Where are the lymph nodes in the neck located. What is the purpose of a neck dissection. How is a neck dissection performed. What are the different types of neck dissections. What structures are involved in a neck dissection. How many lymph nodes are in the neck. What are the consequences of removing certain neck structures.

Anatomy of Neck Glands: Lymph Node Location and Function

The neck contains a significant portion of the body’s lymphatic system, with approximately 200 out of 600 total lymph nodes located in this region. These glands play a crucial role in the body’s immune defense and are often the first to respond to infections or cancerous growths in the head and neck area.

Neck lymph nodes are typically categorized into six zones, labeled I through VI. Each zone corresponds to specific areas of the neck:

• Zone I: Submental and submandibular regions
• Zone II: Upper jugular region
• Zone III: Middle jugular region
• Zone IV: Lower jugular region
• Zone V: Posterior triangle
• Zone VI: Anterior compartment

Understanding the location of these zones is crucial for diagnosing and treating various head and neck conditions, particularly cancers that may spread through the lymphatic system.

The Purpose and Importance of Neck Dissection

Neck dissection is a surgical procedure primarily performed on individuals with head and neck cancer. Its main purposes are:

1. To remove potentially cancerous lymph nodes
2. To allow pathological examination of removed nodes
3. To determine the extent of cancer spread
4. To guide further treatment decisions, such as radiation therapy

Head and neck cancers can originate in various locations, including the throat, mouth, tongue, thyroid gland, and salivary glands. These cancers have a tendency to spread through the lymphatic system to nearby lymph nodes. By removing and examining these nodes, doctors can better understand the extent of the disease and tailor treatment plans accordingly.

Cancer Spread Patterns in the Neck

Research has shown that different types of head and neck cancers tend to follow specific patterns when spreading to lymph nodes. For example:

• Mouth tumors often spread first to the upper neck zones (I, II, and III)
• Laryngeal cancer typically spreads to lower zones (III or IV)

This knowledge helps surgeons determine which zones to focus on during a neck dissection, depending on the primary tumor location.

The Neck Dissection Procedure: A Detailed Overview

A neck dissection is a complex surgical procedure that requires careful planning and execution. The main steps involved in the procedure are:

1. Making an incision in the neck
2. Identifying and preserving important anatomical structures
3. Removing lymph nodes from the targeted zones
4. Potentially removing the primary tumor site, if applicable
5. Closing the incision

Surgeons must navigate through various critical structures in the neck, including nerves, blood vessels, and muscles. The goal is to remove the lymph nodes while preserving as much healthy tissue as possible.

Concurrent Primary Tumor Removal

In many cases, the neck dissection is performed simultaneously with the removal of the primary tumor. For instance, if a patient has laryngeal cancer, part or all of the larynx may be removed during the same operation as the neck dissection. This approach allows for more comprehensive treatment in a single surgical session.

Critical Structures Involved in Neck Dissection

Three key structures in the neck are closely involved in a neck dissection procedure:

1. Internal jugular vein
2. Spinal accessory nerve
3. Sternocleidomastoid muscle

Each of these structures plays a vital role in normal neck function:

• The internal jugular vein is a major blood vessel that returns blood from the head to the heart.
• The spinal accessory nerve controls movement of some of the major shoulder muscles.
• The sternocleidomastoid muscle is a large muscle in the neck involved in head rotation and flexion.

During a neck dissection, surgeons strive to preserve these structures whenever possible. However, if cancer has invaded one or more of these structures, they may need to be removed to ensure complete tumor eradication.

Consequences of Structure Removal

Removal of these critical structures can have significant impacts on a patient’s quality of life:

• Internal jugular vein removal may affect blood flow patterns in the head and neck.
• Spinal accessory nerve removal can lead to shoulder weakness and limited range of motion.
• Sternocleidomastoid muscle removal may affect neck appearance and some neck movements.

Surgeons carefully weigh the potential consequences against the need for complete cancer removal when making decisions about these structures.

Types of Neck Dissection: Tailoring the Procedure

Neck dissections are classified based on the extent of lymph node removal and whether certain critical structures are preserved. The main types of neck dissection are:

1. Radical neck dissection
2. Modified radical neck dissection
3. Selective neck dissection

Radical Neck Dissection

A radical neck dissection involves the removal of all lymph nodes from zones I through V, as well as the internal jugular vein, spinal accessory nerve, and sternocleidomastoid muscle. This extensive procedure is typically performed when there is widespread tumor involvement in the neck.

