Tonsil cancer is a cancer that starts in the tonsils at the back of the throat and is the most common form of oropharyngeal cancer. Nearly all are squamous cell carcinomas. A large and rising proportion are caused by human papillomavirus (HPV), while the rest are linked mainly to tobacco and alcohol.
HPV-related cancers behave differently and respond better to treatment than those related to smoking, which is why the tumour's HPV status is always tested. Treatment consists of radiotherapy, often with chemotherapy, or surgery, and it has significant effects on swallowing and saliva. It should be planned by a head and neck team.
Symptoms
- A painless lump in the neck, often the first sign of HPV-related disease
- A sore throat on one side that lasts more than 3 weeks
- Pain on swallowing, or difficulty swallowing
- Pain in one ear with a normal ear examination
- One tonsil larger than the other, or an ulcer on it
- A change in the voice, or a sensation of something stuck in the throat
- Blood in the saliva
- Unexplained weight loss
Causes and risk factors
There are two main routes. Persistent infection of the tonsil with high-risk HPV, nearly always type 16 and acquired through oral sexual contact years or decades earlier, accounts for the majority of cases in many countries and affects men more than women, typically between 45 and 65. Most HPV infections clear without consequence, and having this cancer says nothing about recent behaviour or fidelity. The second route is long-term smoking and alcohol use, which multiply each other's effect. HPV vaccination in adolescence is expected to reduce future cases.
How it is diagnosed
- Examination and flexible nasendoscopy: An ENT surgeon inspects and feels the tonsil, the base of the tongue and the neck.
- Biopsy: From the tonsil, or an ultrasound-guided needle sample from a neck node. Removal of the tonsil for diagnosis is sometimes needed when the primary tumour is hidden.
- p16 and HPV testing: Performed on the biopsy. It determines the stage grouping and informs the discussion of outlook.
- MRI or CT of the neck: Defines the tumour and the lymph nodes.
- PET-CT: Looks for spread and locates a hidden primary tumour.
- Assessment of teeth, swallowing and nutrition: Done before treatment. Decayed teeth in the radiation field are removed beforehand.
Treatment options
- Radiotherapy: Intensity-modulated radiotherapy over 6 to 7 weeks, alone for early disease.
- Chemoradiotherapy: Cisplatin given together with radiotherapy for more advanced disease. It is the most widely used approach.
- Transoral robotic or laser surgery: Removes small tumours through the mouth with a neck dissection. Radiotherapy may still be recommended afterwards, depending on the pathology findings.
- Neck dissection: Removal of lymph nodes, as part of primary surgery or for nodes that persist after radiotherapy.
- Immunotherapy: Pembrolizumab or nivolumab for recurrent or metastatic disease.
- Swallowing and nutritional rehabilitation: Exercises begun before treatment, dietitian support and, for some patients, a temporary feeding tube.
- Stopping smoking: Improves the response to treatment and lowers the risk of a second cancer.
When it is urgent
Bleeding from the mouth or throat, difficulty breathing or noisy breathing, inability to swallow fluids, or fever during chemotherapy need emergency care at the nearest hospital.
Travelling to Türkiye for treatment
A second opinion on the choice between surgery and chemoradiotherapy, together with a PET-CT and a pathology review, is a reasonable purpose for a visit. Radiotherapy takes 6 to 7 weeks on site, and the hardest side effects, including a sore mouth, difficulty eating and fatigue, peak towards the end and for 2 to 4 weeks afterwards. If you have the treatment abroad, plan to stay for that period or arrange firm supportive care at home. Transoral surgery needs about 2 to 3 weeks. Treatment should begin within roughly 4 to 6 weeks of diagnosis, so do not let the arrangements cause a delay.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Does HPV-positive mean that I am contagious?
The infection was usually acquired many years ago. Long-term partners have typically been exposed already and their cancer risk is not meaningfully raised. No change in intimacy is generally advised.
Surgery or radiotherapy?
For small tumours both are effective and they differ in side effects. The aim is to avoid needing all three of surgery, radiotherapy and chemotherapy where possible.
Will I be able to eat normally afterwards?
Most people return to eating by mouth. A dry mouth, altered taste and some difficulty with dry or tough foods are common in the long term.
Can I have less intensive treatment because my tumour is HPV positive?
Reduced treatment is being studied in trials but is not yet standard. Be cautious about offers of reduced treatment outside a trial.