Brian,
Thanks again for taking the time to post to me. I have decided to go through with the tonsillectomy on Monday. If it is cancer, then I will move immediately to UAB (University of Alabama at Birmingham), which is a CCC and is ranked in the list linked from your site, both generally and for head and neck. Fortunately, it is local.

The ENT told me that the nodes are too small and soft to get a good needle biopsy. He did a CT scan of the neck, and the nodes are "borderline" suspicious in terms of size (1-1.5 cms). I have also read that needle biopsies can sometimes miss cancer and give false negatives. Thus, it seems that the only way to determine for sure whether this is cancer is to remove the nodes or remove the tonsil. Since there is presumably some possibility that there is cancer in the tonsil and not in the nodes, taking the tonsil out seems, although a bit extreme, probably the most conservative approach. Also, although this probably sounds a bit silly, I have a strong need to know as soon as possible whether this is cancer and do not really want to delay. If it is cancer, taking the tonsil out should not hamper the treatment plan that UAB will come up with, right?

As I told Mark, I hope that you are not offended that I sought your opinion, then did not follow your advice exactly. It is a huge help to hear from people who have been there and know so much more about this than I do. I also appreciate the advice about what to do if this is cancer, especially the part about a chest CT. My internist actually had a chest x-ray done before sending me to the ENT (because of the smoking history), and it was clear. But I would probably want more testing done for the known areas of likely metastisis. I will address this with the UAB people if I have cancer.

I hope I am making the right decision to go ahead with the tonsillectomy. I just want to know for sure what I am up against as soon as possible, and this seems to be the way of getting the most definitive answer.

Thank you again,
Jenn