Modified Radical Neck Dissection

In a modified radical neck dissection, lymph nodes from zones I through V are removed, but at least one of the three critical structures (internal jugular vein, spinal accessory nerve, or sternocleidomastoid muscle) is preserved. This approach aims to maintain more normal function while still addressing the cancer comprehensively.

Selective Neck Dissection

A selective neck dissection targets specific zones of lymph nodes based on the primary tumor location and likely spread patterns. This more focused approach helps minimize potential side effects while still addressing the most at-risk areas.

Post-Operative Appearance and Preserved Structures

Following a radical neck dissection, the appearance of the neck changes significantly. Key features of the post-operative neck include:

• Absence of the sternocleidomastoid muscle
• Removal of the internal jugular vein and spinal accessory nerve
• Preservation of vital structures such as the vagus nerve, hypoglossal nerve, and carotid artery
• Visible strap muscles, which help with throat movements
• Elevated skin flaps to provide optimal surgical exposure

The preservation of certain critical structures is crucial for maintaining essential functions:

• The vagus nerve supplies muscles in the throat and larynx
• The hypoglossal nerve controls tongue movements
• The carotid artery provides vital blood supply to the brain

Surgical Technique and Importance of Exposure

Successful neck dissection relies heavily on proper surgical technique and adequate exposure of the neck structures. Key aspects of the surgical approach include:

1. Creating appropriate skin flaps to expose the underlying structures
2. Careful identification and preservation of critical nerves and blood vessels
3. Meticulous dissection to remove lymph nodes while minimizing damage to surrounding tissues
4. Proper management of the surgical site to promote healing and reduce complications

The importance of good exposure cannot be overstated in neck dissection procedures. It allows surgeons to:

• Clearly visualize and identify important anatomical structures
• Safely navigate around critical nerves and blood vessels
• Ensure complete removal of targeted lymph nodes
• Minimize the risk of inadvertent injury to vital structures

Role of Advanced Imaging and Surgical Techniques

Modern neck dissection procedures often benefit from advanced imaging and surgical techniques, such as:

• Preoperative CT or MRI scans to map out the anatomy and extent of disease
• Intraoperative nerve monitoring to help preserve critical nerves
• Minimally invasive approaches for select cases, reducing surgical trauma
• Use of surgical loupes or microscopes for enhanced visualization

These advancements have improved the precision and safety of neck dissection procedures, leading to better outcomes for patients.

Recovery and Follow-up After Neck Dissection

The recovery process following a neck dissection can vary depending on the extent of the surgery and individual patient factors. Key aspects of the recovery period include:

1. Initial hospital stay for monitoring and pain management
2. Wound care and drainage management
3. Gradual return to normal activities and diet
4. Physical therapy to address any shoulder or neck mobility issues
5. Regular follow-up appointments to monitor healing and check for cancer recurrence

Patients may experience various side effects and challenges during recovery, such as:

• Pain and discomfort in the neck area
• Numbness or altered sensation in the neck and ear regions
• Shoulder weakness or limited range of motion, especially if the spinal accessory nerve was affected
• Changes in neck contour and appearance
• Swelling and fluid accumulation (lymphedema) in the surgical area

Long-term Follow-up and Surveillance

Long-term follow-up is crucial for patients who have undergone neck dissection. This typically involves:

• Regular physical examinations to check for signs of cancer recurrence
• Periodic imaging studies (e.g., CT, MRI, or PET scans) to monitor for any new or recurring tumors
• Management of any long-term side effects or complications from the surgery
• Coordination with other healthcare providers for comprehensive cancer care

The frequency and duration of follow-up appointments will depend on the individual patient’s risk factors and overall health status.

Advancements in Neck Dissection Techniques

The field of head and neck surgery has seen significant advancements in recent years, leading to improvements in neck dissection techniques. Some notable developments include:

1. Sentinel lymph node biopsy: This technique allows surgeons to identify and remove only the first few lymph nodes where cancer is likely to spread, potentially reducing the need for more extensive dissection.
2. Robotic-assisted surgery: In some cases, robotic systems can be used to perform more precise and less invasive neck dissections, potentially reducing recovery time and complications.
3. Improved reconstruction techniques: Advanced reconstructive procedures can help restore both function and appearance following extensive neck dissections.
4. Enhanced imaging technologies: High-resolution imaging techniques help surgeons better plan and execute neck dissections, improving accuracy and outcomes.

