What Brett Butler's Story Can Help Us Understand About Throat (Tonsil) Cancer

A sore throat that would not settle

Brett Butler was a center fielder, playing for the Los Angeles Dodgers in 1996. He is not the comedian of the same name.

The North State Journal set out his account in 2021. As he approached his 2,000th career hit, he had a sore throat that would not go away. He got it checked the following March, just before leaving for spring training.

A doctor found one tonsil swollen. Antibiotics were tried first. They did not work, so removing the tonsil was recommended.

Butler planned to put it off until after the 1996 season. He lasted two months. His wife came out from Atlanta to visit, saw his throat, and said waiting was foolish.

By the time surgeons took the tonsil out, it had grown three times larger than at the last check, and it held a tumor the size of a large plum. Two biopsies and a CT scan confirmed tonsil cancer.

The delay is the lesson

Nothing there was unreasonable. A sore throat is almost never cancer, antibiotics are a sensible first step, and wanting to finish a season is human. But the tumor grew during the wait, and by the time it came out the cancer had reached a lymph node.

NCI's rule for head and neck symptoms is about persistence rather than severity. A sore that does not heal. A sore throat that does not go away. Trouble swallowing. A change or hoarseness in the voice. A lump in the neck.

For the throat specifically, NCI lists pain when swallowing, pain in the neck or throat that does not go away, and pain, ringing or trouble hearing in the ears. Ear pain from a throat tumor is referred pain, carried along a shared nerve, and it catches people out.

The practical test: if it has not resolved in three weeks, or if antibiotics did not touch it, it needs looking at rather than more waiting. Our page on a sore throat as a sign of cancer covers what an examination involves.

Where the tonsils sit

NCI groups these cancers by region. The pharynx, or throat, is a hollow tube about 5 inches long, running from behind the nose down to the esophagus.

It has three parts. The oropharynx is the middle one, and it holds the soft palate, the base of the tongue, and the tonsils. Most head and neck cancers begin in squamous cells, the flat cells lining these surfaces. Our page on head and neck cancer covers the regions in detail.

Two different diseases in one place

Tonsil cancer has two main causes, and they have moved in opposite directions.

NCI names alcohol and tobacco as the two most important risk factors for head and neck cancers, and says the risk of using both together is higher than either alone. Smokeless tobacco counts.

The other cause is a virus. NCI states that infection with cancer-causing types of HPV, especially HPV type 16, is a risk factor for oropharyngeal cancers involving the tonsils or the base of the tongue. About three-quarters of all oropharyngeal cancers are caused by chronic HPV infection.

In the United States, HPV-driven oropharyngeal cancers are rising while those from other causes are falling. HPV status changes the outlook and the treatment plan, so it is tested on the biopsy. Our pages on HPV status in head and neck cancer and oral HPV risk go into both.

What treatment involved

Butler's course, as he described it, is a fair picture of the standard approach.

In May 1996 he had surgery to remove the lymph node the cancer had reached. Surgeons also took all the lymph nodes on the right side and back of his neck, plus a quarter inch of muscle around where the tonsil had been.

He spent just under a week in hospital, then had radiation five days a week for six weeks.

His description of the radiation is worth quoting because it is accurate and rarely said out loud. The first two weeks were easy. Around the fifteenth day, it hit. He compared it to sunburn that keeps burning, on the inside.

He returned to the field on September 6, less than four months after diagnosis, and played one more season. About ten years later he was treated for prostate cancer.

When to get checked

There is no routine screening test for throat cancer in the general population. What exists is this list, and a three-week rule of thumb.

• A sore in the mouth or throat that does not heal.
• A sore throat that does not go away.
• Trouble or pain swallowing.
• Hoarseness or a change in the voice.
• A lump in the neck.
• Ear pain or ringing on one side, with no ear problem found.
• A white or red patch on the gum, tongue or lining of the mouth.

Prevention has two clear levers. Not using tobacco, including chewing tobacco and snuff, and limiting alcohol. And HPV vaccination, which our page on the HPV vaccine covers.

The group picture

SEER combines oral cavity and pharynx cancers into one group, which is wider than tonsil cancer alone.

Five-year relative survival across that group is 69.9 percent for cases from 2016 to 2022. By stage it is 88.7 percent while confined to where it started, 69.7 percent once it has reached nearby lymph nodes, and 36.0 percent once it has spread further.

Fifty-five percent are found at that middle stage, with nodes already involved, which is where Butler's was. The median age at diagnosis is 65. For 2026 the American Cancer Society projects 60,480 new cases and 13,150 deaths in this group, a projection SEER republishes.

What this does not mean

Returning to elite sport within four months is not a benchmark, and it is not advice. It describes one man, one stage and one treatment plan.

He also described taking 90 pills a day and drinking juice mixtures. What treated the cancer was surgery and radiation.

The part that transfers is the beginning of the story, not the end. A sore throat that outlasts antibiotics is a reason to go back, not a reason to wait for the off-season.

Sources

• The North State Journal, Coping with a diagnosis: Former MLB outfielder Brett Butler — https://nsjonline.com/article/2021/10/coping-with-a-diagnosis-former-mlb-outfielder-brett-butler/
• NCI, Head and Neck Cancers Fact Sheet — https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet
• SEER Cancer Stat Facts, Oral Cavity and Pharynx Cancer — https://seer.cancer.gov/statfacts/html/oralcav.html

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

The National Cancer Information Foundation publishes Cancer Explained. This page is for learning. It is not medical advice and does not suggest a test or treatment.

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