Where are the lymph nodes located in the neck. What is the function of lymph nodes in the immune system. How are neck dissections performed for head and neck cancers. What are the different types of neck dissection procedures. When is lymph node removal necessary for cancer treatment. What are the potential risks and outcomes of neck dissection surgery.

Anatomy of Lymph Nodes in the Neck

The neck contains a complex network of lymph nodes that play a crucial role in the body’s immune system. Understanding their location and function is essential for both medical professionals and patients dealing with head and neck conditions.

How many lymph nodes are in the neck. Each side of the neck contains between 20 to 100 lymph nodes, forming an intricate system that filters lymph fluid and traps potentially harmful substances.

Lymph Node Regions in the Neck

The neck is divided into six distinct lymph node regions, each serving specific areas of the head and neck. These regions are:

1. Submental
2. Submandibular
3. Upper cervical
4. Middle cervical
5. Lower cervical
6. Posterior cervical

Understanding these regions is crucial for medical professionals when diagnosing and treating various head and neck conditions, including cancers.

The Role of Lymph Nodes in the Immune System

Lymph nodes, often referred to as “glands,” are an integral part of the body’s defense mechanism. They act as filters, trapping and processing potentially harmful substances that enter the body.

How do lymph nodes respond to threats. When confronted with infections, inflammations, or tumors, lymph nodes may enlarge as they work to contain and eliminate the threat. This enlargement is often one of the first signs that the body is fighting an infection or that a more serious condition, such as cancer, may be present.

Lymph Nodes and Cancer Metastasis

In the context of head and neck cancers, lymph nodes play a critical role in the spread of malignant cells. The neck’s lymph nodes are often the first site where these cancers metastasize, making them a key focus in cancer diagnosis and treatment.

Why are lymph nodes important in cancer staging. The presence or absence of cancer cells in lymph nodes helps determine the stage of cancer, which in turn guides treatment decisions. Even microscopic metastases that aren’t visible on imaging studies can have significant implications for a patient’s prognosis and treatment plan.

Neck Dissection: A Crucial Procedure in Head and Neck Cancer Treatment

Neck dissection is a surgical procedure that involves removing lymph nodes from the neck. It’s a critical component in the treatment and staging of head and neck cancers.

When is neck dissection recommended. Surgeons may recommend this procedure in various scenarios:

• To determine if cancer has spread microscopically
• To assess the effectiveness of radiation and/or chemotherapy
• To remove cancerous lymph nodes when surgery is the primary treatment

The timing of neck dissection can vary depending on the individual case. It may be performed early in the treatment process or towards the end, based on the specific circumstances of the patient’s condition.

Types of Neck Dissection Procedures

There are three main types of neck dissection procedures, each varying in extent and the structures involved. The choice of procedure depends on the individual patient’s condition and the characteristics of their cancer.

Selective Neck Dissection

What is selective neck dissection. This procedure involves removing only certain groups of lymph nodes. It’s typically recommended in three situations:

1. To check for microscopic cancer spread
2. To evaluate the effectiveness of radiation and/or chemotherapy
3. To remove small malignant lymph nodes when surgery is the sole treatment

The specific lymph node regions removed depend on the location of the primary tumor.

Modified Radical Neck Dissection

This more extensive procedure involves removing most lymph nodes from the jawbone to the collarbone, along with either a muscle, nerve, or vein (or a combination of two of these structures). It’s typically performed when there’s evidence of more extensive lymph node metastasis.

Radical Neck Dissection

What structures are removed in a radical neck dissection. This is the most comprehensive procedure, involving the removal of:

• Nearly all lymph nodes in the neck
• The sternocleidomastoid muscle
• Cranial nerve XI (spinal accessory nerve)
• The internal jugular vein

Despite the extensive nature of this procedure, it’s generally safe and doesn’t cause significant bodily dysfunction or deformity.

The Surgical Process of Neck Dissection

Neck dissection is a complex surgical procedure that requires careful planning and execution. The process typically involves several key steps:

Pre-operative Planning

Before the surgery, the surgeon explains the specific type of neck dissection to be performed. This decision is guided by the size and location of the involved lymph nodes.

