The tonsil, a usually smooth, almond-shaped mound, can, if it appears subtly different—roughened surface, flecked with irregular white patches—be a cause of concern.
While tonsillitis, an inflammation of the tonsils, is a common occurrence, especially in children, some may experience a more concerning issue: tonsil cancer. In such cases, early detection becomes useful.
What is tonsil cancer?
Even though our tonsils protect us, they are not immune to cancer. Tonsil cancer means harmful tumours grow in the tonsils. These tumours usually start from unusual cell growth that can spread to nearby tissues if not treated in time. It is the most common type of throat cancer. Even those who remove their tonsils can get tonsil cancer from any tissue left behind after surgery.
The role of tonsils in defending our body
Tonsils are small organs at the back of the throat that are crucial to the body’s immune system. Acting as guards, our tonsils help trap and fight bacteria and viruses that enter our mouth and nose. It also helps our body defend against infections.
Types of tonsils
Tonsils come in different shapes and sizes, each playing a unique role in protecting our health. Here are the main types:
- Palatine tonsils: These are the most well-known tonsils located on either side at the back of the throat. Palatine tonsils are the ones most associated with tonsillitis and tonsil-related issues.
- Lingual tonsils: Found at the base of the tongue, lingual tonsils are less visible but still crucial for immune function. They help prevent infections in the throat and mouth.
- Pharyngeal tonsils (adenoids): Positioned high in the throat behind the nose, adenoids are tonsils that help fight infections. They are particularly active during childhood but tend to shrink in size as we age.
Symptoms of tonsil cancer
Dr H K Susheen Dutt, an ENT specialist at Fortis Hospital in Bangalore, suggests the following signs of tonsil cancer:
- Painful sore
- Ulcer on the tonsil
- Blood in the spit or mucus
- Earaches
- One tonsil getting bigger than the other
- Difficulty swallowing, speaking or chewing
“A key risk factor for tonsil cancer is the consumption of alcohol and tobacco in any form,” says Dr Dutt.
The early warning signs of tonsil cancer
- Persistent sore throat: If you have a sore throat that does not seem to go away despite treatment or persists for an extended period.
- One-sided throat pain: Unilateral or one-sided throat pain, particularly if it persists or worsens over time.
- Enlarged tonsil on one side: If one of your tonsils appears significantly larger than the other and this size difference persists.
Diagnostic procedures for tonsil cancer
- Biopsy of the tonsil: This procedure involves taking a small tissue sample from the suspicious area of the tonsil for examination under a microscope. A biopsy is considered the most accurate way to diagnose tonsil cancer
- PET scan (positron emission tomography): If there is a low suspicion of tonsil cancer based on initial examination and symptoms, a PET scan may be done first. PET scans can help detect cell metabolic activity, aiding in identifying areas of concern. However, if suspicion remains after a PET scan or if there are other concerning symptoms, a tonsil biopsy is still necessary for confirmation.
Understanding tonsil cancer stages
Dr Athira Ramakrishnan, consultant-ENT, Fortis Hospital, Bengaluru says that staging is critical in determining the course of treatment and prognosis for tonsil cancer patients. Dr Ramakrishnan delineates the four stages of tonsillar cancer, ranging from localised tumours in stage 1 to extensive spread in stage 4.
“In early-stage cases (stage 1 and 2), where the tumour is confined to the tonsil and measures less than or more than 2cm respectively, treatment protocols often yield favourable outcomes,” she says. However, as the cancer progresses to stages 3 and 4, involving lymph node spread or metastasis to distant organs, treatment complexity intensifies, necessitating a combination of surgical intervention, radiation therapy, and chemotherapy for effective management.
Treatment strategies for different stages
For early-stage tonsil cancers, treatment options typically include transoral robotic surgery (TORS) or radiation therapy alone. However, more advanced stages (3rd and 4th) often require a combination of treatments, such as surgery alongside radiation or chemotherapy combined with radiotherapy. “Recent research has highlighted a concerning link between oral sex with partners carrying the Human Papillomavirus (HPV) and an increased risk of tonsillar cancer,” says Dr Ramakrishnan. Notably, tonsillar cancer related to HPV infection tends to exhibit a slightly better prognosis and response to treatment compared to cases linked to tobacco use.
Proactive measures for tonsil cancer prevention
- Get HPV vaccination: Immunization against HPV can effectively lower the risk of developing this type of tonsillar cancer. Avoid high-risk sexual behaviour to reduce the chances of contracting HPV, a known risk factor for tonsil cancer.
- Quit smoking: Tobacco use is strongly associated with an increased risk of tonsil cancer. Quitting smoking can significantly decrease the likelihood of developing the disease.
- Limit alcohol consumption: Excessive alcohol consumption can also elevate the risk of tonsil cancer. Moderating alcohol intake can help mitigate this risk factor.
Takeaways
Tonsil cancer poses a significant threat, often linked to HPV infection, and tobacco and alcohol use. Early detection through recognising symptoms and diagnostic procedures is critical for effective treatment. By understanding risk factors and adopting preventive measures, individuals can reduce their chances of developing tonsil cancer.
