I was also diagnosed with tonsillar cancer (stage 4) in Aug.2002. I had one enlarged lymph node. The ENT doctor told me that he was pretty sure that it was cancerous without the biopsy of the node.

The surgery I had was tosillectomy, neck dissection, then radiation and weekly chemo. The radiation doctor told me later that the poorly differciated carcinoma was more sensetive to radiation than other type of cells, this maybe the reason some of the patients did not had the surgery to remove the tumor. Usually, if the doctor felt the lymph was cancerous, neck dissection is necessary, even one has radiation + chemo treatment. If the lymph node shrank to nothing after the radiation, "salvage" surgery maybe avoid, but people usually have them revoed just for sure.