My PET/CT report is done and, while I've not seen it yet, I'm told that it shows positive for a "persistent" node within that large (2 cm x 3.9 cm) mass.

At my request, my ENT surgeon has agreed to perform a needle biopsy, but he recommends surgery regardless of the biopsy result (since a negative biopsy could well be a false negative). I think he would have recommended surgery even before the PET/CT, based only on the previous CT.

One worry is that he's not sure he can spare the IJV or the SCM muscle (and still perform an oncologically sound procedure). Further, he indicated there is risk of damaging the SAN because of the location of the persistent node.

I'm still undecided, but open-minded. I have a meeting with my whole medical team scheduled for this Friday. I'll be interested in what they say... as well as seeing the report from the PET/CT and from the needle biopsy.

Are there alternative treatments to surgery? Would some additional radiation treatments (focussed on the lymph nodes, instead of the tonsils) make sense?

I also wonder about the potential for residual disease that might not be addressed by surgery.

Anyone have any thoughts about all this? What are the long-term downside effects of losing the IJV and/or the SCM muscle? What about the SAN? Where can I learn more about what to expect?