The Surgical Procedure

How is the neck dissection performed. The surgeon makes an incision in the neck, starting just below the ear and extending downward towards the center of the neck. This incision provides access to the lymph nodes in the neck.

In some cases, the surgeon may need to remove additional tissues, such as a portion of skin, if affected by the tumor. The extent of tissue removal depends on the individual case and the spread of the cancer.

Implications and Considerations of Neck Dissection

While neck dissection is a crucial procedure in the management of head and neck cancers, it’s important to understand its implications and potential outcomes.

Potential Risks and Side Effects

Like any surgical procedure, neck dissection carries certain risks. These may include:

• Infection
• Bleeding
• Nerve damage
• Shoulder dysfunction (if the spinal accessory nerve is affected)
• Lymphedema (swelling due to disrupted lymph drainage)

However, modern surgical techniques and post-operative care have significantly reduced the incidence and severity of these complications.

Impact on Quality of Life

How does neck dissection affect a patient’s quality of life. While the procedure can have some impact on neck and shoulder function, most patients adapt well. Physical therapy and rehabilitation can help minimize long-term effects and improve functional outcomes.

Advanced Imaging Techniques in Lymph Node Assessment

Modern imaging technologies play a crucial role in the assessment of lymph nodes and the planning of neck dissection procedures. These techniques help surgeons identify potentially cancerous lymph nodes and determine the extent of the surgery needed.

CT Scans (Computed Tomography)

How do CT scans help in lymph node assessment. CT scans provide detailed cross-sectional images of the neck, allowing doctors to identify enlarged lymph nodes and assess their relationship to surrounding structures. This information is vital for surgical planning and determining the extent of cancer spread.

MRI (Magnetic Resonance Imaging)

MRI scans offer excellent soft tissue contrast, making them particularly useful for evaluating the extent of tumor invasion and identifying subtle lymph node abnormalities. They can provide valuable information about the size, shape, and internal structure of lymph nodes.

PET Scans (Positron Emission Tomography)

What unique information does a PET scan provide. PET scans use radioactive tracers to highlight areas of high metabolic activity, which is often associated with cancer. This technique can help identify cancerous lymph nodes that may appear normal on other imaging studies, aiding in more accurate staging and treatment planning.

Post-Operative Care and Recovery After Neck Dissection

The recovery process following a neck dissection is crucial for optimal healing and functional outcomes. Patients typically require a period of hospitalization followed by outpatient follow-up care.

Immediate Post-Operative Care

What can patients expect immediately after surgery. In the immediate post-operative period, patients are closely monitored for complications such as bleeding or infection. Pain management is a key focus, with medications administered to ensure comfort during the initial recovery phase.

Wound Care and Drainage

Proper wound care is essential for preventing infection and promoting healing. Surgical drains are often placed to remove excess fluid from the surgical site, and patients or caregivers may need to learn how to manage these drains at home.

Physical Therapy and Rehabilitation

How important is physical therapy after neck dissection. Physical therapy plays a crucial role in recovery, particularly for patients who have undergone more extensive procedures. Therapy focuses on maintaining range of motion in the neck and shoulder, preventing stiffness, and addressing any weakness or functional limitations resulting from the surgery.

Advancements in Minimally Invasive Neck Dissection Techniques

Recent years have seen significant advancements in surgical techniques for neck dissection, with a trend towards more minimally invasive approaches. These techniques aim to achieve the same oncological outcomes while minimizing post-operative complications and improving cosmetic results.

Robotic-Assisted Neck Dissection

How does robotic-assisted surgery benefit patients. Robotic-assisted neck dissection allows surgeons to perform precise dissections through smaller incisions. This can lead to reduced post-operative pain, faster recovery times, and improved cosmetic outcomes. The robotic system provides enhanced visualization and dexterity, particularly in hard-to-reach areas of the neck.

Endoscopic Neck Dissection

Endoscopic techniques involve using small cameras and specialized instruments to perform neck dissections through minimal incisions. This approach can result in less visible scarring and potentially faster recovery times for suitable patients.

