Tonsil cancer belongs to the large group of so-called oropharyngeal tumors, also known medically as oropharyngeal carcinomas. These affect around 0.5 to 2 cases per 100,000 inhabitants. Men are affected by oropharyngeal tumors three times more often than women. The peak age for these tumors is between the ages of 60 and 70.
Other oropharyngeal tumors are
Most tumors of the head and neck area are pathologically squamous cell carcinomas. Adenocarcinomas or lymphomas occur less frequently.
Smoking and excessive alcohol consumption are the biggest risk factors for tonsil cancer. Up to 85% of people with tonsil cancer have a history of smoking or heavy alcohol consumption.
In addition, infection with human papillomaviruses (HPV) is a significant risk factor for tonsil cancer. The HPV status of the tumors also has an influence on the treatment and prognosis of the disease. In the majority of HPV-positive cases, HPV-16 appears to cause tonsillar carcinoma.
Recent studies have also shown that a positive HPV status could be more favorable for the course of the disease than in HPV-negative tonsillar cancer. Here, 5-year survival rates of 80 % for HPV-positive carcinoma contrast with survival rates of 40-50 % for HPV-negative tumors.
As with many types of tumors of the oropharynx, tonsil cancer often lacks suitable preliminary stages. This makes it more difficult to detect a developing cancer.
The following, still rather unspecific symptoms can indicate tonsil cancer, among other things:
- Difficulty swallowing,
- persistent hoarseness and coughing,
- swelling in the throat area,
- bad breath and
- problems eating or drinking.

Tonsil cancer is a type of oropharyngeal carcinoma © Анна Богатырева | AdobeStock
The easiest way to inspect the oral cavity is a mirror examination. The ENT doctor uses a bright light and a mirror to assess the coloration and texture of the oral mucosa. If there are any abnormalities or visible changes in the tonsils, a tissue sample, known as a biopsy, is taken.
However, deeper anatomical structures cannot be viewed using a mirror. For this reason, imaging procedures are used, above all ultrasound examinations(sonography).
The doctor uses this method to examine the cervical lymph nodes(located on the head), among other things. If the tonsil cancer is already more advanced, the lymph nodes may contain metastases (secondary tumors).
In the search for metastases, doctors use computer tomography(CT) or magnetic resonance imaging(MRI). Both methods are also suitable for showing the exact location and extent of a primary tumor. This can be important for surgical planning.
In the case of advanced tonsil cancer, doctors use skeletal scintigraphy to examine the bones and spine. This allows them to detect possible bone metastases.
The staging of tonsil cancer does not differ significantly from the general T classification of tumors. A distinction is made depending on the size or extent of the tumor focus:
- T1 stage: tumor < 2 cm
- T2 stage: tumor 2-4 cm
- T3 stage: > 4 cm
- T4 stage: tumor has infiltrated surrounding tissue structures regardless of size. The most common sites are the neck, cheeks and the muscles at the base of the tongue.
In most cases, tonsil cancer is treated surgically as the treatment of choice: The tumor focus and surrounding tissue are surgically removed together. The experts ensure that a sufficiently large safety margin is maintained in the healthy tissue. This is to prevent tumor cells from remaining at the edge of the incision, which can later form new tumors (= recurrences).
Metastasis in tonsil cancer mainly occurs via the lymphatic system. For this reason, metastases in the lymph nodes in the head and neck area are also largely removed surgically.
The operation is sometimes followed by
follows.
The prognosis for tonsillar carcinoma depends very much on the stage at diagnosis. Metastases also have a negative impact on the course of the disease. Depending on the stage, the following 5-year survival rate for tonsillar cancer is given:
- T1 stage: approx. 80-90% of patients are still alive 5 years after diagnosis,
- T2 stage: approx. 70-75 %,
- T3 stage: approx. 40-50 %,
- T4 stage: approx. 10-35 %.
Tonsil cancer falls under the specialty of ear, nose and throat medicine, or ENT for short. Experts for tonsil cancer can be found in specialized oncological ENT clinics and practices. Other specialties are also involved, particularly in the area of diagnostics and treatment planning, for example from