Neck dissection is the formal name for removal of the lymph nodes in the neck. Neck dissection is commonly performed as part of the treatment for Head and Neck Cancer.
Each side of the neck contains 20-100 lymph nodes. Lymph nodes, commonly referred to as “glands,” are a part of the immune system. Lymph nodes act as a “filter” for conditions of the Head and Neck. They may enlarge in response to infection, inflammation, and tumors. They can even develop tumors of their own called lymphoma.
Malignant (cancerous) tumors of the Head and Neck can sometimes spread (metastasize). The first place that Head and Neck cancers will typically metastasize is to the lymph nodes of the neck.
The location of a lymph node metastasis is predictable, based on the location of the primary tumor site. If a malignant lymph node cannot be detected by examination or x-ray, it is called and occult node.
After malignant cells have been growing in a lymph node for some time, the lymph node/s enlarge. The nodes can often then be identified on exam, or by one or more types of diagnostic imaging (CT, MRI, PET scanning).
Depending on the staging (extent) of your Head and Neck Cancer, neck dissection might be recommended as part of your treatment plan. Neck dissection might be suggested early in the therapy or towards the end of your cancer treatment, depending on your particular circumstance.
We might recommend neck dissection even if there is no evident spread into your lymph nodes to help us determine if there has been occult metastasis. The presence of occult metastasis would then have significant implications in guiding what other treatments are necessary.
There are several types of neck dissection that we perform, and the particular type of surgery depends on your individual cancer. We will talk to you about whether or not it will be possible to preserve certain anatomic structures in your neck, depending on the type of neck dissection that your situation dictates.
Sometimes the neck dissection is performed upon both sides of the neck. Often, the neck dissection is performed in conjunction with surgery to remove the primary tumor also. Each individual situation is unique, and we will help you understand all the specifics of what we have recommended to you.
In general three types of neck dissection are performed:
Selective or Functional Neck Dissection: Only certain groups of lymph nodes will be removed. There are 6 lymph node regions in your neck as demonstrated in the diagram above. With a Selective or Functional neck dissection, several lymph node regions will be removed, depending on the location of your primary tumor. Usually this type of neck dissection is recommended in three situations: (1) to determine if there has been occult spread of your cancer, (2) to determine if all the cancer cells are gone after radiation and/ or chemotherapy, or (3) to remove a small malignant lymph node if surgery is the only treatment and no chemotherapy or radiation therapy is planned.
Modified Radical Neck Dissection: Most of the lymph nodes from the neck (from the jawbone to the collar bone) will be removed, along with either a muscle, nerve or vein (or combination of 2 of these structures). This type of neck dissection and the below described radical neck dissection are performed when there is evidence of more extensive involvement of lymph node metastasis.
Radical Neck Dissection: Nearly all of the lymph nodes from the neck will be removed, along with a muscle (sternocleidomastoid muscle), a nerve (cranial nerve XI – spinal accessory nerve), and a vein (internal jugular vein). It is important to understand that it is generally safe to remove one of the internal jugular veins, as there are multiple other veins (including the opposite neck internal jugular vein) to allow for continued return of blood to the heart.
At Suburban Ear, Nose & Throat Associates, we take great pride in helping you understand your treatment plan. Care of our Head and Neck cancer patients is a life-long commitment, and we will develop a long term relationship of support and careful follow-up.