After induction of anesthesia by the anesthesia colleagues, a rigid tracheoscopy is performed under laryngoscopic control, revealing the endolarynx, the subglottic region and the trachea up to the carina, intubation by the surgeon without any problems. Subsequent positioning. First perform flexible esophagogastroscopy. For this, enter with the gastroscope under laryngoscopic control. Easy visualization of the stomach. The stomach is inconspicuous and clear, as is the oesophagus on reflection. Now enter with the Kleinsasser tube under dental protection after inspection of the inconspicuous oral vestibule. Inspection of the oral cavity, including the floor of the mouth, tongue and soft palate. First inspection of the endolarynx. As described above, this is completely normal and clear, as is the hypopharynx, which can be easily adjusted up to the esophageal inlet and the tips of the piriform sinus. Inspection of the oropharynx. A clear tonsillar hyperplasia on the left with intratonsillar thickening and coarse changes is clearly suspicious, but based on the palpation findings it is more likely to be an intratonsillar tumor than a lymphoma. The rest of the oropharynx is unremarkable and free except for a left-sided circumscribed vallecula cyst. Demonstration of findings also on <CLINICIAN_NAME>. Subsequently, in case of cT2 tonsillar carcinoma, perform a right tumor tonsillectomy. For this purpose, incision at the anterior palatal arch with subtotal removal of the anterior palatal arch. Resection of the tonsil, leaving a muscle cuff on the tonsil. Mucosal resection distance of a good 1 cm on all sides. Removal at the transition to the tongue base tonsil, also including a muscle cuff in the area of the posterior palatal arch. Extubation of the tumor which is macroscopically resected in sano with a sufficient safety margin on all sides in the mucosal area and also in the soft tissue area. The specimen is thread-marked and sent for urgent histology. Careful hemostasis. Multiple checks and completion of the procedure without any indication of complications. Conclusion: Intraoperative high-grade suspicion of cT2 cN2a tonsillar carcinoma on the right. If this is confirmed histologically, neck dissection of the right side should be planned for a second time, as well as a CT thorax to complete the staging. If an R-1 situation persists despite further macroscopic in sano resection, a subsequent resection in the basal area with delayed neck dissection must be planned. Alternatively, neck dissection with the option of flap coverage.