Head & Neck Cancer

Tonsil Cancer

Cancer of the tonsils is one of the most common types of head-neck cancer, occurring more commonly in men than women. It usually occurs between the ages of 40 and 80 years old. Tonsil cancer is normally diagnosed following the investigation of an enlarged tonsil or following the investigation of a lump in the neck.

Patients with enlargement of one of the tonsils or with a persistent swelling in the neck should be investigated by a specialist in ear, nose, and throat (ENT) surgery or head neck cancer. Usually, the condition is confirmed by a biopsy of the tonsil or neck.
If tonsil cancer is suspected, then usually a CT or MRI scan is performed in the first instance, and this is sometimes supplemented with a PET CT scan.

Treatments for tonsil cancer

For small tonsil cancer tumours confined to the tonsil then often surgical treatment with tonsillectomy is the treatment of choice.
For larger tumours or those that have spread to the neck then the commonest treatments are either with surgery followed by radiotherapy or with a combination of chemotherapy and radiotherapy without the need for surgery.

For those patients who choose to undergo surgery then, this usually entails a hospitalisation of a few days, and in most cases, radiotherapy over a 6-week period is required afterwards. In some patients, both chemotherapy and radiation are required.

For patients who prefer to avoid surgery, to reduce long term risk of damage to speech and swallowing, chemoradiotherapy treatment combines radiotherapy for head and neck cancer with chemotherapy drugs over a 6-week period.

Radiotherapy for tonsil cancer

Radiotherapy is an x-ray treatment which delivers high doses of radiation to the tonsil cancer area and neck.

These treatments are usually given every weekday treating Monday to Friday with weekends off over a 6 to 7 week period. The treatment requires attending the radiotherapy department at the hospital for treatment which takes around 30 minutes each day. During the treatment it is critical that the patient lies still, and a radiotherapy mask is used to make sure there is no movement of the head and neck during the treatment. This is just for a few minutes.

The radiotherapy mask is custom made for each patient. It fits tight around your face and neck and holds everything still during treatment. Many people are anxious about this and some find it claustrophobic. Usually after the first couple of treatments you get accustomed to it and listening to a favourite music sound track can also help relax you during treatment.

Chemotherapy is sometimes used with radiotherapy for tonsil cancer and it is either given weekly or on 2 occasions during the 6 weeks of radiotherapy. This involves an intravenous infusion of a drug. The most commonly used drug is called cisplatin.

Radiotherapy for tonsil cancer side effects

During your consultation, we’ll discuss the potential side effects anticipated with your particular type of radiotherapy in the areas you need to have treated.

In general terms side effects that occur during the radiotherapy treatment include soreness of the skin and lining of the throat which can affect swallowing and be painful. Skin care during radiotherapy for head neck cancer is important the mouth becomes dry and the mucus may be thickened. Fatigue is common. Loss of taste for certain food is frequently seen.

Long term side effects of tonsil cancer radiotherapy treatment are seen in 5 to 10% of patients and usually include reduced saliva production leading to a dry mouth and loss of taste which usually takes several months to recover. Swallowing function can be affected in the long-term but can be reduced by the use of IMRT.

What happens after radiotherapy for tonsil cancer?

Once the radiotherapy is completed and the immediate side effects of settled then patients are normally reviewed regularly by their oncologist and this is usually monthly in the first year with a clinic examination. Following completion of treatment CT and MRI scans are used and the PETCT scan is normally performed at 3 months. Long-term check ups are required after radiotherapy treatment for head neck cancer and usually will be every few months for at least 5 years.