Future Directions in Neck Cancer Treatment

Ongoing research in head and neck cancer treatment may lead to further improvements in neck dissection procedures and overall patient care:

• Personalized medicine approaches based on tumor genetics and individual patient factors
• Immunotherapy and targeted therapies that may reduce the need for extensive surgery in some cases
• Advanced imaging techniques for more accurate preoperative staging and surgical planning
• Minimally invasive approaches for select patients, potentially reducing surgical morbidity

As these advancements continue to evolve, the management of head and neck cancer patients will likely become more tailored and effective, potentially improving both survival rates and quality of life outcomes.

Description of a Neck Dissection (Removal of the Lymph Nodes in the Neck)

EVMS Ear, Nose & Throat Surgeons

Head & Neck

Surgeons must be very careful
When they take the knife!
Underneath their fine incisions
Stirs the culprit,-Life!

Emily Dickenson

A neck dissection is an operation that is done for individuals with cancer of the head and neck. The purpose of this web page is to describe the reasons for this surgery, how it is done, and what to expect during and after the surgery.

PURPOSE OF A NECK DISSECTION

The purpose of a neck dissection is to remove the lymph nodes in the neck. The surgery is almost always done for individuals with certain types of head and neck cancer. (Head and neck cancer is often described as throat cancer, but it can also include cancer of the mouth, the tongue, the thyroid gland, the saliva glands, etc.) Cancer in this region can spread through the lymphatic system to adjacent lymph nodes. If there is concern that this type of spread may have occurred, a neck dissection can be done to remove the suspicious lymph nodes. There approximately 600 lymph nodes in the body, and 200 of this are located in the neck. A neck dissection is useful not only to remove the cancer, but also so that the nodes can be examined by a pathologist. If the microscopic examination by the pathologist shows extensive spread of cancer, additional treatment such as radiation therapy may be recommended.

This image shows the various regions of the neck where the lymph nodes are located. The neck is typically divided into zones (zones I through VI are shown on this diagram). Research has shown that tumors tend to follow certain trends in the manner in which the spread. For example, tumors of the mouth tend to spread first to the upper neck zone ( e.g. zones I, II, and III). Tumors lower in the neck, for example laryngeal cancer, tend to spread to lower zones (zones III or IV). 

HOW A NECK DISSECTION IS DONE

A neck dissection is done through an incision in the neck. There are many important anatomical structures, such as nerves and blood vessels, that run through the neck, and these structures are carefully identified and preserved in the course of the operation. If the original (also called primary) tumor is going to be treated with surgery, this tumor resection is usually done at the same time as the neck dissection. For example, if the primary site of tumor is the larynx (voicebox), a part or all of the larynx will be removed at the same time as the neck dissection.

OTHER STRUCTURES INVOLVED IN A NECK DISSECTION

There are three other important structures in the neck that are closely involved in a neck dissection. These are the internal jugular vein, the spinal accessory nerve, and the sternocleidomastoid muscle. The internal jugular vein is a major blood vessel through which blood returns from the head to the heart. The spinal accessory nerve controls movement of some of the major shoulder muscles. The sternocleidomastoid muscle is a large muscle in the neck.

During a neck dissection the surgeon will try to save the structures. However, if the tumor invades into one or all of these structures, one or all of them will have to be removed. The consequences of their removal is discussed below.

DIFFERENT TYPES OF NECK DISSECTION

Neck dissection are classified by the zones from which the lymph nodes are removed, and whether or not the three structures described above are preserved. If all the nodes are removed (zones I through V) and the three structures (internal jugular vein, accessory nerve, and sternocleidomastoid muscle) are removed it is called a radical neck dissection (radical is a misleading term; it just means that a complete neck dissection has been done). A radical neck dissection would be done if the tumor spread to the neck is quite extensive. If the nodes from zones I through V are removed and one of these three structures is preserved, it is called a modified radical neck dissection. And if the operation does not involve all five zones, it is called a selective neck dissection.  

‌The image to the left shows the appearance of the neck after a radical neck dissection. The sternocleidomastoid muscle, the internal jugular vein, and the spinal accessory nerve have been removed. The surgeon has saved the vagus nerve (which supplies the muscles in the throat and the larynx) and the hypoglossal nerve (which supplies the muscles that move the tongue). Also preserved is the carotid artery, which is extremely important for providing oxygen to the brain. The strap muscles are strap-shaped muscles that help raise and lower structures in the neck. Note that skin “flaps” have been elevated, which allows very good exposure to all the structures in the neck. Exposure is very important in surgery. The important structures to be saved must first be identified, and exposure is key to finding and protecting these nerves and blood vessels.

