Neck Dissection

Could someone explain to me why a neck dissection would not be done on every person diagnosed with neck cancer?

My husband was diagnosed with squamous cell in three lymph nodes.  Two lymph nodes were removed and one remaining lymph node remains but it is only very slightly enlarged.  I asked the doctor before chemo/radiation treatment why the lymph node that remains was not removed.  My exact question was:  "If you know something is there, why not go in and remove it?"  His answer was that, that is not the way this is treated.  I must add that when the first two lymph nodes were removed they originally thought they were fluid-filled branchiogenic cysts and it wasn't until they were removed that we were told they were, in fact, lymph nodes.

 I read in this forum about all the people have modified or radical neck dissections and I wonder why they don't perform these on every single patient?

Thanks for any reply.

 

Hi,

My mom just had a dissection in November and is currently having radiation and chemo because the cells surrounding the lymph node tumors were positive for cancer.

Her treatment is at U of C in Chicago.  Their protocol is radiation/chemo together as this is a good outcome of treatment. 

I would ask which section of the neck his lymph node tumor remains in and if if has anything to do with nerve damage as to why they don't remove it all.  The tumor that remains may be compromising something major, such as the juggular, etc. and radiation & chemo may be better to treat it if surgical removal is dangerous. 

That is a very vauge answer and I would want more explanation.  If this is not the treatment,  than what is?

Best to you and family, hope this helps.

Performing a neck dissection is sometimes a judgment call made by the physician in charge. If, after considering all aspects of the treatment and recovery, they decide that there will be no measurable benefit from performing the surgery they may opt out. As with all surgical procedures there are risks involved so they may not feel that the risks are worth the outcome. There is also a whole set of therapy concerns for after surgery that have to be taken into account.Statistically there are a few percentage points of difference between having the dissection and not in most cases but on an individual case basis the doctor may feel as though those differences are insignificant. I had chemo and radiation but was not given a dissection. One of the reasons in my case was that one of the involved lymph nodes was said to be inoperable and they figured that they could get it with IMRT. 

I hope this makes some kind of sense.

Joe 

With my SCC, stage IV diagnosis, they found-for sure-4 malignant lymph nodes on one side. I had cisplatin and IMRT, then a PET about 7 wks later. One node was still a bit over 1cm. My ENT oncologist decided to go ahead with a modified dissection. I wasn't happy about the thought of it, so got a 2nd ENT opinion as well as consulting my radiology and medical oncologists. All agreed-maybe a 1 in 3 chance there was still a node malignancy; BUT to be thorough and for peace of mind, do it. Kind of a "cover all bases" thing. As I wrote in an earlier post re dissections-it was not bad at all. Easy surgery and recovery-so much better than anticipated. I had a skilled surgeon; and have had very few side/after effects at all. Nothing like what I'd read about in the past  (which truly had scared me!) As it turned out-path was negative. Lucky for me; and I don't regret for one moment having the surgery. Gayle