unilateral asymmetric tonsils

[Jenny Wren]

I have had a much larger right tonsil since young. Throughout the years been to many drs. Not for my throat but for various reasons. They ask about my large palatine tonsil and I tell them it's always been that way. I never really seemed concerned about it. I was wondering what causes one of them to be so much more bigger than other. It seems to be a grade 3. The other is barely noticeable. Should I be concerned about cancer? Any googling I've done comes up as this is almost always a malignancy. Thanks. It has always been larger but I'm not sure if it's gotten bigger over the years. Scared.

[John Irlam, DO, FASCP]

You're very welcome!  I don't think there's much to worry about but stopping smoking in general is a good thing, even it it's such a small number of cigarettes.  I'm not sure as to why it's enlarged though.  We do have a LOT of lymphatic tissue in our mouths and throats (and that's what the tonsil is for, to help fight off pathogens) so I think it could swell in any direction.  I don't think there's much for concern still but you could always get it looked at by an ENT doc for piece of mind :)    

[Jenny Wren]

Is it normal to swell downwards? It's about  1 1/2" long. Runs down along side the throat.

[Jenny Wren]

Boy I had that post all mixed up, lol. I meant to say it sticks out about a cm and a half and is about an inch long. Thanks.

[Jenny Wren]

Forgot to add, I do not drink.

[Jenny Wren]

Thank you. I am soon to be 43. I am an occasional smoker, maybe a pack every two months. I believe it was within the last 20 years that Drs have mentioned it. I don't remember if I had lots of sore throats growing up but do know of twice (I think one was mono) that I had an extremely sore throat. Never went to doctor. I also had strep diagnosed a few hours after the birth of my son 18 years ago. I had been sick for three days before labor.  The right tonsil protrudes about 2 cm past the  palatine arch. It extends about 1 1/2 downwards  along throat. I have never paid much attention to it cause it was no concern. Couldn't even say if it's gotten bigger since the few doctors mentioned it cause I never worried about it since they didn't. I just know that they say your right tonsil is large. It's nice to know that 99.9% are benign. If it is enlarged because of scar tissue will it ever get bigger with recurrent infections? The left one is barely visible.  The enlarged one is bumpy (not smooth looking)with some deep crypts. I will keep an eye on it. Thank you kindly for your thoughts. :)

[John Irlam, DO, FASCP]

Hi Jenny,
Thanks for the question.  Unfortunately (or fortunately in this case) we aren't as symmetrical as the books would make us think.  At my institution we have a lot of adults have a/both tonsils removed for tonsillar enlargement, 99.9% of them which are benign.  I would really doubt that this is cancer if it's been life long.  Can  I ask how old you are?  Do you have a history of smoking or drinking?  The only definitive way to make a diagnosis would be for someone to take a good look at it (usually an ENT) and see if there is anything suspicious at which case a biopsy could be performed.  I would say the chances are extremely low of a malignant process from what you've told me but it might be worth checking out further if it would give you piece of mind.  Please let me know if there is anything else I can help you out with.
Thanks,
John