WHAT TO EXPECT AFTER A NECK DISSECTION

Recovery time from a neck dissection alone is quite quick. If a patient has only had a neck dissection, the total hospital stay may only be several days. However, the surgery is also done along with resection of the primary tumor site, and this can take longer. Considering only the neck dissection, there usually will be drains placed under the skin at the time of surgery to collect any serous fluid or blood that accumulates at the operative site. These drains will be removed after a couple days. Once they are out, and if the incision looks to be healing well, the patient can usually go home.

It is not unusual to develop some numbness in the neck skin and ear after a neck dissection. Much of the numbness goes away after several months, but some may be permanent. The nerve supplying sensation to the ear often must be cut during the surgery, and some of this sensation never returns. If you live in a cold climate, you will have to be careful since a numb ear can develop frostbite without first feeling cold or painful. The remaining numbness can be bothersome but seldom causes any major problems.

EFFECT OF REMOVING THE INTERNAL JUGULAR VEIN, THE SPINAL ACCESSORY NERVE, OR THE STERNOCLEIDOMASTOID (SCM) MUSCLE

As mentioned above, one or more of these structures may need to be removed in a neck dissection. Removal of one jugular vein usually causes minimal or no problems. There are many other veins in the neck and the blood can flow back through them. There may be some temporary swelling, but this usually decreases after a couple weeks. If a neck dissection is being done on both sides of the neck, the surgeon will try to save at least one jugular vein. Both veins can be removed at the same time, but the consequences of the swelling can be quite severe. Removal of the spinal accessory nerve limits the upward movement of the shoulder. In particular, it will be more difficult to move the arm from the horizontal position to directly overhead. There also may be some shoulder droop on the side of surgery, and there can be some mild pain due inflammation at the shoulder joint. If the spinal nerve is removed, post-operative physical therapy will be crucial to maintain good shoulder function.

Removal of one sternocleidomastoid muscle generally causes no problems. The neck may look a little sunken due to its removal. The muscle also provides some coverage of the carotid artery, so this will be reduced if the muscle is resected. This can cause a problem if there is a post-operative infection, but otherwise is not that important. If both sternocleidomastoid muscles are removed, one’s strength in flexing the head forward will be reduced.

OTHER POSSIBLE COMPLICATIONS OF A NECK DISSECTION

As mentioned earlier, there are many important structures running through the neck, and any one of these can be injured during a neck dissection. Nerves to the lower lip and the tongue are in the operative field, and if they are injured there can be reduced movement of the tongue. If this weakness occurs, it usually is temporary. Another nerve supplies some of the muscles in the lower lip, and these can become weak after the surgery.

As with any surgery, there are risks of bleeding or infection after surgery. If the bleeding or infection is severe, it may be necessary to go back to the operating room to treat the problem. The operation is done under a general anesthetic, and if there are pre-existing lung or heart problems this can increase the risk of a pneumonia or heart attack.

But the risk of a major complication after a neck dissection is relatively small, and almost always far outweighed by the benefits of the operation.

Thyroid Cancer | Cedars-Sinai

ABOUT

DIAGNOSIS

TREATMENT

Overview

The thyroid gland is located in the lower front of the neck, below the voice box (larynx) located in the upper part of the neck, and above the collarbones. Thyroid cancer (carcinoma) usually appears as a painless lump in this area. In most cases, the lump affects only one side, and the results of thyroid function tests (blood tests) are usually normal.

Over 35,000 new cases of thyroid cancer are expected in the United States every year. Women are two to three times more likely to have thyroid cancer than men. Thyroid cancer is most common after 30, but can develop at any age.

Related Conditions

• Hyperparathyroidism
• Hyperthyroidism
• Hypothyroidism

Symptoms

Many patients with thyroid cancer have no symptoms whatsoever. A lump on the thyroid gland may be found by chance on a routine physical exam or an imaging study of the neck done for unrelated reasons. Other patients feel a gradually enlarging lump in the front portion of the neck or have difficulty swallowing or speaking. Occasionally, the lump may cause a feeling of pressure or shortness of breath. Finding a lump in the neck should be brought to the attention of your physician, even in the absence of symptoms.

Causes and Risk Factors

The exact reason nodules grow in the thyroid gland is not known. But these factors increase the risk:

• Family History. If a parent or sibling had a thyroid nodule, the chance of developing a nodule is increased
• Age. The risk of developing a nodule increases as you age.
• Gender. Woman develop nodules more often than men
• Thyroiditis. Nodules are more likely to form in people who have chronic inflammation of the thyroid gland.
• Radiation exposure to the head or neck. Babies, children and teenagers were treated with radiation for birthmarks, acne or enlarged tonsils in the 1940s and 1950s. People who had these treatments have an increased risk. Exposure to nuclear power plant accidents (for example, the 1986 nuclear power plant explosion in Cherynobyl), or radioactive particles released into the air during atomic weapons testing also increases the risk.

