Tonsil Cancer: Types, Symptoms, Causes, Risks, Complications, Diagnosis, Prevention, Treatment and Outlook

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1Overview

Before commencing into the topic of tonsil cancer, it is important to get a glimpse and understand more about the tonsils, their functions and the root causes of cancer development. The tonsils are a group of tissues that are located in the throat region of the body.

Situated on each side of the back of the throat are two lymph nodes called tonsils whose role is to act as a defense mechanism and help prevent the body from infection.

The pharyngeal, Palatine and the lingual tonsils are the three kinds of tonsils.
The pharyngeal tonsils are located behind the nose and sometimes called the adenoids.
The palatine tonsils, which are most likely to become cancerous, are situated behind the throat and the lingual tonsils are seen at the back of the base of the tongue.

Cancer of the tonsil is a form of oropharyngeal cancer that starts in the cells of the tonsils. This cancer is often lately diagnosed when cancer has metastasized to adjacent areas.

Tonsil cancer is the type of cancer that happens in one of the three layers of the tonsils, but it most commonly emerges in the palatine tonsils. Majority of tonsil cancers are squamous cell carcinoma in nature, which is usually found in the lining of the mouth tissues.

The most common risk factor for squamous cell carcinoma is smoking. However, drinking alcohol may also be a risk factor. Moreover, combining excessive smoking and alcohol drinking may even heighten the risk of developing tonsil cancer.

2Types

Squamous cell carcinoma (SCC) and lymphoma are the two types of cancer affecting the tonsils.

Squamous cell carcinoma (SCC) – This is slow-growing cancer and the second (2nd) most common skin cancer form that is usually found on the sun-exposed skin of the head, neck, lips, ears, arms, legs, and hands. This type of cancer can spread to the tissues, bones and adjacent lymph nodes where it may be hard to treat. Tonsil cancer that is caused by HPV is a type of squamous cell carcinoma.

Lymphoma – This is a type of tonsil cancer usually arises from the lymphatic cells which are seen in the walls of the tonsils.

3Symptoms

Some clients with tonsil cancer may not experience the symptoms of tonsil cancer even after the diagnosis.  The symptoms may also be associated with other medical conditions aside from cancer so it is best to seek medical help for proper diagnosis. Discomfort in swallowing or pharyngeal pain are some of the complaints being experienced by some clients. Here are some of the manifestations of tonsil cancer:

  • Dysphagia (difficulty of swallowing); pain during swallowing and mouth pain
  • Extreme weakness or fatigue
  • Feeling unwell
  • Dysphagia (difficulty of swallowing); pain during swallowing and mouth pain sores that don’t heal in the back of the mouth or throat
  • Swollen tonsils; sometimes tonsil is larger on one side; the presence of cauliflower-like ulcers
  • Ear pain
  • Lumps in the neck
  • Pain in the neck
  • Hoarse voice
  • Difficulty chewing or speaking
  • Blood-tinged saliva
  • Halitosis (bad breath)
  • Fatigue
  • Weight loss 

4Causes

The leading cause of tonsil cancer is tobacco use. Another potential cause is the exposure to Human papillomavirus (HPV) leading to squamous cell carcinoma.

Every year, about 9,000 people are diagnosed with HPV-related cancer of the mouth and throat. Some lymphomas may develop in lymph system just like in the tonsils since it’s a part of it.

5Risk Factors

Tonsil cancer can develop at any age but often clients who are diagnosed to have this type of cancer are mostly at the age of 50 or older and are male.

Those who are smoking and drinking alcohol are also at risk of having this type of cancer.

Recently, more young people are having tonsil cancer, as well as throat and neck cancers even if they do not smoke or drink.

There are also clients who may develop tonsil cancer because of having decreased immune system like those who were exposed to HPV 16 and 18; those who received organ transplant; and those people with human immunodeficiency (HIV) virus disease.

6Complications

Some complications of tonsil cancer can be serious and potentially fatal. If the cancer is left untreated, it will metastasize or spread to the other parts of the body and can have complications like nasopharyngeal carcinoma.

