What is tonsil cancer?

Tonsil cancer is also called tonsillar carcinoma and describes a malignant disease of the palatine tonsils. The disease belongs to the large group of so-called mouth and throat tumours, which are also called oropharyngeal carcinomas and are mostly squamous cell carcinomas. Men between the ages of 60 and 70 are on average three times more likely to develop an oropharyngeal tumour than women.

What are the causes of tonsil cancer?

Doctors assume that tonsil cancer is triggered by excessive smoking and alcohol consumption. In any case, almost 85 percent of all patients with tonsil cancer have a history of excessive nicotine and/or alcohol consumption. However, human papillomaviruses (HPV) can also contribute to the development of tonsil cancer. Studies have shown that the presence of HPV viruses can contribute to the course of the disease.

How can you prevent tonsil cancer?

Tonsil cancer can be avoided by avoiding the triggers of the disease, i.e. nicotine and alcohol. Since these two addictive substances have the reputation of causing other diseases as well, they should be avoided completely if possible. In addition, one should also pay attention to careful oral and dental hygiene in order to prevent tonsil cancer. This also includes regular preventive and check-up examinations at the dentist.

What are the symptoms of tonsil cancer?

Tonsil cancer can initially cause the following non-specific symptoms:

• Difficulty swallowing,
• long-lasting hoarseness and/or coughing,
• Swelling in the throat area,
• Bad breath,
• Problems eating and/or drinking

If you notice whitish discolouration in the oral cavity that lasts for more than 14 days, this can also be a sign of tonsil cancer. In any case, the discolouration should be checked out by a specialist at an early stage.

How is tonsil cancer diagnosed?

Tonsil cancer can cause changes in the oral cavity, which can nowadays be easily detected using modern examination methods. One possibility is a mirror examination. Here, the ENT doctor examines the condition of the oral mucosa using a bright light and a mirror. Possible discolourations can be noted. If there are any abnormalities in the tonsils (tonsils), the doctor will take a tissue sample (biopsy).

Since the mirror examination cannot diagnose any deeper anatomical structures, the doctor can also use other imaging procedures, such as an ultrasound examination (sonography). This mainly examines the (cervical) lymph nodes located on the head. If the tonsil cancer is already in an advanced stage, the lymph nodes usually contain metastases. In order to exclude a  metastasis, a computer tomography (CT) or a magnetic resonance imaging (MRI) is also carried out. Both procedures enable the doctor to determine the exact position and extent of the tumour. This information is crucial for surgical removal of the tumour.

What tumour stages are distinguished in tonsil cancer?

The tumour stages in tonsil cancer do not differ significantly from the general T-classification of tumours, which can be represented as follows, depending on the size and extent of the tumour focus:

• T1 stage: The tumour is smaller than 2 cm.
• T2 stage: The tumour has a size between 2 and 4 cm.
• T3 stage: The tumour is larger than 4 cm.
• T4 stage: The tumour has infiltrated the surrounding tissue structures. Such tumours are particularly common in the neck, cheeks and/or base of the tongue.

How is tonsil cancer treated?

Tonsil cancer is often removed surgically. This involves surgically removing the primary tumour and the surrounding tissue, making sure that there is a sufficiently large safety distance from the healthy tissue. The removal of the tissue surrounding the tumour is intended to prevent tumour cells from remaining in the body, which could form new tumours (recurrence) at a later time. If the tumour has already metastasised to the lymph nodes of the head and neck, these will also be surgically removed. Following surgery, further radiotherapy, chemotherapy or combined radiochemotherapy should be carried out.

What is the aftercare for tonsil cancer?

After the tumour has been surgically removed, the patient should attend regular check-ups so that any recurrence of the tumour can be diagnosed and treated at an early stage. In each case, a thorough clinical examination is carried out, which includes imaging diagnostics in the form of an ultrasound, CT or MRI examination. This is not only to rule out the possibility of the tumour forming again, but also to exclude the possibility of metastases. If necessary, a tissue sample (biopsy) can also be taken.

The intervals at which follow-up examinations should take place depend not only on the aggressiveness of the tumour, but also on its location and size. As a rule, follow-up examinations at intervals of 1 to 3 months are recommended for the first year. At a later stage, examinations can take place every 6 months and from the fifth year onwards, a check-up should take place every year.

The following follow-up therapies may be required as a result of the surgical removal of tonsil cancer:

• Voice and swallowing training to improve organ function,
• Pain therapy,
• Assistance to help the patient reintegrate into the social and professional environment,
• psychological care (psycho-oncology)

What is the prognosis for tonsil cancer?

As with other types of cancer, the earlier tonsil cancer is diagnosed, the better the prognosis. Studies have shown that for patients who test positive for the HPV virus, the 5-year survival rate of 80 per cent chances of cure is reduced to 40 to 50 per cent for those who do not test HPV-positive.