Sentinel Lymph Node Biopsy

What is the benefit of sentinel lymph node biopsy. This technique involves identifying and removing only the first lymph node(s) to which cancer is likely to spread. If these sentinel nodes are free of cancer, it may be possible to avoid a more extensive neck dissection, thereby reducing the potential for complications and long-term side effects.

The Role of Multidisciplinary Care in Head and Neck Cancer Treatment

The management of head and neck cancers, including the decision to perform neck dissection, often involves a multidisciplinary approach. This collaborative effort ensures that patients receive comprehensive care tailored to their individual needs.

The Multidisciplinary Team

Who are the key members of a head and neck cancer care team. A typical multidisciplinary team may include:

• Head and neck surgeons
• Medical oncologists
• Radiation oncologists
• Radiologists
• Pathologists
• Speech and language therapists
• Dietitians
• Psychologists or psychiatrists

Each specialist brings unique expertise to the table, contributing to a comprehensive treatment plan that addresses all aspects of the patient’s care.

Collaborative Decision Making

How does multidisciplinary care benefit patients. The collaborative approach allows for thorough discussion of each case, weighing the potential benefits and risks of various treatment options, including neck dissection. This ensures that treatment decisions are made based on the most current evidence and tailored to the individual patient’s needs and preferences.

Ongoing Support and Follow-up

The multidisciplinary team also plays a crucial role in providing ongoing support and follow-up care after treatment. This may include regular check-ups, imaging studies, and supportive care to address any long-term effects of treatment.

In conclusion, understanding the anatomy and function of lymph nodes in the neck, as well as the various surgical procedures used in their removal, is crucial for both medical professionals and patients dealing with head and neck cancers. As research continues and surgical techniques advance, the management of these conditions will likely become even more precise and personalized, leading to improved outcomes and quality of life for patients.

Lymph Node Removal Surgeons Chicago IL

Your surgeon at Suburban Ear, Nose, and Throat has extensive training in the treatment of head and neck cancer. Part of that treatment includes surgically removing lymph nodes in the neck. The formal name for this operation is called a neck dissection. 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. Malignant (cancerous) tumors of the head and neck can sometimes spread (metastasize). The site of origin of the cancer is called the primary tumor, and any spread of cancer to other sites is called metastasis. The first place that head and neck cancers will typically metastasize is to the lymph nodes of the neck. They can even develop tumors of their own called lymphoma.

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 scan, MRI, or PET scan). Depending on the staging (extent) of your head and neck cancer, a 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 on exam or imaging. This is done to help us determine if there has been microscopic metastasis. The presence of microscopic metastasis would then have significant implications in guiding what other treatments are necessary, e.g. radiation or chemotherapy.

There are several types of neck dissections, 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 other surgery to remove the primary tumor also. The primary tumor can be anywhere in the head and neck, including the tongue, tonsils, throat, larynx (voice box), or other sites. 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 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 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 microsopic 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 these structures without causing significant bodily dysfunction or deformity.

Before your operation, your surgeon at Suburban Ear, Nose, and Throat will explain the type of neck dissection you are going to have. The surgery is guided by the size and location of the involved lymph nodes in your neck. During the operation, the surgeon will make an incision in your neck, which begins just below your ear and extends downward towards the center of your neck. This will provide exposure to the lymph nodes in your neck. Occasionally, the surgeon may also remove other tissues such as a portion of skin, if it is affected by the tumor.

The indications and risks of surgery must be understood prior to proceeding with surgery. Alternatives to surgery including radiation therapy and/or chemotherapy will be discussed before proceeding with surgery.

2 WEEKS PRIOR TO SURGERY: Strictly avoid all anti‐inflammatory drugs for two weeks pre‐operatively. This includes aspirin, Advil, ibuprofen, Naprosyn, Celebrex or any other non‐steroidal anti‐inflammatory drug (NSAIDs). These medicines increase your risk of bleeding. These medicines must also be avoided for at least one week after surgery. Tylenol (acetaminophen) is not an anti‐inflammatory so it is fine to take.