Thyroid Cancer Types

Papillary Tumors

• Papillary thyroid cancers account for about 80 to 90 percent of all cases.
• Papillary tumors develop more often during 30 to 60 years of age.
• They occur three times more often in women than in men.
• The cure rate is usually 97 percent or better.
• Papillary tumors often spread to lymph nodes in the neck (about 25 percent of the time), but rarely spread to distant organs.
• Distant metastases to lung, bones and other sites are rare (<3 percent at time of initial diagnosis).

Follicular Thyroid Carcinoma (including Hurthle Cell Carcinoma)

• Follicular thyroid cancers are the second most common thyroid cancer, comprising about 15 percent of total cases.
• Follicular thyroid cancers usually develop during 40-60 years of age.
• They occur three times more often in women than men.
• The cure rate is typically 90 percent or better.
• Metastasis to the lymph nodes is less common than in papillary cancers
• Metastasis to distant organs (for example. lungs, bones, brain, or liver) is more common than with papillary carcinoma.

Medullary Tumors

• Medullary thyroid cancers are a rare type of thyroid cancer and accounts for about three to five percent of all thyroid cancer cases.
• It occurs more often in older adults.
• Metastasis to the lymph nodes is common at the time of diagnosis.
• Prognosis varies depending on extent of disease at time of diagnosis and post-operative calcitonin levels.

Anaplastic Tumors

• Anaplastic tumors are the least common type of thyroid cancer, making up only one percent of all thyroid cancer cases.
• The tumors grow rapidly, are difficult to treat and the cure rate is very low.
• The average age of onset is 65 years of age and older.
• Men are two times more likely than women to have anaplastic cancer.
• The prognosis is generally poor due to the aggressive nature of these cancers.

Diagnosis

A combination of symptoms, medical history, physical exams and tests are used to determine a diagnosis. Thyroid nodules are often found during a routine physical examination. Your doctor might feel an abnormal lump on the front of your neck.

Blood Work
The TSH blood test measures a pituitary gland hormone that stimulates the thyroid gland. If the TSH level is increased, the thyroid gland may not be functioning properly. Additional blood tests are needed to measure other thyroid hormones. Both pituitary and thyroid tests are required to confirm that the problem is located in the thyroid gland. Click here for more information on blood work for thyroid diagnostics.

Neck Ultrasound
Thyroid ultrasound uses painless sound waves to create an image of the thyroid gland and identify nodules. Ultrasound can show if a nodule is solid or a fluid-filled cyst, but it cannot determine if a nodule is benign or malignant.

Ultrasound Guided Fine Needle Aspiration Biopsy
Fine Needle Aspiration Biopsy (FNA). A needle is placed into the thyroid nodule, the cells are aspirated, and then examined under a microscope to determine if a nodule is cancerous.

Treatment

Surgery

The most important treatment for thyroid cancer is to completely remove the tumor along with the remaining thyroid gland (total thyroidectomy). Surgeons at the Thyroid Cancer Program are experts in the treatment of thyroid tumors. Using this type of therapy, the majority of cancers will be either cured or controlled and less than 20 percent will show progression. Most of the time, residual cancer can be treated with additional surgery or radioactive iodine. For resistant tumors, external beam radiation may be prescribed or the patient may be entered into a clinical trial with newer therapies or receive some existing targeted chemotherapies. Fortunately, most patients have an excellent prognosis when treated early by experienced physicians.

Radioactive Iodine

Radioactive iodine treatment has been prescribed for over 50 years and is often used to destroy residual thyroid tissue as well as any thyroid cancer that is remaining. It may be administered by swallowing a capsule after an individual has been off their thyroid hormone for a number of weeks (endogenous withdrawal protocol) or following two injections of thyrogen while the patient remains on thyroid hormone. The patient must be on a low-iodine diet for two weeks before the therapy and are usually hospitalized for two days in isolation in order to avoid environmental contamination with radioactivity. Two days after the radioactive iodine is given, thyroid hormone therapy is resumed if the patient has stopped their thyroid hormone. A full body scan is done at two days and seven days following the therapeutic doses of radioactive iodine in order to detect residual thyroid tissue. Since surgery removes the vast majority of thyroid tissue, much of the radioiodine will not be absorbed and will leave the body primarily through the urine. Small amounts will also be excreted in saliva, sweat, tears, vaginal secretions, and feces. Nearly all the radioactive iodine will leave the body during the first two days after the dose has been given.

