Q&A: What to Know About Tonsil Cancer
CancerWise - June 2008
Whether people have had their tonsils removed or not, they still might develop tonsil cancer and should be educated about the disease.
Answering questions about tonsil cancer is Ann Gillenwater, M. D., associate professor in M. D. Anderson's Department of Head and Neck Surgery and director of the cancer center's Oral Cancer Prevention Clinic.
What are tonsils?
The tonsils are a collection of lymph tissue, or white blood cells, at the back of your mouth that gather there to help fight infection.
What raises the risk of tonsil cancer?
Traditionally, the known risk factors for tonsil cancer are tobacco and alcohol use, but now there seems to be an increased rate of tonsil cancer in patients who don't smoke or drink. There is some evidence that it's related to the human papillomavirus (HPV).
Can you have tonsil cancer and no tonsils?
Even if you have had your tonsils removed (tonsillectomy), you can still get tonsil cancer because during the procedure, some tonsil tissue is left behind.
What are the symptoms of tonsil cancer?
The number one symptom is asymmetrical tonsils, having one tonsil larger than the other. Another symptom is a persistent sore throat.
At later stages, there are enlarged lymph nodes or cysts in the neck and maybe ear pain. As a general rule, any time someone is thought to have a tonsil infection and antibiotics don't work, doctors should consider tonsil cancer.
Many times tonsil cancer that has metastasized or spread to lymph nodes is mistaken for a benign cyst called a branchial cleft cyst, which sometimes develops in children. In adults, it's more common that the cyst is really metastatic tonsil cancer.
How is it diagnosed?
An otolaryngologist (ear, nose and throat doctor) examines the area and determines if a biopsy is needed.
What is the standard treatment?
Radiation, because tonsil cancer responds well to it and it has less of an impact on swallowing and speaking than surgery.
In advanced cases, we use chemotherapy with the radiation therapy.
Are there new treatments for tonsil cancer?
M. D. Anderson has been using a combination of radiation and molecular targeting agents called EGFR (epidermal growth factor receptor) inhibitors, which I explain to my patients like this:
The receptor is like a docking station for EGF, a type of growth hormone. Cancer cells overproduce these docking stations, so they can absorb more of that growth factor. If we can block that docking station using the EGFR inhibitor, then the cancer will die or stop growing.
How can patients prepare for treatment?
Radiation makes the muscles in the neck tight and fibrous. It's very important for patients to see a speech pathologist before they begin treatment to learn stretching and strengthening exercises to help them maintain their swallowing function.
It's also really important before radiation for patients to see a dentist to get an assessment on whether any dental work needs to be done, such as having wisdom teeth pulled or decayed teeth extracted. Radiation causes a lot of side effects on the mouth and teeth, and dental work after treatment may not be possible.
Radiation can decrease the amount of saliva, which is important for fighting cavities.
Radiation also decreases the blood supply to the jaw bone, so the bone would have a hard time healing if there were dental procedures after radiation. If an abscess developed after radiation treatment, it also would be very difficult to heal, and may lead to loss of the jaw bone.
What should patients know about the recovery?
Sometimes patients need a feeding tube because the radiation can cause burning inside the mouth, and sometimes it can cause difficulty swallowing.
What is the recurrence rate for tonsil cancer survivors?
Recurrence of tonsil cancer caught at an early stage is very low, as it is with tonsil cancer caused by HPV.
Is there a screening for tonsil cancer?
Not presently. If you get a physical every year, ideally, your doctor can look in your mouth and see if you have one tonsil bigger than the other or any other symptoms. Many dentists detect tonsil cancer during a dental exam.