Radical Neck Dissection
Radical neck dissection is an operation used to remove cancerous tissue in the head and neck.
The purpose of radical neck dissection is to remove lymph nodes and other structures in the head and neck that are likely or proven to be malignant. Variations on neck dissections exist depending on the extent of the cancer. A radical neck dissection removes the most tissue. It is done when the cancer has spread widely in the neck. A modified neck dissection removes less tissue, and a selective neck dissection even less.
This operation should not be done if cancer has metastasized (spread) beyond the head and neck, or if the cancer has invaded the bones of the cervical vertebrae (the first seven vertebrae of the spinal column) or the skull. In these cases, the surgery will not effectively contain the cancer.
Of the six hundred lymph nodes in the body, about 200 are in the neck. Only a small number of these are removed during a neck dissection. In addition, other structures such as muscles, veins, and nerves may be removed during a radical neck dissection. These include the sternocleidomastoid muscle (one of the muscles that functions to flex the head), internal jugular (neck) vein, submandibular gland (one of the salivary glands), and the spinal accessory nerve (a nerve that helps control speech, swallowing and certain movements of the head and neck). The goal is always to remove all the cancer but to save as many components surrounding the nodes as possible.
Radical neck dissections are done in a hospital under general anesthesia by a head and neck surgeon. An incision is made in the neck, and the skin is pulled back to reveal the muscles and lymph nodes. The surgeon is guided
Radical neck dissection is a major operation. Extensive tests are done before the operation to try to determine where and how far the cancer has spread. These may include lymph node biopsies, CT (computed tomography) scans, magnetic resonance imaging scans, and barium swallows. In addition, standard pre-operative blood and liver function tests are performed, and the patient will meet with an anesthesiologist before the operation. The patient should tell the anesthesiologist about all drug allergies and all medication (prescription, non-prescription, or herbal) that he or she is taking.
A person who has had a radical neck dissection will stay in the hospital several days after the operation, and sometimes longer if surgery to remove the primary tumor was done at the same time. Drains are inserted under the skin to remove the fluid that accumulates in the neck area. Once the drains are removed and the incision appears to be healing well, patients are usually discharged from the hospital, but will require follow-up doctor visits. Depending on how many structures are removed, a person who has had a radical neck dissection may require physical therapy to regain use of the arm and shoulder.
The greatest risk in a radical neck dissection is damage to the nerves, muscles, and veins in the neck. Nerve damage can result in numbness (either temporary or permanent) to different regions on the neck and loss of function (temporary or permanent) to parts of the neck, throat, and shoulder. The more extensive the neck dissection, the more function the patient is likely to lose. As a result, it is common following radical neck dissection for a person to have stooped shoulders, limited ability to lift the arm, and limited head and neck rotation and flexion due to the removal of nerves and muscles. Other risks are the same as for all major surgery: potential bleeding, infection, and allergic reaction to anesthesia.
Normal lymph nodes are small and show no cancerous cells under the microscope.
Abnormal lymph nodes may be enlarged and show malignant cells when examined under the microscope.
American Cancer Society. National Headquarters, 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS-2345). <http://www.cancer.org>.
Cancer Information Service. National Cancer Institute, Build ing 31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800) 4-CANCER. <http://www.nci.nih.gov/cancerinfo/index.html>.
The Voice Center at Eastern Virginia Medical School. (Febru ary 17, 2001). <http://www.voice-center.com>. (June 7, 2001).
John Thomas Lohr
Tish Davidson, A.M.
—Barium is used to coat the throat in order to take x-ray pictures of the tissues lining the throat.
Computed tomography (CT or CAT) scan
—Using x rays taken from many angles and computer modeling, CT scans help size and locate tumors and provide information on whether they can be surgically removed.
—Primary defense against infection in the body. The tissues, organs, and channels (similar to veins) that produce, store, and transport lymph and white blood cells to fight infection.
—Small, bean-shaped collections of tissue found in lymph vessels. They produce cells and proteins that fight infection and filter lymph. Nodes are sometimes called lymph glands.
—Cancerous. Cells tend to reproduce without normal controls on growth and form tumors or invade other tissues.
—Spread of cells from the original site of the cancer to other parts of the body where secondary tumors are formed.
Magnetic resonance imaging (MRI)
—MRI uses magnets and radio waves to create detailed cross-sectional pictures of the interior of the body.
QUESTIONS TO ASK THE DOCTOR
- What tests will you do to determine if my cancer has spread?
- Which parts of my neck will be removed?
- How will a radical neck dissection affect my daily activities after recovery?
- What is the likelihood that all my cancer can be removed with a radical neck dissection?
- Are the lymph nodes on one or both sides of my neck involved?
- What will my appearance be like after surgery?
- How will my speech and breathing be affected?