The N staging is based on the extent of spread of cancer to the lymph nodes. Finally, the M stage indicates if the cancer has spread beyond the head and neck or not. T Staging
The basis of deciding the T stage depends on physical examination and imaging of the tumor. N staging
This stage is decided through the assessment of the lymph nodes. M staging
Based on the examination of the entire body. FInally, the stage is decided by concluding the above results and referring the following chart:

Treatment
The treatment for tonsil carcinoma includes the following methods:

Radiotherapy
Early radio-sensitive tumors are treated by radiotherapy along with irradiation of cervical nodes. The radiation uses high-energy X-rays, electron beams, or radioactive isotopes to destroy cancer cells. Chemotherapy
Induction chemotherapy is the treatment adapted for shrinking the tonsil tumor. It is given prior to other treatments, hence, the term induction. After the therapy is completed, the patient is asked to rest and is evaluated over a period of time. Then the patient is given chemo-radiation therapy (a combination of chemotherapy and radiation) to completely destroy the tumor cells. Surgery
If radiation and chemotherapy are unable to destroy the tumor, surgical intervention is considered. Excision of the tonsil can be done for early superficial lesions. Large lesions and those which invade bone require wide surgical excision with hemimandibulectomy and neck dissection (Commando operation)

Combination therapy
Surgery may be combined with pre- or post operative radiation. Chemotherapy may be given as an adjunct to surgery or radiation.
Tumor extension
Extension of the tumor to the base of tongue reduces the chances of cure drastically. It also increases the chances of recurrence after treatment. Metastasis
Spread of cancer cells to local structures like tissues, vessels, large nerves and lymphatics worsens a patients prognosis.A study that analyzed the survival rate in HPV-related oropharynx carcinoma to that in HPV-unrelated oropharynx carcinoma. The study revealed that based on the HPV status of the patient, for STAGE III and STAGE IV oropharynx carcinoma, there was a discrepancy in survival after three years. The survival was 82% in HPV positive and then also 57% in HPV negative cancers. References


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