Testicular Cancer: Symptoms, Diagnosis, and Treatment for Those with Increased Risk Factors and Early Signs

Tonsil cancer belongs to the large group of so-called oropharyngeal tumors, also known medically as oropharyngeal carcinomas. These affect approximately 0.5 to 2 cases per 100,000 people. Men are three times more likely to develop oropharyngeal tumors than women. The peak incidence for these tumors occurs between the ages of 60 and 70.

Other oropharyngeal tumors include

• palatal carcinoma,
• carcinoma of the base of the tongue, and
• pharyngeal carcinoma.

Most tumors in the head and neck region are, pathologically speaking, squamous cell carcinomas. Adenocarcinomas or lymphomas are less common.

Smoking and excessive alcohol consumption are the greatest 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 papillomavirus (HPV) is a significant risk factor for tonsil cancer. The HPV status of the tumors also influences the treatment and prognosis of the disease. In the majority of HPV-positive cases, HPV-16 appears to trigger tonsil cancer.

Recent studies have also shown that a positive HPV status may be associated with a more favorable course of the disease than in HPV-negative tonsil 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 in the oropharyngeal region, tonsil cancer often lacks clear precursor lesions. This makes it more difficult to detect a developing cancer.

The following, still rather nonspecific symptoms may, among other things, indicate tonsil cancer:

• difficulty swallowing,
• persistent hoarseness and cough,
• swelling in the neck area,
• bad breath, and
• difficulty eating or drinking.

The simplest way to examine the oral cavity is with a mirror examination. During this procedure, the ENT specialist uses a bright light and a mirror to assess the color and texture of the oral mucosa. If abnormalities or visible changes are found on the tonsils, the doctor takes a tissue sample, known as a biopsy.

However, deeper anatomical structures cannot be viewed using a mirror. For this reason, imaging techniques are used, primarily ultrasound (sonography).

Using this method, the doctor examines, among other things, the cervical (head-level) lymph nodes. If the tonsil cancer is already more advanced, the lymph nodes may contain metastases (secondary tumors).

To search for metastases, doctors use computed tomography (CT) or magnetic resonance imaging (MRI). Both procedures are also suitable for determining the exact location and extent of a primary tumor. This can be important for surgical planning. In cases of advanced tonsil cancer, doctors use bone scintigraphy to examine the bones and the spine. This allows them to detect possible bone metastases. 

The staging system for tonsil cancer does not differ significantly from the general T-classification of tumors. Depending on the size or extent of the tumor, the following distinctions are made:

• Stage T1: Tumor < 2 cm
• Stage T2: Tumor 2–4 cm
• Stage T3: > 4 cm
• Stage T4: The tumor has infiltrated surrounding tissue structures, regardless of its size. Most commonly, these 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 and surrounding tissue are surgically removed together. During the procedure, experts take care to maintain a sufficiently large safety margin into the healthy tissue. This is intended to prevent tumor cells from remaining at the margins of the incision, which could later form new tumors (= recurrences).

In tonsil cancer, metastasis occurs primarily via the lymphatic system. For this reason, metastases in the lymph nodes of the head and neck region are also largely removed surgically.

Surgery is sometimes followed by

• further radiation therapy,
• chemotherapy (primarily with cisplatin), or
• combined chemoradiotherapy

.

The prognosis for tonsil cancer depends heavily on the stage at diagnosis. Additionally, metastases have a negative impact on the course of the disease. Depending on the stage, the 5-year survival rates for tonsil cancer are as follows:

• Stage T1: Approximately 80–90% of patients are still alive 5 years after diagnosis,
• Stage T2: approximately 70–75%,
• Stage T3: approximately 40–50%,
• Stage T4: approximately 10–35%.

Tonsil cancer falls within the field of otolaryngology, or ENT for short. Experts in tonsil cancer can be found in specialized oncology ENT clinics and practices. Other medical specialties are also involved, particularly in the areas of diagnosis and treatment planning, such as

• radiology,
• surgery, or
• pathology.

What are the common symptoms of tonsil cancer?

The most common symptoms of tonsil cancer include a persistent sore throat, difficulty swallowing, ear pain, and a painless swelling in the neck. Enlarged lymph nodes in the neck or weight loss can also be early signs. If symptoms persist for more than two weeks, you should see a doctor immediately.

How is tonsil cancer diagnosed?

Tonsil cancer is diagnosed through thorough medical examinations of the mouth and throat. CT scans, MRIs, or tissue samples are also used to assess the tonsil carcinoma and the characteristics of the tumor. Early diagnosis improves detection and significantly increases the chances of recovery.

What treatments are available for tonsil cancer?

Treatment for tonsil cancer depends on the stage of the disease and the patient’s overall health. Options include surgery, chemotherapy, and radiation therapy, or a combination of chemotherapy and radiation therapy. The goal of treatment is to remove tumor cells, stop the spread of cancer, and maintain the patient’s quality of life.

What risk factors contribute to tonsil cancer?

The most important risk factors include smoking, alcohol, poor oral hygiene, as well as HPV and the human papillomavirus. An HPV infection, in particular, increases the risk of tonsil cancer in the head and neck region. Genetic predisposition or chronic inflammation in the throat can also lead to tonsil cancer.

What are the chances of recovery from tonsil cancer?

The chances of recovery depend on the stage of the disease, the extent of the tumor, and early diagnosis. If tonsil cancer is diagnosed early, patients generally respond better to treatment. Therefore, it is important to have persistent symptoms carefully examined and to attend regular follow-up appointments after completing treatment.