Side effects are minimal and typically transient. The most common side effects include decreased taste, nausea, inflammation of the salivary glands or dry eyes. Nuclear medicine staff and your endocrinologist will provide you with more information should this be part of your thyroid cancer treatment.

External Beam Radiation

External beam radiation uses radioactivity from a high energy X-ray machine to destroy cancer cells. Malignant cells receive a high dose of radiation for approximately five minutes, during a six- to eight-week course of treatment. Side effects are fatigue, redness in the treated area, hoarseness or difficulty swallowing.

Targeted Therapies

Unlike other cancers, traditional chemotherapy has not been shown to be beneficial in the treatment of thyroid cancer. For thyroid cancers that have become resistant to radioactive iodine or which continue to progress despite surgery and/or external beam radiation, a number of new medications that target the biochemical abnormalities in thyroid cancer are available. Although none of these therapies are currently approved by the Food and Drug Administration for the treatment of thyroid cancer, a number of clinical studies have shown that they are reasonably effective in halting the progression of the tumor. As part of the Southern California Thyroid Cancer Consortium, Cedars-Sinai Thyroid Cancer Program physicians are well versed in the administration of targeted therapies and are kept abreast of current clinical trials on the west coast.

Follow-Up

Following surgery or other treatments, regular follow-up visits with an endocrinologist are very important to check for the return of cancer to the thyroid or the spread of cancer cells to other organs in the body. Monitoring of thyroglobulin levels with periodic blood tests is key to proper treatment. Consistently high levels of thyroglobulin can signal a return of the cancer. Depending on the size of the tumor, the rate of growth or how close it is to other organs, a physician may recommend further imaging diagnostics and treatment. Thyroid cancer can recur as late as 20 or 30 years after the original diagnosis or treatment, although if a patient remains cancer free for five years, the recurrence rate decreases.

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Biopsy of the lymph node on the neck: how is it performed, what shows how to take a biopsy of the lymph node on the neck in oncology?

The lymphatic system, which consists of lymphatic vessels and lymph nodes, performs important functions in the human body. First of all, this, of course, is protection against various pathogens, for example, pathogenic bacteria. The lymph nodes contain immune cells – T- and B-lymphocytes, macrophages (“devourer cells”).

When blood passes through the smallest blood vessels – capillaries – plasma is filtered. Some of the liquid part of the blood enters the surrounding tissues. Part of it is absorbed back into the bloodstream, and part enters the vessels.

This is how lymph is formed – a clear watery liquid that contains immune cells and some substances.

Lymphatic vessels gather into increasingly larger ones and finally merge into the right and left thoracic lymphatic ducts, which drain into veins. Thus, the fluid from the lymphatic system returns to the bloodstream.

In different parts of the body on the path of the lymphatic vessels there are lymph nodes – small (0.5–20 mm) rounded or bean-shaped formations. Lymph nodes are part of the body’s immune system, they play the role of mechanical and biological filters, they are a barrier to infectious agents and cancer cells.

Lymph nodes are located in groups in certain parts of the body. Some of them are located deep inside the body, for example, in the chest, others are under the skin.

Where are the lymph nodes located in the neck?

There are several groups of lymph nodes in the neck area:

• submental;
• submandibular;
• preglottal;
• jugular;
• parotid;
• behind the ear;
• occipital;
• back neck;
• supraclavicular.

During the examination, the doctor can feel them. If the lymph node is enlarged, it means that pathological processes are taking place in it. Most often, an increase in lymph nodes indicates inflammation, a purulent process, an infection, and sometimes an oncological disease.

What types of cancer cause enlarged cervical lymph nodes?

Some malignant tumors begin in the lymph nodes—these are called lymphomas. There are Hodgkin’s lymphomas and non-Hodgkin’s lymphomas. Metastases are much more common in lymph nodes – foci that develop from tumor cells that have penetrated from other organs.

The ability to metastasize is a common property of malignant tumors that distinguishes them from benign neoplasms. Some cancer cells break away from the primary tumor and enter the blood or lymph vessels. They migrate with the flow of lymph and blood, then settle in different parts of the body and give rise to secondary foci. If the tumor cell migrates through the lymphatic vessels, it first of all penetrates into the nearby (regional) lymph nodes.

Which malignant tumors can metastasize to cervical lymph nodes?

