Diagnosis
To diagnose tonsil cancer, a healthcare professional might start by looking closely at your mouth and throat. Other tests and procedures might include imaging tests and a procedure to remove some cells for testing.
Examining the throat and neck
A healthcare professional may use a mirror or tiny camera to examine your mouth and throat. The health professional may feel your neck to check for swollen lymph nodes.
Removing a tissue sample for testing
Your healthcare professional may recommend a biopsy to get some tonsil cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab. To get the sample, a healthcare professional may cut away some cells from the tonsil. Or the health professional may use a needle to draw some cells out from a swollen lymph node in the neck.
In the lab, doctors called pathologists look for signs of cancer in the tissue sample. The tissue sample also will be tested for human papillomavirus, also called HPV. If your cancer cells show signs of HPV, this greatly impacts your prognosis and your treatment options.
Taking imaging tests
Imaging tests make pictures of the body. They may help your healthcare team better understand the size of your cancer. Imaging tests also can look for signs that cancer may have spread beyond your tonsils.
Imaging tests used for tonsil cancer may include:
- Computerized tomography, also called CT.
- Magnetic resonance imaging, also called MRI.
- Positron emission tomography, also called PET.
Tonsil cancer staging
Your healthcare team uses information from these procedures to assign your cancer a stage. The stage tells your healthcare team about the extent of your cancer and about your prognosis.
The stages of tonsil cancer range from 0 to 4. The lowest numbers indicate a small cancer that may only be in the tonsil or may have spread to a few nearby lymph nodes. As the cancer gets bigger or spreads to more lymph nodes, the stages get higher. A stage 4 tonsil cancer is one that has grown beyond the tonsil or has spread to many lymph nodes. A stage 4 tonsil cancer also may have spread to other parts of the body.
The stages of tonsil cancer are different for cancers that show signs of HPV infection and those that don't. Talk with your healthcare team about your tonsil cancer stage and what it means for your outlook.
Treatment
Treatments for tonsil cancer include surgery, radiation therapy and chemotherapy. Other treatments include targeted therapy and immunotherapy.
Your healthcare team considers many factors when creating a treatment plan. These factors might include the cancer's location and how fast it's growing. The care team also may look at whether the cancer has spread to other parts of the body and the results of tests on the cancer cells. Your care team also considers your overall health and your preferences.
Your treatment also may depend on whether your cancer cells show signs of human papillomavirus, also called HPV. Researchers are studying whether people with HPV-related tonsil cancer can be treated with lower doses of radiation and chemotherapy. This less intense treatment causes fewer side effects. Studies have found that it seems to be as effective as higher doses. If your tonsil cancer is found to be HPV-related, you and your healthcare team might consider a clinical trial studying less intense treatments.
Surgery
The goal of surgery for tonsil cancer is to remove as much of the cancer as possible. Surgery can be used to treat all stages of tonsil cancer.
Surgery is most often done through the mouth. Doing surgery in this way is called transoral surgery. Surgeons pass tools through the mouth to access the cancer. The surgeons remove the cancer with cutting tools or lasers.
In certain situations, it may be necessary to make a large incision in the neck. This approach lets surgeons remove larger cancers and cancers that have spread to the lymph nodes. Reconstructive surgery and rehabilitation may be needed to restore your ability to eat, speak and swallow.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, a machine directs beams of energy to specific points on the body to kill the cancer cells.
Radiation therapy might be used alone to treat small cancers that haven't grown beyond the tonsil. Sometimes radiation therapy is used after surgery if the cancer can't be removed completely. It also may be used after surgery if there's a risk that the cancer may have spread to the lymph nodes.
Radiation also can be combined with chemotherapy. The chemotherapy makes the radiation work better. Radiation and chemotherapy together is sometimes used as the first treatment for tonsil cancer. Or radiation and chemotherapy might be used as extra treatment after surgery.
Chemotherapy
Chemotherapy treats cancer with strong medicines. For tonsil cancer, chemotherapy is usually combined with radiation therapy. It also can be used alone to slow the growth of tonsil cancer that has come back or has spread to other areas of the body.
Targeted therapy
Targeted therapy uses medicines that attack specific parts of cancer cells. By blocking these parts, targeted treatments can cause cancer cells to die. Targeted therapy might be used to treat tonsil cancer that spreads to other parts of the body or comes back after treatment.
Immunotherapy
Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Immunotherapy might be used when tonsil cancer spreads to other parts of the body and other treatments haven't helped.
Rehabilitation services
If treatment affects your ability to speak and eat, you might need rehabilitation services. Rehabilitation specialists who work with people with tonsil cancer include those in speech therapy, swallowing therapy, dietetics, physical therapy and occupational therapy. These services can help with your recovery after tonsil cancer treatment.
Coping and support
People who are facing a serious illness often say they feel worried about the future. With time, you'll find ways to cope with the feelings brought on by a tonsil cancer diagnosis. Until you find what works for you, you may find comfort in these strategies:
Ask questions about tonsil cancer
Write down questions you have about your cancer. Ask these questions at your next appointment. Also ask your healthcare team for reliable sources where you can get more information.
Knowing more about your cancer and your treatment options may help you feel more confident in making decisions about your care.
Stay connected to friends and family
Your cancer diagnosis can be stressful for friends and family too. Try to keep them involved in your life.
Your friends and family will likely ask if there's anything they can do to help you. Think of tasks you might like help with, such as caring for your home if you have to stay in the hospital or just being there when you want to talk.
You may find comfort in the support of a caring group of your friends and family.
Find someone to talk with
Find someone you can talk to who has experience helping people facing a life-threatening illness. Ask your healthcare team to suggest a counselor or medical social worker you can talk with. You might find it helpful to talk with other cancer survivors through support groups. Contact the American Cancer Society or ask your healthcare team about local or online support groups.
Preparing for your appointment
Start by making an appointment with your doctor, dentist or other healthcare professional if you have symptoms that worry you.
If your healthcare professional is concerned that you may have tonsil cancer, you may be referred to:
- A surgeon who operates on the head and neck.
- A doctor who uses medicine to treat cancer, called a medical oncologist.
- A doctor who uses radiation to treat cancer, called a radiation oncologist.
Because appointments can be brief it's a good idea to be prepared. Here's some information to help you get ready.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as change your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medicines, vitamins or supplements you're taking and the doses.
- Consider taking a family member or friend along. Sometimes it can be hard to remember all the information provided during an appointment. Someone who comes with you may remember something that you missed or forgot.
- Write down questions to ask your healthcare team.
Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For tonsil cancer, some basic questions to ask your doctor include:
- What is my stage of tonsil cancer?
- Can you explain the pathology report to me? Can I have a copy of my pathology report?
- Will I need more tests?
- What are the treatment options for my tonsil cancer?
- What are the benefits and risks of each option?
- Is there one treatment option you recommend over the others?
- What would you recommend to a loved one in my same situation?
- Should I get a second opinion from a specialist? What will that cost, and will my insurance cover it?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you've prepared, don't hesitate to ask other questions during your appointment.
What to expect from your doctor
You are likely to be asked a number of questions. Being ready to answer them may allow time later to cover points you want to address. You may be asked:
- When did you first begin experiencing symptoms?
- Are your symptoms ongoing or do they come and go?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, seems to worsen your symptoms?
Nov. 27, 2024