Husband was dx tonsil ca and we have just completed Rt and chemo. Guess I am somewhat surprised they did not want to remove the tonsils. When I asked about this they said there was no reason because they were treated with the RT. makes sense to me, but also having them removed sounds reasonable too. They added because HPV + not necessary. Thoughts?

That's mainly the treatment plan now for HPV positive oropharyngeal cancer, Chemoradiation, and surgery as a last resort, being HPV is highly responsive to radiation, and even better with Chemoradiation. Some do a tonsillectomy before doing chemoradiation. Also, after having radiation, surgery is more difficult, have complications, and on adults there is risk of bleeding. If anything comes up suspicious on the post treatment PET/CT, usually done 3-6 months post treatment, they may remove. If they think it is still activity now, they can do an earlier scan, biopsy, and proceed from there. Doing surgery now just may be unnecessary, and would rather wait when it is.

Yours is not unusual, and is typically done. I hope this helps, and good luck on the scans.

Agreed with Paul. One thing my multiple oncologist consults agreed on was to try to limit the treatment to 2 out of 3 modalities (neck dissection/surgery, radiation, chemo). There are nccn treatment guidelines for head amd neck cancers which show the standard treatment protocols based on clinical staging. I'd post the link but copy paste on my phone doesnt work on this forum for me.

My docs decided against recommending a neck dissection/surgery because they thought it most likely that there would not be sufficient margins on the primary and I would still need chemo and radiation even with surgery.

Thanks for input. We have a PET scan at the 2 mo mark which first surprised not a PET ...seems like the darn radiation would cure anything with the shape it left his throat in.... And we will be praying like crazy that is the case! Always reassuring to get input and hear from others!

Good luck, most post treatment scans come back clear, other than inflammation, fibrosis. HPV positive has a much lower recurrence rate too, compared to HPV negative.

Hi Colleen,
New one here and already giving my opinion! Husband also diagnosed with tonsil cancer (right tonsil only). All scans showed clean for any spread, however our ENT surgeon believes in removing the tonsils and a neck dissection before treatment for best survival rate. Only his opinion. I know at MD Anderson in TX they do NOT do the surgery, as we have a friend who chose that path. He moved down there for 7 weeks of treatments, no surgery, and is doing just fine. In our case, the surgery is already behind us, so it is a mote issue. The good news is our tumor team feels very confident with the treatment proposed and gave us a 90% chance of no reoccurance.
When we pass the 5 year mark I will allow myself to believe it!
We will have 6 weeks of radiation along with a once weekly dose of Erbitux. We are getting a second opinion at The Siteman Cancer Center this week, but expect the same treatment from them. Our ENT was with Siteman for 12 years, so I am guessing they follow the same standard. Our journey began May 8 and we have been on a rollarcoaster all of this time. This forum has been a lifesaver for me to turn to with questions and concerns. Also, a great deal of support. Looks like we are going through this one together at about the same time. Good luck to both of us and we shall celebrate when it is all over!

My best to you!
Nancy

My Team removed only my left Tonsil before Tx, they believe that this was/is the best course of action, but as long as the end result is all clear, then each battle plan is good!! Semper-Fi Bob

Good luck to you both Nancy, it is a roller coaster for sure! The recovery phase just as much a coaster, and we are still on. A day at a time.This site has been wonderful for answers , suggestions, and support . Stay connected !