Tonsil Cancer

At UT Southwestern Medical Center, our cancer teams are dedicated to providing exceptional care for people with head and neck cancer, including tonsil cancer. We provide comprehensive care from screening and diagnosis to treatment, including services to help restore vital functions and cosmetic appearance.

As the only National Cancer Institute-designated comprehensive cancer center in North Texas, we deliver the best cancer care available today and push to discover new treatments. NCI designation means we offer patients the ability to participate in the broadest possible range of clinical trials, with access to potential therapies that aren’t available at other facilities.

Advanced Diagnosis and Treatment for Tonsil Cancer

Cancer can develop in the tonsils, a pair of soft tissue masses in the back of the throat that help fight infection as part of the immune system. Tonsil cancer, one of several types of throat cancer, can develop even in people who have had their tonsils removed, if small areas of tissue remain.

Our tonsil cancer care team includes ear, nose, and throat (ENT) specialists; radiation and medical oncologists; oral and reconstructive surgeons; physical and occupational therapists; and speech pathologists. We work collaboratively for each patient, providing personalized treatment that combines experience and expertise from all team specialties.

Risk Factors of Tonsil Cancer

Certain factors can increase the risk of developing tonsil cancer, but not everyone at risk develops the condition. In fact, people without known risk factors can develop tonsil cancer. Risk factors include:

• Age, with most people being diagnosed over age 55
  
• Alcohol use
  
• Tobacco use
  
• Human papillomavirus (HPV), a sexually transmitted virus

Some risk factors can be avoided to help prevent tonsil cancer. Learn more about head and neck cancer awareness and prevention.

Symptoms of Tonsil Cancer

Tonsil cancer symptoms can resemble those of other, less serious conditions such as infections, so the cancer is often not detected until it has spread to the mouth, throat, or nearby lymph nodes. Patients should see their doctors if they have any of the following symptoms that persist, even with the use of antibiotics or other treatments:

• One tonsil is larger than the other
• Either tonsil is bleeding
• Changes in the voice, such as hoarseness
• Difficulty swallowing
• Ear pain, especially if it is on only one side
• Fatigue
• Lump in the neck
• Persistent sore throat
• Unexplained weight loss

Diagnosis of Tonsil Cancer

Our ENT cancer specialists conduct a thorough evaluation, which includes a:

• Physical exam
• Discussion of personal and family medical history
• Discussion of symptoms and risk factors
• Review of any previous treatments

We often use a mirror and light to examine the mouth and throat, or we might use a laryngoscope (a thin, flexible tube with a lighted camera), which is inserted through the nose, for a closer look.

Our doctors might recommend one or more tests, such as:

• Computed tomography (CT) scan: CT uses specialized X-rays with or without a contrast agent to produce cross-sectional, 3D images of the mouth, throat, and neck.
  
• Magnetic resonance imaging (MRI) scan: MRI uses radio waves and a strong magnet to produce detailed images of the mouth, throat, and neck. We sometimes use a contrast agent with MRI for more detail, and the scan can also show whether cancer has spread to lymph nodes in the neck.
  
• Positron emission tomography (PET) scan: Using small amounts of radioactive materials and a special camera, PET scans produce highly detailed images that can detect cancerous cells.
  
• Ultrasound: We can look at blood vessels, lymph nodes, and other soft tissue in the neck with an ultrasound, which uses high-frequency sound waves and a computer to produce images.
  
• Chest X-ray: We sometimes use a chest X-ray to see if cancer has spread to the lungs.
  
• Biopsy: Our ENTs take a small tissue sample that a pathologist analyzes under a microscope for the presence of cancer cells or HPV. We can usually perform biopsies in the office using numbing medication and a fine needle. If more tissue is needed, we can perform surgery to remove a piece of tonsil tissue or the entire tonsil.
  

Treatment for Tonsil Cancer

Treatment options vary based on the stage of cancer, its size and location, and whether it has spread. For early-stage cancers, we often recommend chemoradiation (combined chemotherapy and radiation therapy) or surgery followed by radiation therapy. Treatment options include:

• Surgery: Because it is particularly effective for early-stage tonsil cancer, we often begin with surgery to remove as much of the cancer as possible. We might remove cancer tumors, the entire tonsil, or surrounding tissues such as lymph nodes if cancer has spread to them. For open surgery, we access the tonsils through an incision in the neck. Some patients need radiation therapy or chemoradiation after surgery.
  
• Minimally invasive robotic surgery: Our surgeons also have expertise in minimally invasive procedures that require no incisions. We perform transoral (through the mouth) procedures to remove cancer tumors, an entire tonsil, or nearby tissues, if needed. Minimally invasive procedures we use include transoral robotic surgery (TORS) and transoral laser microsurgery, in which the surgeon uses a microscope and laser technology to view and destroy cancer cells. Some patients need radiation therapy or chemoradiation after surgery.
  
• Radiation therapy: Our doctors use radiation, a treatment with high-energy waves such as X-rays or gamma rays, to treat tonsil cancer. Radiation therapy can destroy cancer cells that remain after surgery, and it can also treat inoperable tumors.
  
• Chemoradiation: Chemotherapy (medications that destroy cancer cells) given at the same time as radiation therapy is known as chemoradiation. It’s used in some cases to help preserve speaking and swallowing ability. Chemoradiation is also helpful in destroying any remaining cancer cells after surgery.
  
• Chemotherapy: Anticancer medications work to destroy cancer cells and prevent them from spreading. We sometimes use chemotherapy to shrink tumors before radiation or surgery to improve success of those treatments.
  
• Targeted therapy: Some types of tonsil cancer cells have a specific protein, EGFR, that causes aggressive growth. Specialized chemotherapy known as targeted therapy works to block the action of the EGFR protein and slow cancer growth.
  
• Reconstructive surgery: Patients with advanced tonsil cancer might need reconstruction after the removal of large tumors. Our plastic surgery and ENT experts work together to restore swallowing and other oral functions or to reconstruct a more natural appearance of the face, neck, and jaw.

For patients who are having radiation therapy for tonsil cancer, we recommend having any necessary dental work done before treatment. Radiation treatment slows healing and can cause other side effects. Learn more about cancer and transplant dental care.

At UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, patients have access to every available treatment option, delivered by the most experienced head and neck cancer specialists in Dallas. Find out more about all the options we offer for head and neck cancer treatment.

Support Services

We offer a variety of head and neck cancer support services for patients and their families, such as:

• Oncology rehabilitation
• Integrative therapies
• Nutrition counseling
• Support groups

Clinical Trials

As a medical research institution, UT Southwestern frequently conducts head and neck cancer clinical trials, giving our patients access to the newest treatments. Patients should speak with their doctors about the availability of clinical trials.