The tonsil can be swollen for a number of reasons, cancer could be one, and so can an infection. HPV does not present the same progression of cancer as tobacco related does. In fact, usually the first sign with HPV HNSCC is a swollen cervical lymph node, even before the primary has obvious signs, due to the high nutrients, blood in the neck, and reason why there are sometimes an unknown primary, around 5%, which 90% percent if the time the primary is in the oropharynx. Two ENT's could not see anything on the flex scope, palpitation in the back of my throat, except my neck lymph node, in level II, which is usually the first drainage area for the oropharynx, but there can be skip metastases.

After that I had a non infectious enlarged lymph show on my CT, then went for a FBAB, which confirmed metatastic cancer SCC in the node, then a PET/CT, and then a pandendoscopy to check the upper aerodigestive tract, and cancer was confirmed in the two tonsils from the biopsy. Also, HPV HNC usually does not involve other structures like tobacco related does, so some find no reason to do the largynoscopy, if HPV. My course of treatment was Induction chemo, as neo adjunct therapy, to be followed by 7 weeks Chemoradiation, and did not have a tonsillectomy or other surgery. For some reason, I never was or found out my HPV status, due to unforeseen circumstances, but back in 2009 treatments were the same, and not too much info out there with HPV, stats, as there is now.

There are a number of ways to approach, but I would like to have a PET first to see the size of the tumor, any other involvement, metastases, then a pandendoscopy, with biopsy, with HPV testing, pathology. If confirmed cancerous, then possibly removal after consulting with others, that's me, and I'm no doctor. Others had a tonsillectomy first, maybe with a larynoscope, a frozen section biopsy to confirm cancer before proceeding with surgery.

September/Oct is too far off, in my opinion, it could be aggressive, and if cancerous you're talking a month or two later to start treatment. Also, its good to get is a 2nd opinion. Sometimes later down the line some wish they did, I'm one of them, even though I had good doctors. Opinions, treatments and outcome can differ. Get copies for every test, even blood, you have for future reference, even if its positive or not, and just good info to know either way, and if you go for any consultation, it's asked for.

The only thing that can confirm cancer is a biopsy. The only curative treatment is surgery and radiation or chemoradiation, which chemo is added as a radiosensitizer to make radiation work better, reduce tumor size, but is not curative alone. I don't know about 75% chance of a swollen tonsil being malignant nor 20%. I believe the chance of HPV-16 exposure to has a 1% chance of turning cancerous in the population.

P.S. Stay off Dr Google Read the info supplied in the blogs, search, and the many links at the opening page.

Good luck.