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Tonsil Cancer

Tonsil cancer is a type of head and neck cancer which encompasses a wide variety of cancers that occur in the head and neck region, including areas such as the throat, salivary glands, tongue, nasopharynx, oral cavity, and tonsils. According to data from the Hong Kong Cancer Registry of the Hospital Authority, there are as many as 1,600 new cases of head and neck cancer each year.

The survival rate for tonsil cancer depends on the stage at which the cancer is diagnosed. Tonsil cancer is divided into four stages. If diagnosed at stage 1 or 2, the five-year survival rate is typically over 45%. However, if diagnosed at stage 3 or 4, considered late stages, the five-year survival rate decreases to 30% or lower. Generally, by the time tonsil cancer symptoms become apparent, it is already in the late stages.

Tonsil cancer tends to occur in individuals over the age of 45. There are many contributing factors, including a correlation with unsafe sexual practices.

Symptoms

The early symptoms of tonsil cancer may not be obvious, but as the disease progresses, common symptoms include:

Persistent sore throat
Difficulty or pain when swallowing
Lump or ulcer in the throat or mouth
Ear pain (without external infection)
Hoarseness or changes in the voice
Feeling of a foreign object in the mouth
Unexplained weight loss
Swollen lymph nodes in the neck
Persistent bad breath

Causes and Factors

The exact cause of tonsil cancer is not fully understood, but several risk factors are associated with its development:

Smoking: Long-term smokers have a higher risk of developing tonsil cancer.
Excessive alcohol consumption: Heavy drinking, especially when combined with smoking, increases the risk.
Human papillomavirus (HPV) infection: In particular, infection with HPV serotype 16 is closely linked to the development of tonsil cancer.
Immunosuppression: People with weakened immune systems, such as those with HIV or organ transplant recipients, are at higher risk.
Age: It is more common in adults over the age of 40.
Gender: Men have a higher risk of developing tonsil cancer compared to women.

Diagnosis

Clinical Examination	The doctor will examine the patient's mouth, throat, and neck lymph nodes for abnormalities.
Imaging Tests	CT, MRI, or PET CT scans can help determine the extent of cancer spread.
Endoscopy	An endoscope is used to observe abnormalities in the tonsil area directly.
Tissue Biopsy	A tissue sample is taken from the suspicious area for pathological analysis to confirm whether it is cancer.
HPV Testing	Testing to determine if the tumour is related to HPV infection.

Treatments

Surgery	Early-stage tonsil cancer can be surgically removed. For more advanced cancers, partial or complete removal of the tonsils and surrounding affected tissues may be necessary. Surgery is often combined with other treatments to improve recovery chances.
Radiation Therapy	Radiation therapy uses high-energy radiation to kill cancer cells and is especially effective for localized tonsil cancer. It can be used alone or with other treatments like surgery or chemotherapy. External Radiation Therapy: The most common method, where radiation is directed externally to target the cancerous area precisely. Intensity-Modulated Radiation Therapy (IMRT): A precise radiation therapy that adjusts the dose according to the tumour's shape and size to minimize damage to surrounding healthy tissues. Postoperative Radiation Therapy: If there are residual cancer cells after surgery or concerns about recurrence, doctors may recommend radiation after surgery.
Chemotherapy	Chemotherapy uses anti-cancer drugs to kill cancer cells, commonly used for advanced tonsil cancer or when it has spread to other areas. It can be used alone or in combination with radiation therapy or surgery. Adjuvant Chemotherapy: Used after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence. Concurrent Chemoradiotherapy: Radiation therapy and chemotherapy are given simultaneously to improve treatment effectiveness. This approach is often used in more advanced cancers, as chemotherapy enhances cancer cells' sensitivity to radiation. Neoadjuvant Chemotherapy: Given before surgery to shrink the tumour and make surgery easier.
Targeted Therapy	Targeted therapy focuses on specific molecular characteristics of cancer cells to block their growth and division. It is a more precise treatment option that interferes with the cancer's ability to spread.

FAQ

Tonsil cancer is not one of the most common cancers, but it does account for a certain proportion of head and neck cancers. With the increasing prevalence of HPV infections, particularly HPV type 16, the incidence of tonsil cancer has risen globally in recent years, especially in developed countries. According to cancer data in Hong Kong, the incidence of tonsil cancer is relatively low compared to other head and neck cancers, such as oral and laryngeal cancers. However, due to lifestyle changes (such as smoking and drinking) and the rise in HPV infection rates, the risk of this disease has increased in specific high-risk populations.

The high-risk age group for tonsil cancer is usually those over the age of 45. However, in recent years, many men have been diagnosed with tonsil cancer due to HPV infections acquired through oral sex, leading to a trend of younger patients being diagnosed.

The survival rate for tonsil cancer generally depends on the stage of the cancer at the time of diagnosis. Tonsil cancer is divided into four stages. For stage I and stage II (early-stage) tonsil cancer, patients who receive treatment have a five-year survival rate of over 45%.

As mentioned earlier, if tonsil cancer is diagnosed at stage III or IV (late-stage), it is considered advanced. At this stage, doctors usually recommend concurrent radiation therapy and chemotherapy, a treatment approach known as "chemoradiotherapy."

Since tonsil cancer is a type of head and neck cancer, surgery may lead to changes in appearance, swallowing difficulties, or speech impairment. Radiation and chemotherapy may also cause side effects such as loss of appetite, changes in taste, and frequent nausea.

Patients are advised to eat small, frequent meals instead of three large meals per day during treatment. They should consume high-calorie supplements, high-protein foods, and adequate minerals and vitamins if there is significant weight loss. However, patients should consult their doctor before taking vitamin supplements. During recovery, patients need to get nutrition from a variety of foods. If their appetite is poor, they can eat appetite-stimulating foods or drinks before meals to help improve their appetite.