NIGHT BEFORE SURGERY: No solid foods (that includes milk, cream etc.) for 8 hours prior to surgery. Typically this means no solid foods after midnight before the surgery. Small volumes of clear liquid may be drank up to 4 hours prior to surgery (examples: water, tea, Gatorade, or coffee with NO milk or cream).

HOSPITAL STAY: Patients who undergo neck dissection will usually be admitted to the hospital for 2-5 days. They will usually spend the first night in the intensive care unit for observation.

LAB WORK: Your physician may request that blood work is done prior to surgery. If this is needed, you will receive an order form for this blood work, and the location of the lab to perform the blood draw is usually recommended based on your insurance company and where your surgery is to be performed.

SURGICAL RISKS AND POSSIBLE COMPLICATIONS:

Despite neck dissection having many potentially serious risks, they occur very infrequently, and the surgical procedure is usually performed without difficulty. Although substantial tissue involved with cancer is removed from the patient’s neck, this operation does not generally lead to a dramatic degree of disfigurement or dysfunction.

BLEEDING: significant bleeding is rarely encountered during neck dissection surgery. Despite this, there is a small chance of excessive blood loss possibly requiring transfusion. If carotid artery injury was to occur you may suffer a stroke, or this could be a fatal event. This injury is extremely rare.

There are multiple nerves in the head and neck that are exposed during neck dissection surgery, and therefore, placed at risk during the surgery:

Marginal mandibular nerve: injury to the marginal mandibular branch of the facial nerve can lead to temporary or permanent facial weakness to the lower lip on the surgical side.

Spinal Accessory Nerve: depending on the type of neck dissection performed, you may have temporary or permanent weakness to your shoulder. Sometimes it is required that the spinal accessory nerve be removed as a planned part of the neck dissection in order to optimize eradication of the cancer. The spinal accessory nerve gives strength to your shoulder muscles, allowing shrugging and full raising of your arm. Shoulder pain can occur after removal of this nerve, but it can be managed with post-operative physical therapy. Even when the spinal accessory nerve is preserved, up to 50% of patients may experience temporary shoulder weakness and/or discomfort.

Vagus nerve: Injury to the vagus nerve, though extremely rare, will result in hoarseness, swallowing troubles or throat dysfunction after surgery.

Phrenic nerve: One half of your diaphragm may be paralyzed if the phrenic nerve is injured during surgery. This is an extremely rare injury. Although in many cases, injury to one of the phrenic nerves is not that symptomatic, it can lead to chronic shortness of breath.

Lingual nerve: Injury to the lingual nerve will result in numbness to one half of your tongue, but the tongue will have normal mobility.

Hypoglossal nerve: Injury to the hypoglossal nerve will cause weakness or paralysis to one half of the tongue. The tongue will retain normal sensation. Some slurred speech can be initially expected, but with speech and swallowing therapy, normal or near-normal function can be re-established.

CHYLE LEAK: On occasion, larger lymph vessels are encountered during surgery. Care is taken to prevent leakage of lymph fluid; however, if this occurs post-operatively, it may require a period of time after surgery where you are only fed with IV fluids in order to facilitate resolution of this leak. In addition, when food is introduced, it may be a modified diet for several weeks. Rarely, further surgery may be required to control this problem.

SWELLING: patients may notice intermittent, but long-term swelling of the skin of the face and neck after undergoing neck dissection. This can be improved by sleeping upright for a couple of nights.

Poor scarring or poor healing can occur, especially if you have already received radiation therapy. On occasion further surgery is necessary to correct this problem.

With most neck dissections, one or more sensory nerves are removed during the surgery. Removal of these nerves is a planned part of the neck dissection, and does not represent a complication. In addition, it does not alter one’s appearance. It will likely result in numbness to the ear, neck, and/or shoulder skin.

Your operation will be carried out under a general anesthetic. As with any type of surgery, the risks of anesthesia such as drug reaction, breathing difficulties and even death are possible. Please feel free to discuss any specifics of the anesthesia with your anesthesiologist.

