It's a reasonable question. I think if you consider the known pathways of metastasis of oral SSC, that some plausible answers might reveal themselves. This is the way it was explained to me, by a viral oncologist.

We know that SCC does not arise as a primary lesion in cervical lymph nodes, but it is the site of secondary lesions and disease. It is on a well established pathway originating from other lymph tissues in the oral environment, and the place most likely for regional metastasis to occur. The tonsils themselves are part of system of lymphatic type tissues that are charged with the removal of the debris of cellular battles, infections and the like, along with other oral structures like the lingual tonsils on the periphery of the left and right posterior tongue and even the lymph type tissue which covers the base of the tongue, and are all connected. The detritus they collect moves in one direction - oral to cervical to clavicular to thoracic.

We also now know that HPV is attracted and prospers in these same tissues. Oral HPV infections are, as in most HPV transfers, an issue of epithelial surface cells coming in contact with similar tissues or with free virus in other fluids, and not as in some other viral infections a result of a "infected" fluid transfer (blood, semen, saliva). Think of a virus floating in a medium or residing on the surface of a tissue, vs. a virus living within the cellular structure of a medium. Children in grade school easily transfer benign HPV's to other children,s hands just by touching each other, no fluid involved. Those HPV's manifest themselves as benign warts. So the primary cancer site is intra-oral, the secondary metastasis is further downstream in the cervical nodes. If left long enough, it will progress further down the pathway into your chest.

If this premise is true, it is most likely that SCC was in your tonsillar tissues prior to being further down the known path in the nodes. When your tonsils were removed the cancer cells already resided in your cervical nodes. That a surgery released it to move is perhaps not impossible, but less likely than the very common occurrence of a primary spinning off micro mets for protracted periods of time (many months), before those small few cell size mets grow and prosper enough to actually be seen by any scanning technology that we have or other discovery method. While the spin off of micro mets is an on going process, the actual formation of a regional, new cancer site takes a long time to occur. I urge you to read this page on the main OCF web site http://oralcancerfoundation.org/facts/metastasis.htm which I wrote several years ago, but still describes the process properly in detail. So I think that what we see as a normal spread pattern, with occult disease already in the cervical nodes at the time of your tonsil removal, was the most likely, because it happens with regularity in most patients with regional spread.

As to the perio surgery, I am assuming that the periodontist wishes to graft tissue to overcome cervical mucous membrane recession. Since all of us with some degree of xerostomia have this problem, and it leads to chronic cervical caries issues, (which leads to crowns being done again and again as more teeth succumb to the problem) I would be curious to see how this works. Now ten years out and chasing cervical caries no matter what I do to prevent them, I would certainly be interested in some kind of solution. The perio people that I have talked to that are familiar with radiation patients, are not hot to do the surgery. The first reason is there is a loss of micro vascularization in those tissues, and because of that, healing may be a problem. The second is that the acute dry mouth that I have would only eventually impact the tissue around the cervical line of my teeth in the same manner again. So a lot of work and $ spent, only to end up in the same place again. If you choose this route, I would appreciate you continuing to post on it so we may all learn from your experiences.

As to the surgery triggering something negative more than this, I would put that out of your mind. If that were true, the many people that have various small surgeries intra-orally would be having recurrences associated with them, and that is not clinically seen.