Malignant tumors of the head and neck often metastasize to the cervical lymph nodes: squamous cell carcinoma of the upper respiratory tract, cancer of the thyroid, salivary glands, and skin. In some cases, the primary tumor is located in another part of the body:

• breast cancer metastasizes to the neck in 2.3-4.3% of cases, but this is one of the most common causes of metastases in the cervical lymph nodes;
• lung cancer – in 1.5-32% of cases;
• cancer of the esophagus – in 20-30% of cases;
• in gastric cancer, Virchow’s metastasis is often found – in the lymph nodes of the left supraclavicular region;
• in rare cases, there are metastases in the cervical lymph nodes in liver cancer – hepatocellular carcinoma;
• kidney cancer – in 8% of cases;
• metastases in the cervical lymph nodes in bladder and ovarian cancer indicate a running process and an unfavorable prognosis;
• cervical cancer – 0. 1-1.5% of cases;
• cancer of the body of the uterus – 0.15% of cases;
• prostate cancer – in about 0.5% of cases;
• testicular cancer – 2.6-4.5%;
• malignant tumors of the central nervous system.

Is it easy to detect metastases in the lymph nodes?

This is often a difficult task. If there are still few cancer cells in the lymph nodes, then they are usually not enlarged, and the patient does not experience any symptoms. At the same time, it is very important for the doctor to correctly understand the situation and establish the correct diagnosis, because if the primary tumor is removed, but the lymph nodes into which the cancer cells have spread are not removed, a relapse will occur in the future.

Appointment for a consultation around the clock

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One of the most reliable and reliable ways to understand the situation is to perform a biopsy of the lymph nodes. This can be done in a number of ways:

• A fine needle biopsy is usually performed when enlarged lymph nodes are found under the skin. The procedure is performed under local anesthesia and lasts an average of 15-30 minutes. The doctor inserts a needle into the enlarged knot and receives some tissue.
• An open biopsy is a minor surgical procedure, lasts 30-54 minutes, and can be performed under local or general anesthesia. An incision is made on the skin, and the affected lymph node is removed entirely or part of it.
• Sentinel lymph node biopsy is indicated in some cases. If the doctor does not know whether the cancer has spread to the lymph nodes, during the operation, he injects a radiopharmaceutical or a fluorescent dye into the tumor. The drug penetrates into the lymphatic vessels and begins to spread through them. They look at which lymph node the dye enters first. This lymph node is called the sentinel: it is removed and sent to the laboratory for examination. If cancer cells are found in the sentinel lymph node, this means that, with a high probability, other regional lymph nodes are also affected, and they also need to be removed.

How is lymph node tissue examined in the laboratory?

Carry out cytological and histological examination, see how tissue and cells look under a microscope. If tumor cells are found in the sample, the diagnosis leaves no doubt.

It is important to determine from which organ the tumor cells originate, what mutations that contribute to the progression of cancer have occurred in them. Molecular genetic studies help with this. Knowledge of the molecular and genetic characteristics of the tumor helps the doctor to prescribe the optimal treatment.

Appointment for a consultation around the clock

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Salivary gland cancer – symptoms, signs.

Have you been diagnosed with salivary gland cancer?

Surely you are wondering: what to do now?
Such a diagnosis always divides life into “before” and “after”. All the emotional resources of the patient and his family are thrown into experiences and fear. But it is at this moment that it is necessary to change the vector “for what” to the vector “what can be done”.

Very often, patients feel overwhelmingly alone at the beginning of their journey. But you must understand that you are not alone. We will help you cope with the disease and will go hand in hand with you through all stages of your treatment.

Here is a brief but very detailed overview of salivary gland cancer.

It was prepared by highly qualified specialists of the Department of Radiation and Surgical Treatment of Head and Neck Diseases of the A.F. Tsyba – branch of the Federal State Budgetary Institution “NMITs Radiology” of the Ministry of Health of Russia.

This booklet provides information on the diagnosis and treatment of salivary gland cancer. Here are collected the main methods of treating this disease, including the latest developments of domestic and foreign oncologists.

We will help you beat cancer!

Introduction

The major salivary glands are located in the parotid, submandibular, and sublingual regions and are lobed and produce saliva. Their structural unit is the epitheliocyte (serocyte, mucocyte). Tumors formed from these cells can be benign (adenoma, epithelioma) and malignant (adenocarcinoma, etc.)

Statistics of salivary gland cancer (epidemiology)

Major salivary gland cancer accounts for up to 1.5% of all oncological pathology and up to 50% in the structure of all malignant neoplasms of this localization. This pathology is found everywhere. The incidence tends to increase, especially in large cities. The treatment algorithm includes surgery, and in some cases radiation and chemotherapy.

