The primary treatment for oropharyngeal cancer is radiation therapy to the tumor and lymph nodes. Surgery followed by radiation therapy is another option that may be considered in some cases. In more advanced stages, the primary treatment is often a combination of chemotherapy and radiation therapy, radiation therapy plus targeted therapy, or surgery followed by chemoradiation. For metastatic disease, the doctor may recommend chemotherapy, clinical trials, or palliative treatments intended to shrink tumors and relieve symptoms. The doctor may recommend any of the following treatments:
Surgery may be recommended to remove the tumor from the tonsil, throat or surrounding lymph nodes of the mouth. Depending on the size of the mass, minimally invasive robotic surgery may be recommended. Some doctors may use transoral robotic surgery, in which a robotic system is used to guide surgical tools in small spaces to remove oropharyngeal cancers like tonsil cancer. Transoral robotic surgery usually leads to fewer complications and a shorter recovery time. Another common surgery is a tonsillectomy, in which the tonsils are completely removed.
Radiation therapy uses waves of high-energy rays produced by a machine to destroy cancer cells. Doctors give radiation therapy to eradicate cancer either by itself or combined with surgery. Patients with head and neck cancer should meet with an oncologic dentist before this treatment, as radiation can cause tooth decay and other side effects when administered to the head and neck region. New techniques of radiation therapy can be more focused to treat the tumor and spare more normal, uninvolved tissues. This approach is referred to as Intensity Modulated Radiotherapy (IMRT).
Proton beam radiation therapy
Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, possibly resulting in less damage to healthy tissue and fewer side-effects.
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Doctors give chemotherapy to shrink the tumor before other treatments such as radiation or surgery or at times both. In more advanced stages in which the cancer has spread, chemotherapy may be the best treatment option to relieve symptoms and improve survival prior to treatment of the main tonsil cancer and lymph nodes with radiation or chemoradiation.
Chemoradiation is a combination of chemotherapy and radiation therapy and is a common treatment for advanced tonsil cancer. Combining these two treatments makes both more effective. Doctors give chemoradiation to destroy the tumor thus avoiding surgery in some cases, or to destroy any traces of cancer left after surgery.
Some cases of tonsil cancer contain cells that overexpress the EGFR protein, which causes the cancer to grow more aggressively. Targeted therapy specifically targets these cells, preventing the EGFR proteins from fueling cell growth.
Cancer immunotherapy is the use of the immune system to treat cancer and it is being increasingly used to treat many types of cancers. It has not become a standard treatment for tonsil cancer yet, but is being used more frequently in carefully planned clinical trials.
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.