Tonsil cancer is a type of head and neck cancer that develops from the oropharyngeal tissues located in the mouth and throat area. It originates from the lymphoid tissue in the tonsils and usually starts unilaterally. When detected early, the success of treatment is quite high. Today, the incidence of tonsil cancers, especially those associated with HPV (Human Papilloma Virus), has increased; the course of these tumors may be better compared to classic type tumors. Tonsil cancer may not show symptoms in the early stages. Unilateral tonsil enlargement, marked asymmetry between the two tonsils, rapid enlargement of one tonsil, and a feeling of fullness and pressure on the enlarging side are early warning signs. When these findings occur, the patient must be evaluated by an Ear, Nose, and Throat (ENT) specialist. Tonsil cancer can very often spread to the lymph nodes in the neck. A unilateral, painless, palpable hard lump or mass in the neck, or enlarged lymph nodes, are the most common reasons for presentation. Difficulty swallowing and painful swallowing (odynophagia), a stinging sensation when eating, a feeling of something stuck in the throat, and pain radiating to one side when swallowing can become particularly prominent in the advanced stage. The tumor in the throat can cause pain radiating to the ear via nerve pathways, resulting in unilateral earache. Unilateral pain that persists without an ear infection is important. A non-healing sore or an inflamed appearance on the tonsil, irregularity on the tonsil surface, white, ulcerative areas on it, and tissue changes that constantly look like an infection suggest tonsil cancer. In advanced cases, bad breath and occasional bleeding from the mouth may be observed.
HPV infection (especially HPV-16), smoking and alcohol consumption, a weakened immune system, and long-term oral hygiene problems are risk factors for tonsil cancer. Today, HPV-related tumors can be seen at younger ages and show a better clinical course. If these complaints exist, they are supported by an endoscopic examination performed by an ENT specialist, neck ultrasound, MRI imaging, and a biopsy from the suspicious tissue. In the biopsy, the HPV/p16 test is examined by pathology. Early diagnosis is the most important determinant of treatment success.
The treatment plan is determined according to the tumor’s stage, spread, and HPV association. The main treatment method is surgery. The complete removal (tonsillectomy) of the cancerous tonsil and dissection of the neck lymph nodes on the same side are applied. Radiotherapy is applied after surgery according to the pathology report. In some selected cases, it may also be preferred as primary treatment. Chemotherapy can be applied simultaneously with radiotherapy. It is recommended for advanced-stage tumors or those with risky pathological findings.
When tonsil cancer is caught in the early stage, the treatment success rate is high. Additional treatment may not be required after surgery. The chance of recovery is further increased in HPV-related cases. Therefore, findings such as unilateral sore throat, earache, neck swelling, and unilateral tonsil enlargement should not be neglected. If one or more of the complaints—unexplained unilateral throat or ear pain, a hard lump felt in the neck, a non-healing sore in the tonsil area, difficulty swallowing, or unilateral tonsil enlargement—persists for longer than two weeks, an ENT examination is definitely required. Early presentation directly affects the quality of life and treatment success.
Tonsil cancer is a disease whose symptoms can be overlooked but is completely curable when diagnosed early. The prognosis is better in HPV-related tumors, and satisfactory results are obtained with modern surgical techniques, as well as radiotherapy and chemotherapy. If you have any suspicions, it is important to consult an Ear, Nose, and Throat specialist without delay.
Prof. Dr. Elif Aksoy
ENT Head and Neck Surgery Specialist
Voice and Swallowing Disorders