Nasopharyngeal Carcinoma – This is an uncommon type of head and neck cancer that starts in the nasopharynx (upper part of the throat, behind the nose) located at the base of the skull, directly above the roof of the mouth. The air we breathe flows through the nose into the throat, nasopharynx, and the lungs.

7Diagnosis

The following are tests and latest diagnostic techniques used to determine the cancer cells and to know the stages of the cancer progression. Note that clients with tonsil cancers are to be tested for HPV because it will have an impact on the prognosis and treatment.

History taking and physical exam

Diagnosis begins when the doctor gathers data particularly getting accurate health history from the client. After that, he examines the mouth and feels the neck, especially the lymph nodes, for the presence of abnormalities. The physician uses a little, flexible, fiber-optic scope to examine the tonsils and nearby tissue carefully.

Imaging Tests

Computerized tomography (CT) scan, the Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) are imaging tests that are not used to diagnosed tonsil cancer. However, these also help the physician to understand the extent of cancer, to help look for a tumor if one is suspected, assist in planning for treatment, and to look for possible signs of recurrence of cancer after treatment.

Neck ultrasound

This procedure is done to see vessels, structures, and lymph nodes in the neck and thyroid gland. This is a safe procedure and the client is not exposed to radiation.

Biopsy

The physician may recommend removing a sample of tissue from the tonsil and sent to the laboratory for testing in order to confirm the diagnosis of tonsil cancer. Using the microscope, the skilled pathologists examine the tissue to determine the types of cells and the aggressiveness of the cancer.

8Treatment

The management of this type of cancer depends on what stage of the tonsil cancer the client has. The following are treatments for tonsil cancer.

Surgery

Most clients will need advanced surgical approaches to remove the cancerous tissue. It can also be used to address all stages of tonsil cancer but considered effective for early-stage cancers.

Transoral surgery is done to remove tumors from the mouth. The doctors use lasers or cutting tools to eliminate cancer. This does not require long rehabilitation of the throat area. It will help improve swallowing and speech.

Transoral robotic surgery is a minimally invasive but a safe surgery that provides an accurate access to cancer. The recovery is fast compared with the usual surgical approaches.

Open Surgery is done for cancers that have spread to the neck. Surgeons use a large incision in the neck to remove the cancer.

Radiation therapy

Patients undergo radiation therapy after surgery to destroy any remaining cancer tissue. This is done by directing a beam of radiation that passes through the body and into the tumor site where cancer cells are destroyed. This procedure may be used for the early or advanced type of tonsil cancer.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells and to slow down the growth of cancer. There is also a new treatment used to shrink tumors and that is called the induction chemotherapy. For advanced tonsil cancer, the client will likely need a combination of radiation and chemotherapy.

Rehabilitation

Rehabilitation is needed to help the client improve swallowing and speech function. Specialists, like the speech therapists, occupational therapists, physical therapists, and dieticians help the client to cope and recover in this situation.

9Prevention

Quit smoking – It is the best way to prevent tonsil cancers. Do not use tobacco products or chew tobacco. The largest cause of cancers in the head and neck is smoking.

Avoid second-hand smoke –  It may increase the chance of having cancers in the head and neck.

Be responsible – Limit the number of people you have sex with or be faithful in order to protect yourself from HPV. Use condom but it doesn’t protect you from HPV since HPV can also be spread during oral sex (fellatio/cunnilingus).

Get an HPV vaccine  – This is to protect your children (preteen girls and boys) from HPV infection before they will have their first sexual activity and to prevent them from having tonsil cancers in the future.

Regular checkup – Have a regular check-up with your doctor and dentist who can help detect tonsil cancers early.

10Outlook

If throat cancer is related to Human papillomavirus, and if detected early, there is a better prognosis and that it can respond to treatment better. There is a low recurrence.

On the other hand, if the cancer is not related to HPV, it can become larger and may also metastasize to the nearby areas at a later stage before it is detected. Thus, making treatment more intense and most likely cancer will recur.