Morphological classification of salivary gland cancer

According to the WHO histological classification (lymphomas and sarcomas not included), the most common morphological forms of malignant tumors of the major salivary glands are: mucoepidermoid carcinoma, acinar cell carcinoma, adenocystic carcinoma and nonspecific adenocarcinoma.

Stages and symptoms of cancer of the salivary glands

Cancer of the major salivary glands in the initial stages is characterized by the appearance of a painless rounded dense tumor anterior to the auricle or in the submandibular region. In a fairly short time period, it increases in size, ulcerates the skin of the face, and affects the facial nerve. The smile of a person, at the same time, becomes skewed, the nasolabial fold becomes smoothed, and the lower eyelid is lowered. There is lacrimation. Metastases in the cervical lymph nodes are manifested by tumor-like formations on the lateral surface of the neck. Signs of distant metastases are due to their location, most often dysfunction, pain.

The stages of cancer are determined both by the degree of damage to the salivary glands themselves, and the degree of damage to the cervical lymph nodes, as well as the presence of distant metastases. Primary tumor of the salivary gland is denoted by the letter T: TX – insufficient data to evaluate the primary tumor, TO – primary tumor is not detected, T1 – tumor up to 2 cm in greatest dimension without spread outside the gland, T2 – tumor less than 2 cm but not more than 4 cm in greatest dimension without spreading beyond the gland, T3 – tumor with spread beyond the parenchyma without damage to the VII nerve and / or from 4 to 6 cm in greatest dimension, T4a – tumor more than 6 cm in greatest dimension with spread to the mandibular bone, external auditory canal and / or with damage to the VII nerve, T4b – the tumor spreads to the base of the skull, pterygopalatine space, internal carotid artery. The letter N denotes the cervical lymph nodes: NX – insufficient data to assess the condition of the lymph nodes, N0 – no signs of metastatic lesions, N1 – metastases in one lymph node on the side of the lesion up to 3 cm and less than 6 in the largest dimension, N2 – metastases in one or several lymph nodes on the side of the lesion up to 6 cm in the largest dimension or metastases in the lymph nodes of the neck on both sides, or on the opposite side up to 6 cm in the largest dimension, N2a – metastases in one lymph node on the side of the lesion up to 6 cm in the largest dimension, N2b – metastases in several lymph nodes on the side of the lesion up to 6 cm in the largest dimension, N2c – metastases in the lymph nodes on both sides or on the opposite side up to 6 cm in the largest dimension, N3 – metastasis in the lymph node more than 6 cm in the largest dimension. Letter M – distant metastases: MX – insufficient data to determine distant metastases, M0 – no signs of distant metastases, M1 – there are distant metastases.

Grouping by stage of salivary gland cancer.

901 58 M0

9016 6

9016 6

Causes of salivary gland cancer and risk factors

Among Causes of cancer of the salivary glands are not genetic factors. The risk group consists of people who drink alcohol excessively, use tobacco for smoking and chewing. There are also indications of errors in the use of too hot or too cold food.

Diagnosis of cancer of the salivary glands

The list of diagnostic tests for cancer of the major salivary glands includes personal data, anamnesis of the disease, palpation, medical examination and echographic examination. Unique diagnostic procedures include the use of CT, MRI, PET, SPECT/CT. There are no specific tumor markers for this pathology. Conducting screening programs, as international practice has shown, is not advisable.

Treatment of salivary gland cancer

Only in the first stage of cancer of the large salivary glands, an operation is performed – resection of the affected organ, in all other cases – its complete removal (sialadenectomy, paradytectomy), as well as removal of the cervical lymph nodes (lymphadenectomy). According to the results of a histological examination, a council of doctors consisting of an oncologist, a radiologist and a chemotherapist decides on the tactics of using radiation and systemic drug therapy.

Complications of antitumor treatment

Depend on the method of treatment, for example, during surgery, in cases of involvement of the facial nerve in the tumor process and its resection, paralysis develops and, as a result, asymmetry of the face, requiring additional correction. After radiation therapy, radiation reactions from the skin are possible (radiation epidermitis, etc.), and after chemotherapy, anemia, hair loss, stomatitis, nausea / vomiting, infectious complications, neutropenia, bleeding, thrombocytopenia, etc.

The use of unique techniques

Currently, hyperthermia and chemoembolization are used in cancer of the major salivary glands involving the vital structures of the head and neck.

Rehabilitation

It is carried out in oncological institutions, to which patients are territorially assigned and is determined individually after control examinations by an oncologist. During the first two years after completion of treatment – 1 time every 3 months, over the next three years – 1 time every 6 months.