery to remove the cancer and some of the lymph nodes. After surgery you may also need radiotherapy, chemotherapy or chemoradiotherapy (chemotherapy and radiotherapy together) if it is believed that there is a high risk of the cancer returning.
Early tonsil cancers may only need a simple minimally invasive endoscopic surgical procedure, or a robotic procedure known as:
- Transoral laser microsurgery (TLM)
- Transoral robotic surgery (TORS). Dr McGuinness is one of only a handful of experienced robotic ENT surgeons in Australia who is able to treat tonsil cancer with TORS.
In some instances, some of the lymph nodes in the neck may be surgically removed during the procedure for further laboratory testing to check for cancer cells. If the tests detect cancer, you may need to undertake further surgery to remove more nodes.
Sometimes, early tonsil cancer can be treated with radiotherapy of the throat and neck.
Advanced tonsil cancer treatments will vary depending upon the size of the tumour and whether it has invaded other areas. Treatment options include:
- Chemoradiotherapy to the throat and neck.
- Surgery to remove the section of the throat affected by the cancer along with some of the lymph nodes. Surgery is followed by radiotherapy or chemoradiotherapy.
In some rare instances, Dr McGuinness and the MDT (multi-disciplinary team) that he works with may recommend chemotherapy prior to surgery if the cancer is very large. For larger advanced tonsil cancers, more complicated surgery may be necessary and this will involve a longer hospital stay.