Be guided by your doctor, and if needed, they can do a FNAB, Fine Needle Aspirational Biopsy, on the palpable lymph node, even if it's not, with UltraSound Guidance. They do the pathology of the sample taken to show if it's cancer or not, if HPV, and other histology possibly not cancer related, which samples takes 10 minutes to obtain, is relatively painless, in a medical office/hospital, most times with a pathologist, all mine were.

All my office flex scopes, 3, with two separate doctors, showed no sign of cancer in the oropharynx or oral cavity, but did through an FNAB of the lymph node, so they knew I had HNC most likely, and subsequent pandendoscopy, with surgical biopsy, proved positive for small T1 tonsil cancer. Not saying it is, but HPV tonsil/bot may grow faster in the node than in the primary in the oropharynx due to the nutrient rich lymphatics, which also can be microscopic, and not seen visually or by scan or died off at the primary from lack of nutrients when it metastasizes.

A small percentage of patients have an unknown primary that is never found, although the node proves positive, but most eventually are through a PET/CT scan, Ebstein Barr testing, which could indicate nasopharynx, and HPV, in the oropharynx.

Good luck, and hopefully the matter resolves on its own.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs