Brushing my teeth in the morning, I felt something hard in the back of my throat. I looked in the mirror with a flashlight at the back of my throat and saw what appeared to be something very hard. It actually felt like I had something lodged there in a tonsil. I tried to scrape it off with my toothbrush, but it didn't come loose. I pushed on it with a cotton swab and it burst out like a core in a pimple or boil. It looks terrible. Should I have a culture of this tested? It is about the size of large grape and is tan color. Smells terrible.

G.

Until your penultimate sentence ("it is about the size of a large grape"), I thought we were dealing with a simple case of tonsillolithiasis (tonsil stones). In tonsillolithiasis, the deep pits of our tonsils (the crypts) accumulate sloughed, dead mucous-membrane cells. This dead material may stick together, forming a hard, tiny, white or yellow ball. It smells bad because bacteria just love to feed on this dead stuff, and bacterial waste products are malodorous. Tonsilloliths, however, are usually pea-sized or smaller.

But ... a "large grape"? I suppose this could be the tonsillolith from hell, but the shear SIZE of this thing makes me wonder about other possibilities. In particular, we need to consider the possibility of tonsil cancer.

Tonsil cancer occurs most commonly in men (the male-to-female ratio is a whopping four to one) aged 40 to 70. Usually, there is a history of heavy use of alcohol and tobacco. Early diagnosis and treatment are absolutely vital to preserve any chance of survival.

Cancers, as they grow, will sometimes outstrip their blood supply. The central (older) portion of the cancer dies due to this poor blood supply. As with tonsilloliths, bacteria love to feed on this dead tissue. The result would be an off-color lump of smelly dead stuff.

You REALLY need to have your tonsil looked at by a doctor, preferably an ENT (ear, nose and throat doctor). If you are male, have a long smoking/drinking history, and if the tonsil still looks nasty, then you should see your doctor TODAY. On the other hand, if you are a young woman who has never smoked and drinks rarely or not at all, and if the tonsil looks fairly normal, then there's a fairly good chance that this is not a cancer, just the tonsillolith that ate Manhattan ... but you must still see an ENT to be certain of this. It is an unfortunate fact of life that cancer can strike the young and innocent.