What is tonsil cancer?

Cancer of the tonsil is a rare type of head and neck cancer. Cancer happens when abnormal cells start to divide and grow in an uncontrolled way. 

Symptoms often include a painless neck lump and a sore throat. The main risk factors for tonsil cancer are smoking, drinking alcohol and infection with the human papilloma virus (HPV).

What are the tonsils?

The tonsils are 2 glands at the back of your throat. They are in the part of the throat just behind your mouth, called the oropharynx (pronounced oar-o-far-rinks).

They help reduce infection by stopping harmful germs from coming through the mouth and nose.

The oropharynx includes:

• the back third of your tongue
• the soft area at the back of the roof of the mouth (the soft palate)
• the tonsils and two ridges of tissue in front of and behind the tonsils
• the back wall of your throat

What are the types of tonsil cancer?

Most tonsil cancers are a type called squamous cell carcinoma. A small number of tonsil cancers are lymphomas.

The information in this section is about squamous cell carcinoma. The treatment for lymphomas is different.

What are the symptoms of tonsil cancer?

Symptoms can include:

• a persistent sore throat

• ear pain

• a painless lump in your neck

• difficulty or pain when swallowing

• hoarse voice

What are the risk factors for tonsil cancer?

The main risk factors for developing this type of cancer are

• smoking
• regularly drinking a lot of alcohol
• infection with a virus called human papilloma virus (HPV)

If you smoke and drink a lot together, you increase your risk even further.

Human papilloma virus (HPV)

There are many types of HPV. Tonsil cancer is especially linked to type 16. HPV is a sexually transmitted infection. It is very common. For many people, HPV causes no harm and goes away without treatment. Only a very small number of people with HPV develop tonsil cancer.

What are the tests for tonsil cancer?

Your doctor will examine you. They might look at the back of your throat using a small mirror that they put into your mouth. They will check for swollen lymph nodes in your neck.

The only way to confirm a diagnosis of cancer is to take a small amount of tissue (biopsy) from the abnormal area. A specialist doctor examines it under a microscope. They also test your cancer cells to check for HPV infection.

You might have an examination and biopsy under a general anaesthetic. The doctor uses a tube and camera called a panendoscope to look into your throat.

You usually have one or more of the following tests:

• MRI scan
• CT scan
• PET-CT scan
• ultrasound of the lymph nodes in your neck

Your doctor may also look at the back of your throat using a thin tube with a light on the end. This is called a nasoendoscopy. 

What are the stages of tonsil cancer?

The stage of your cancer tells you how big it is and whether it has spread. It helps your doctor decide what treatment you need.

The stage of your cancer depends on:

• how far your cancer has grown into local tissues
• whether it has spread to nearby lymph glands
• whether it has spread to any other part of the body

The stage of tonsil cancer also depends on whether your cancer cells contain the HPV. The doctors test your cancer cells. This is called the p16 test. Your cancer is either called:

• P16 positive - it contains HPV
• P16 negative – it doesn’t contain HPV

Tonsil cancers that contain HPV tend to do better than tonsil cancers that don’t contain HPV.

What is the treatment for tonsil cancer?

Treatment for tonsil cancer could include:

• surgery
• radiotherapy
• chemotherapy
• chemotherapy with radiotherapy (chemoradiotherapy)
• targeted and immunotherapy drugs