Cancer of the Tonsils

Cancer of the tonsils occurs when cells on the outside of the tonsils become abnormal and start to grow out of control. This usually starts in very thin, flat cells that line the surface of your mouth (squamous cells). Cancer cells can spread and form a mass of cells called a tumor. The cancer may spread deeper into the tonsils, or it may spread to other areas of the body (metastasize).


The exact cause of cancer of the tonsils is not known. However, some risk factors make this more likely:

  • Use of tobacco products, including cigarettes, pipes, cigars, smokeless (chewing) tobacco, and snuff. This is the number one risk factor of cancer of the tonsils.

  • Male gender.

  • Age of 50 years or older.

  • Frequent use of alcohol.

  • Human papillomavirus (HPV) infection.

  • Poor oral hygiene (not brushing or flossing your teeth regularly).


  • One tonsil that is larger than the other.

  • A sore throat (on just one side) that does not go away on its own or after receiving treatment.

  • A sore or lump on a tonsil that does not go away.

  • Difficulty swallowing or chewing.

  • Ear pain.

  • Bad breath.

  • Bleeding in your mouth.

  • A lump on your neck.

  • Difficulty when trying to open your mouth.


To diagnose cancer of the tonsils, your caregiver may perform the following exams:

  • A physical exam of your tonsils for a sore or lump. Your caregiver will also look at other parts of your mouth, throat, and neck. Your caregiver may use a mirror with a long handle or a thin, flexible tube with a tiny light and camera at the end (fiberscope) to see the back of your mouth.

  • Removal and exam of a small number of cells (biopsy) from your tonsils or a lump on your neck. The cells are checked for cancerous formations under a microscope.

  • Imaging exams, such as X-rays of your mouth and neck. The images can show if there is an abnormal mass.

If you do have cancer, your caregiver will stage your cancer. Staging provides an idea of how advanced your cancer is. The stage of your cancer depends on how much your cancer has grown and if it has metastasized. The meaning of the stage depends on the type of cancer. For cancer of the tonsils:

  • Stage I means the cancer is the size of a peanut or smaller. It has not metastasized.

  • Stage II means the cancer is larger than a peanut, but not larger than a walnut. It has not metastasized.

  • Stage III means the cancer has grown larger than a walnut. It may have spread to a lymph node or lymph gland on the same side of your neck as the cancer. (Lymph is a fluid that carries white blood cells all over your body. White blood cells fight infection.)

  • Stage IV means the cancer has spread to nearby areas. It may have spread heavily into your lymph glands. 


Treatment for tonsil cancer can vary. It will depend on the stage of your cancer and your overall health. Treatment options may include:

  • Radiation therapy. This uses waves of nuclear energy to kill cancer cells on your tonsils. It may be used for stage I or stage II cancers.

  • Surgery. This may be needed if the cancer has spread to your lymph nodes or if it has spread to other parts of your neck. A procedure may also be done to make it easier for you to swallow and talk.

  • A combination of radiation, drugs that kill cancer cells (chemotherapy), and surgery. This may be used for stage III and stage IV cancers.


  • You have pain in your throat or in your ear.

  • Your throat is numb.

  • You notice changes in the way you speak.

  • You notice changes in the way you swallow.

  • You notice a lump on your neck.


  • You have pain that gets worse. This may be pain in your throat or your ear.

  • You have bleeding in your mouth.

  • Your throat or neck swells.

  • You have difficulty swallowing.

  • You have difficulty breathing.

  • You have difficulty opening your mouth.

  • You have pain in your mouth.

  • You have a fever.