All efforts are taken by the physicians of Suburban Ear, Nose, & Throat Associates, as well as your other physicians, to attempt to cure you of your head and neck cancer. There is a realistic chance of recurrence of your cancer over time. The chance of tumor recurrence is directly related to the size and stage of your cancer, as well as the biological aggressiveness of your tumor. This latter factor is unfortunately very difficult to predict. For tumor surveillance, you will be closely monitored with regularly scheduled office visits in the months and years to follow.

GENERAL POST-OPERATIVE INSTRUCTIONS/CARE

• 
  Activity: Light activity for 1 to 2 weeks is recommended after neck dissection surgery.
• 
  Diet: You can eat a diet as you tolerate after neck dissection, unless throat surgery is performed simultaneously.
• 
  Medicines: You will be prescribed pain medicines and possibly antibiotics. Take these as directed.
• 
  Bathing: Generally, you may shower 24 hours after the drains are removed. Please do not take a bath until one week after your sutures or staples are removed.
• 
  Post-operative follow-up: your sutures or skin clips will be removed 7 to 14 days after surgery. If this post-operative visit has not already been scheduled, please call our office to make that appointment.

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. We go to great lengths to try to help you understand your plan of care. If, at any time during your care, you have any questions or concerns, please call us at (847) 259 -2530.

Anatomy of the Breast | Memorial Sloan Kettering Cancer Center

What does the inside of the breast look like? This illustration shows the makeup of breast anatomy both inside and outside.

What’s inside your breasts? Most people aren’t really sure, but if you want to understand breast cancer prevention, risk, or diagnosis, it’s important to know the kinds of tissue and structures breasts are made of. This information will help you visualize what parts of the breast your doctor is referring to. If you have been diagnosed with breast cancer, knowing this will help you talk to your doctor about surgery and other treatment options.

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• What is a breast made of?
• What are breast lobes and breast ducts?
• What are lymph nodes?
• What does a mammogram show? 
• What are dense breasts?

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If you were assigned female at birth, your breasts contain different types of tissue:

• glandular tissue, which includes the breast lobes and breast ducts
• fibrous, or supportive or connective tissue, which is the same tissue that ligaments and scar tissue are made of
• fatty tissue fills in the spaces between glandular and fibrous tissue and largely determines your breast size

Doctors refer to all non-fatty tissue as fibroglandular tissue. There are also bands of supportive, flexible connective tissue called ligaments, which stretch from the skin to the chest wall to hold the breast tissue in place. Muscle plays an important role too. The pectoral muscle lies against the chest wall underneath both breasts, giving them support. Blood vessels provide oxygen to the breast tissue and carry away waste.

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Embedded in the breast’s fatty and fibrous tissue are 15 to 20 glands called lobes, each of which has many smaller lobules, or sacs, that produce milk. Lobules are arranged in clusters, like bunches of grapes.

Ducts are thin tubes that carry milk to the nipple. The nipple is located in the middle of the areola, which is the darker area surrounding the nipple. Breast cancers can form in the ducts and the lobes.

Learn more about where breast cancer begins.

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Lymph nodes are small, bean-shaped organs that help fight infection and are found throughout the body. They produce and filter a colorless fluid called lymph, which contains white blood cells known as lymphocytes (immune cells involved in defending against infections and such diseases as cancer).

Lymph vessels filter and carry lymph fluid from the breast to the lymph nodes. Clusters of lymph nodes near the breast are located in the armpit (known as axillary lymph nodes), above the collarbone, in the neck, and in the chest.

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A mammogram is a test that uses low-dose x-rays to show the inside of your breast. A radiologist (a physician trained to interpret mammography and other images) can identify abnormal areas, masses, or calcium deposits (microcalcifications) that may or may not be cancerous. The greater the detail on the image, the more likely it is that doctors can spot unwanted changes at an early stage, before potentially cancerous cells have a chance to grow or spread. Mammograms done in women with no breast complaints to look for early cancer are called screening mammograms. Those done to evaluate symptoms such as a lump or nipple discharge are diagnostic mammograms. In addition to mammograms, ultrasound and MRI may also be used to take a closer look at changes in the breast.