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I had the exact same thing. I’m sure you know that the HPV P16+ is a good factor for treatment.
I had surgery to remove the tonsil and a difficult time settling on radiation treatment. I ended up getting referred for proton beam therapy at a hospital over an hour away.

After my surgery I had no demonstrable tumor or lymph involvement. So radiation treatment was complicated to prescribe. One Doctor wanted to include chemo but changed his mind after consulting with the “Tumor Board” at another hospital. But they say there were “positive margins” on the tonsil which indicated that cancer cells were left behind. So radiation was prescribed.

I finished treatment on 03/19/26. So I’m almost two months post treatment.

The proton radiation shredded the skin on my neck and really change the anatomy of my throat around the surgery area. It was difficult to open my mouth for about two weeks before I finished til about two weeks after. Still stiff.

My most significant side effect is that my throat opening has been changed in such a way that I can no longer expel phlegm through my mouth (Hock and spit). That seems to be a product of surgery and made worse by radiation. In short, my throat around the tonsil area is much smaller now. I seem to have a sinus condition that creates a lot of phlegm so I’m forced to swallow it.

My sinus’ are burning unless I irrigate with saline mist and throat spray. When I AM able to expel phlegm through my mouth it has had blood in it. The process of getting phlegm out through my mouth is almost like vomiting.
Sorry for all the disgusting mental images.

I’m hoping that my anatomy returns to close to what it used to be.

Hang in there!

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Replies to "I had the exact same thing. I’m sure you know that the HPV P16+ is a..."

Thank you for your input @sf2026. You are perhaps getting to the point of seeing some improvement now from all the radiation. It sounds like with the blood you are seeing that there is still a lot of damaged tissue to heal. Radiation burns heal slowly in my experience, and leave behind scarring and fibrosis that worsen with time. Staying on top of the changes is important and I wondered if you have a speech therapist and physical therapist to help with swallowing and jaw mobility? My radiation centered on the base of skull below ear but was photon so more collateral damage, but swallowing was not affected. Tongue control from facial paralysis postop was an issue with eating but I feel lucky that I could always swallow. A family member just completed proton radiation for tonsil/lymph node hpv + SCC and is relying on a PEG tube for nutrition with minimal swallowing. It seems that the patients who followup with regular swallowing exercises and supervision do the best.