David --

If you are a non-smoker and have tonsillar SCC, you may well be HPV positive -- this affects both prognosis and response to treatment (better) but you should be tested. If your hospital doesn't do it, Johns Hopkins does:

http://pathology.jhu.edu/labservices/hpv.cfm

There is a lot on the OCF web site and also, this forum, about HPV since it is now generally recognized as a major factor in some forms of this disease. Lots recently due to a paper published this month linking HPV to tonsillar and base of tongue cancers.

As to treatment, the recommended treatment for a stage III or IV oral cancer is chemoradiation. If it will make you feel any better, my husband (who had very similar experience as you with neck lump etc) and who was treated at Hopkins, says the chemotherapy was a "non-event" due to the excellent new antinausea drugs and careful oversight, the real difficulty was with the radiation and its side effects during treatment. The usual drug is cisplatin but the much less toxic drug carboplatin is being used more widely and you should ask about this (my husband got carbo- only).

IMRT is the most targeted form of radiation, and allow the radiologist to avoid the many deligate organs in the area of the throat, and helps preserve salivary function. Get on the OCF web site itself and look all this up before meeting with the doctor. Ask about salivary gland preservation, swallowing therapy, and pain and other side-effect management -- the PEG is there to help you stay hydrated and fed during treatment but you will need to try to continue to swallow (even tiny sips) during therapy to maintain the ability. It can be lost!

This road is hard but many get through and resume completely normal lives, so go into this with confidence and optimism...

Best,
Gail