Treating tonsil cancer
The main treatments for tonsil cancer are surgery, radiotherapy and chemotherapy. You might have a 
of these or one treatment on its own.
The tonsils are part of the . Treatment for tonsil cancer 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.
An increase in the number of tonsil cancers are related to a virus called . The stage of your cancer depends on whether your cancer cells contain the HPV or not. However, this doesn’t affect your treatment. There is not enough evidence to change someone’s treatment based on whether or not they have HPV.
Early stage tonsil cancer
Early tonsil cancer means a that is small and 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
If your doctor thinks there is a high risk that your cancer will come back, you might need:
- radiotherapy
chemoradiotherapy after surgery
Locally advanced and advanced tonsil cancer
Locally advanced tonsil cancer means the cancer has grown outside the tonsils to nearby tissue. Advanced tonsil cancer means it has spread to other parts of the body.
You might have:
- 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 10 to 12 weeks 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 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 suggest a selective neck dissection. This is when they remove lymph nodes in some areas of your neck. 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 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
-
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, between 4 to 7 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 .
You might have cetuximab:
- with radiotherapy for locally advanced
squamous cell mouth and oropharyngeal cancer - with platinum chemotherapy for squamous cell mouth cancer that has come back or has spread to other parts of the body
Nivolumab (Opdivo)
Nivolumab is a type of This type of treatment stimulates the body’s to fight cancer cells.
You have nivolumab if you have squamous cell cancer and:
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your cancer has come back or has spread to other parts of the body
-
you had platinum based chemotherapy, and your cancer has started to grow within 6 months of having chemotherapy
In Scotland, you can have nivolumab if your cancer continues to grow. This is while you are 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.
You might have pembrolizumab if you have squamous cell cancer and:
-
you haven’t had any treatment for an advanced cancer
-
your cancer has come back and you can’t have surgery to remove the cancer
-
the cancer shows a type of protein called programmed cell death ligand 1 (PD-L1)
Research
Researchers are always interested in finding new ways to treat head and neck cancer.
They are 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 giving chemoradiotherapy and immunotherapy drugs together.
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.
