Tonsils come in a pair located at the back of your throat in an area known as the oropharynx. Their role is to help fight infection. Cancer can develop in your tonsils. Tonsil cancer is classified as head and neck cancer, throat cancer, and oropharynx cancer.

Tonsil cancer can develop even in people who’ve had their tonsils removed because a small piece of tonsil tissue may be left behind.

Many people with tonsil cancer may not notice any symptoms even after they’re diagnosed.

The number one symptom of tonsil cancer is having one tonsil larger than the other. Another common symptom is a persistent sore throat. Symptoms depend on the size of the cancer. It’s not uncommon for the first symptom to be a lump in the neck.

Other symptoms may include:

  • hoarseness or a change in your speaking voice
  • fatigue
  • unexplained weight loss
  • ear pain, especially on only one side
  • difficulty swallowing or opening your mouth
  • bleeding from your mouth

Having one or more of these symptoms doesn’t mean you have tonsil cancer. Several noncancerous problems cause the same symptoms.

But it’s important to see a specialist if you have a tonsil infection that doesn’t get better with antibiotics or unexplained ear pain that doesn’t go away. Doctors who specialize in problems in the ear, nose, and throat are called ENTs, or otolaryngologists.

In the past, the known risk factors for tonsil cancer were being older and using tobacco or alcohol. People who both smoke and drink heavily have double the chances of developing cancers in their throat.

Those are still risk factors, but recently more young people who don’t smoke or drink are developing tonsil cancer, as well as other cancers in their throat or head and neck. The connection seems to be human papillomavirus (HPV). HPV is a common virus associated with sexual contact. Tonsil cancer caused from HPV is a type of squamous cell carcinoma.

As with all cancers, tonsil cancer results from a combination of factors, including your genetics, behavior, and environment.

A primary care doctor may see symptoms that are common with throat cancer and try some medicines or tests to rule out other problems. If the diagnosis isn’t clear, your doctor may refer you to head and neck specialists for a cancer workup, which may include the following:

  • your complete medical history
  • a review of anything you’ve done to help ease symptoms
  • a thorough exam of your mouth, throat, neck, ears, and the inside of your nose
  • a check of nerves in your head and neck, done by having you stick out your tongue, lift your shoulders, and respond to having your face touched
  • a visual exam of the throat

The specialist may be able to exam your throat by looking into your mouth using a mirror and headlight. Or it may require placing a flexible tube with a camera down your nose, a test that’s called a flexible pharyngolaryngoscopy.

They may also use a combination of imaging tests, which may include:

  • a CT scan with contrast dye to see the size of the mass and its spread into your neck
  • an MRI scan, which may or may not involve contrast dye, to show more subtle details of the main mass and to check spread in your lymph nodes
  • a PET scan to see if there is a tumor when cancer is only found in a lymph node
  • a neck ultrasound to look at blood vessels and lymph nodes in the neck and thyroid gland (During this test, the doctor may use a needle to take a small sample of a tissue or a tumor, called a biopsy.)
  • chest X-ray to see if cancer has spread into your lungs

Confirming a diagnosis of tonsil cancer requires a biopsy. An ENT may be able to do this in the office using numbing medicine and either forceps or a fine needle. The removed cells are sent to a pathologist, who looks for cancer cells as well as for signs of HPV.

Sometimes a doctor will perform surgery with a laryngoscopy to get a biopsy. The biopsy may be a small piece of tissue or the whole tonsil.

Treatment for tonsil cancer depends on whether HPV is involved. In some cases, radiation may be the first treatment because it affects swallowing and speaking less than surgery does.

In many cases, surgery is the first treatment. Surgery may include placement of a feeding tube if the tumor’s size doesn’t allow you to get enough nutrition by mouth. Or surgery may include a tracheostomy, which is placing a breathing tube in the front of your neck and directly into your windpipe.

After surgery, other treatment may include:

  • speech pathology before radiation to learn strengthening and stretching exercises that enable you to keep the ability to swallow during treatment
  • dental work before radiation, as needed (It’s hard to heal from dental work during radiation treatment.)
  • radiation with or without chemotherapy
  • molecular targeting medicines called epidermal growth factor receptor (EGFR) inhibitors
  • microsurgical reconstructive surgery to help restore the look and use of your throat after removing large tumors or some bone

Throat cancer related to HPV seems to respond better to existing treatments and has better outcomes compared with throat cancer not associated with that virus. It’s often caught early, and that makes the chance of recurrence low.

Throat cancer not related to HPV is more likely to be at a later stage before it’s found. That means the cancer is larger and may have spread, which makes treatment more involved. This type of throat cancer is also more likely to recur.

Tips to prevent tonsil cancer

  • The best way to prevent cancer in the tonsils is to quit smoking any tobacco products or marijuana. Not chewing tobacco or using snuff also helps. Smoking is the largest cause of cancers in the head and neck.
  • Avoid being around smokers and in areas where smoking is common because secondhand smoke may also increase the chance of developing cancers in the head and neck.
  • Protect yourself from HPV by limiting the number of people you have sex with. Using a condom doesn’t protect you from HPV. Remember that HPV can also be spread during oral sex.
  • Protect your children from tonsil cancer in the future by allowing them to get the vaccine to prevent HPV infection before they have sex for the first time. The Centers for Disease Control and Prevention recommends that all preteen girls and boys get the HPV vaccination.
  • See your doctor and dentist routinely. Because both examine your mouth, they can help find tonsil cancer early.
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