Hi Shawna,
I second Mark's views that your dad's cancer may not be stage 4 in view of the small size of the lymph node. You need not guess the stage because the doctors can give you a definite answer. Moreover, for tonsil cancer, sometimes surgery may not be necessary if radiation and chemo are effective. In my case, I didn't need surgery after concurrent chemo and radiation treatment.Neither did I need any feeding tube or trach throughout or after treatment. Everyone is different and I always think that the team of doctors should design the best treatment. Don't worry.

Karen.