Treating tonsil cancer

The main treatments for tonsil cancer are surgery, radiotherapy and chemotherapy. You might have a combination of these or one treatment on its own.

The tonsils are part of the oropharynx and treatment is similar to other cancers of the oropharynx.

Treatment by stage

Staging is a way of describing the size of cancer and how far it has grown. We have information about treatment for early and advanced cancer. Your doctor will tell you more about the stage of your cancer and the treatment you will have.

There is an increase in the number of tonsil cancers that are related to a virus called human papilloma virus (HPV). The stage of your cancer depends on whether your cancer cells contain the HPV or not.  

Early stage tonsil cancer

Early tonsil cancer means a tumour that is small and is contained within the tonsil.

You might have either:

• surgery to remove the cancer and some of the lymph nodes in your neck or
• radiotherapy to the throat and neck

You might need radiotherapy or chemoradiotherapy after surgery if your doctor thinks there is a high risk that your cancer will come back. Chemoradiotherapy means you have chemotherapy and radiotherapy together.

Locally advanced and advanced tonsil cancer

This means the tonsil cancer has grown outside the tonsils to nearby tissue (locally advanced). Or it has spread to other parts of the body (advanced).

You might have:

• chemotherapy and radiotherapy together (chemoradiotherapy) to your throat and neck
• surgery to remove the part of the throat affected by cancer and some of the lymph nodes in your neck, followed by radiotherapy or chemoradiotherapy
• radiotherapy on its own

You might have chemotherapy before surgery if your cancer is very large, although this isn't very common.

You usually have a PET CT scan a few months after chemoradiotherapy. This is to check if your lymph nodes contain cancer. If there are signs of cancer, you usually have surgery to remove the lymph nodes.

You might have radiotherapy, chemotherapy or surgery to control symptoms of advanced cancer.

Surgery

You might have an operation to remove the part of the throat that contains the cancer. There are different types of operation. The type of surgery depends on where exactly the cancer is and the size of your cancer.

Early cancers

You might only need a simple operation if your cancer is very small. You can sometimes have this using local anaesthetic or with laser surgery. So you don't need to stay overnight in hospital. 

Usually surgery for early stage cancer is through your mouth (endoscopic surgery). This is also called:

• transoral laser microsurgery (TLM) 
• transoral robotic surgery (TORS)

The surgeon might also remove lymph nodes in some areas of your neck. This is called a selective neck dissection. They send the nodes to the laboratory to check them for cancer cells. 

If there is cancer in the lymph nodes you might need to have more surgery to remove more nodes.

Larger cancers

For larger cancers, you may need a more complicated operation and need to stay in hospital for a while.

For the most complicated surgery, you might have part of your soft palate or the back of your tongue removed. Your surgeon rebuilds this with tissue taken from another part of the body. 

Possible problems after surgery

You will have some pain after most types of surgery, but this is usually well controlled. Your doctors and nurses give you painkillers by drip, tablets, or liquids if you need them.

Having an operation to your mouth may affect eating and drinking for a while afterwards. 

Talk to your doctor or specialist nurse before your operation. You can ask them how it will affect you and what support there is.

Radiotherapy

Radiotherapy uses high energy waves similar to x-rays to kill cancer cells. You might have radiotherapy:

• on its own as your main treatment or after surgery
• combined with chemotherapy (chemoradiotherapy) as your main treatment or after surgery
• to help relieve the symptoms of advanced tonsil cancer

You have radiotherapy to the part of the throat affected by cancer. And the doctor might also treat the lymph nodes in your neck.

You usually have radiotherapy treatment once a day for a few weeks.

Radiotherapy to the head and neck area can cause several side effects. These include a dry, sore mouth and taste changes.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer.

You might have chemotherapy combined with radiotherapy (chemoradiotherapy). The chemotherapy helps the radiotherapy work better. You might have this:

• after surgery if there is a high risk of your cancer coming back
• as your main treatment

Some people have chemotherapy to shrink the cancer before the main treatment, although this isn’t very common. This is called neo adjuvant treatment. 

The most commonly used drug is cisplatin. You might have this with fluorouracil (5FU). Some people have carboplatin instead of cisplatin.

The side effects of chemotherapy include feeling sick and lower resistance to infections. Your side effects also depend on the drug you have and whether you have it with other treatments.

Targeted and immunotherapy cancer drugs

Cetuximab (Erbitux)

Cetuximab is a type of targeted cancer drug called a monoclonal antibody.

You might have cetuximab with radiotherapy if you have squamous cell head and neck cancer which has spread close to the mouth and oropharynx. It is also given for mouth cancer that has come back after treatment or advanced mouth cancer.

You might have it in one of the following situations:

• your platinum chemotherapy (for example cisplatin or carboplatin) is not working
• you cannot have chemotherapy

Nivolumab  (Opdivo)

Nivolumab is a type of immunotherapy. This type of treatment stimulates the body’s immune system to fight cancer cells.

Nivolumab is available on the NHS in the UK. In England, Wales and Northern Ireland, you can have nivolumab if you have:

• squamous cell cancer that has come back or spread to other parts of the body
• had platinum based chemotherapy (such as cisplatin or carboplatin) and your cancer has started to grow within 6 months of having chemotherapy

In Scotland, the Scottish Medicines Consortium (SMC) says that you can have nivolumab if your cancer continues to grow while on or after having platinum based chemotherapy.

You can have it for up to 2 years.

Pembrolizumab (Keytruda)

Pembrolizumab is also a type of immunotherapy.

It is a treatment for squamous cell cancer of the head and neck that has either:

• spread to other parts of the body (advanced) and has not been treated before
• has come back (recurred) and not been treated since it has come back

As well as the above, your cancer

• is not suitable for surgery
• expresses a certain amount of a protein known as PD-L1

You can have up to 2 years of treatment of pembrolizumab.

Research

Doctors and researchers are always interested in finding new ways to treat head and neck cancer.

Some tonsil cancers are caused by the human papilloma virus (HPV). Doctors know that HPV positive tonsil cancers respond well to treatment. They want to find out if these patients could have less intensive treatment.

Researchers are also looking at different treatment combinations for people with tonsil cancer. They want to compare how well the different treatments work and learn more about the side effects. For example, they are looking at different ways to give radiotherapy and drugs together. This might improve how well radiotherapy works.

In other studies, researchers are looking at targeted and immunotherapy drugs for head and neck cancers. They are trying to improve the treatment for people whose cancer:

• is at a high risk of coming back
• has spread or come back following treatment

Doctors want to work out when it’s best to have these treatments and to learn more about the side effects. Trials are looking at the following drugs:

• nivolumab
• atezolizumab

Coping

Coping with a diagnosis of cancer can be difficult. Being well informed about your cancer and its treatment can help. It can make it easier to make decisions and cope with what happens.

Talking to other people who have the same thing can also help.

Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people.

You can call our nurse freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.