12 things to know about tonsil cancer 

Most people will experience swollen tonsils at some point in their lives. But how do you know if yours are due to a common cold, strep throat or tonsil cancer? And, can you still get tonsil cancer even if you’ve had your tonsils removed?  

Here are answers to these and 10 other questions I hear as director of MD Anderson’s Oral Cancer Prevention Clinic.  

What are tonsils?  

Tonsils are a collection of lymphatic tissue found in the back of the mouth. They help our bodies fight off infection by trapping viruses, bacteria and other pathogens that can harm us. 

Humans have tonsils in four different locations:  

1. lingual: located at the back of the tongue 
2. palatine: located on either side of the back of your throat 
3. pharyngeal: located in the center of where the nasal cavity meets the throat 
4. tubal: located on either side of where the nasal cavity meets the throat  

The tonsils are roughly organized in a circle, in an arrangement known as Waldeyer’s ring. But the ones most people think of when you say the word “tonsils” are the palatine tonsils. 

Can you get tonsil cancer if you don’t have tonsils? 

Yes. Even if you’ve had a tonsillectomy (a procedure in which the palatine tonsils are surgically removed), you can still get tonsil cancer (also called oropharyngeal cancer). There’s always a possibility that some tonsil tissue was left behind. 

Are swollen tonsils ever a symptom of tonsil cancer? 

They can be, though that usually only applies when one tonsil is swollen. Asymmetrical tonsils, or having one tonsil that looks markedly different from the other, is a classic symptom of tonsil cancer. Another is a persistent sore throat, which does not respond to antibiotics or steroids.  

The most common symptom of tonsil cancer right now, though, is usually a painless lump in the neck. Tonsil cancer that has metastasized, or spread to the lymph nodes there, is often mistaken for infection or a benign growth called a branchial cleft cyst, which sometimes develops in children. But in adults, a lump in the neck is more likely to be metastatic cancer. 

How is tonsil cancer usually diagnosed? 

The only way to definitively diagnose tonsil cancer is to have a doctor examine your throat and perform a biopsy. But a lot of people come in with a neck mass they’ve noticed while shaving or putting on makeup.  

Others complain of a chronic sore throat or a “hot potato” voice — so-called because their voice sounds thick and muffled, like they’re trying to speak with a hot potato in their mouth. Some notice bleeding in their throats, which they can taste when they swallow or cough it up.  

What are the risk factors for tonsil cancer? 

Historically, tonsil cancer was connected most often with tobacco and alcohol use. But the rates of tonsil cancer among those groups have either stabilized or decreased over time. That’s because fewer people are smoking and drinking alcohol.  

Meanwhile, the number of tonsil cancer diagnoses among patients who don’t smoke or drink is skyrocketing. Roughly 90% of those cases are caused by the human papillomavirus (HPV). The vast majority of those are squamous cell carcinomas. 

How is tonsil cancer typically treated? 

There are two different pathways.  

Surgery first

This usually involves minimally invasive robotic surgery with lymph node dissection. It’s sometimes followed by radiation therapy or radiation therapy with chemotherapy, depending on what the pathology report shows. 

Radiation therapy first

This may or may not be given with chemotherapy. 

Is there anything special I should do before starting treatment for tonsil cancer? 

Yes.  

See a speech pathologist

Radiation therapy can make the muscles in the neck tight and fibrous. This may affect your ability to swallow. A speech pathologist can teach you stretching and strengthening exercises to help you maintain that function. 

See a dentist

Radiation causes a lot of side effects in the mouth, so having wisdom teeth pulled or decayed teeth extracted after treatment may not be possible. See a dentist before radiation therapy so they can determine whether you need any dental work.  

Is tonsil cancer curable? 

Yes, if it’s caught early enough. Cancer is almost always easier to treat when it’s caught early. Once a cancer is far advanced, we can often treat it, but we are unlikely to cure it. 

What are the latest developments in tonsil cancer? 

One of biggest developments in the past five or so years has been the concept of “de-escalation” among patients with HPV-related tonsil cancer. That means we’re exploring whether we can get the same results with lower dosages of chemotherapy and/or radiation.  

We cure about 90% of patients with HPV-related tonsil cancer here at MD Anderson. But chemotherapy and radiation can be quite toxic, and can cause side effects, such as problems swallowing. So, we’re conducting Phase III clinical trials to see if we can reduce their dosages. Hopefully, that will lessen these side effects.  

We’re also exploring immunotherapy, vaccines, and the effectiveness of proton therapy versus standard radiation treatment.  

What’s the recurrence rate for tonsil cancer? 

If you are diagnosed with tonsil cancer at a very early stage, its recurrence rate is very low. The same applies to tonsil cancer that’s caused by HPV. 

Is there a screening test for tonsil cancer? 

No, but scientists are working to develop a blood test for both screening and monitoring purposes. And there’s a blood test to detect HPV DNA, which can be elevated in patients with HPV-related tonsil cancer. 

If you get an annual physical, your doctor can examine you and see if one tonsil is bigger than the other, whether there are any enlarged lymph nodes in your neck, or if you have any other symptoms. Many dentists also check for tonsil cancer during dental exams. 

How can I reduce my risk of tonsil cancer? 

Don’t smoke, vape or use other tobacco products

And, if you do, quit. Medication and counseling are the best ways to do it. You can call 1-800-784-8669 or text QUIT to 47848. Patients and caregivers at MD Anderson can also join our Tobacco Research and Treatment Program.    

Limit your use of alcohol

For cancer prevention purposes, it’s best not to drink alcohol at all. But if you do, try to limit yourself to one drink per day if you’re female and two drinks per day if you’re male.  

Get vaccinated against HPV

This can protect you against multiple cancers — including throat, anal, cervical, penile and vaginal. Everyone ages 9-26 should get it, but people ages 27-45 may still benefit from it. Talk to your doctor to see if the HPV vaccine series is right for you.  

Ann Gillenwater, M.D., is a head and neck surgeon who serves as director of MD Anderson’s Oral Cancer Prevention Clinic. 

Request an appointment at MD Anderson online or call 1-877-632-6789.