Neck dissection

A neck dissection is done to:

• check for cancer in the lymph nodes in the neck
• remove lymph nodes that may contain cancer
• remove lymph nodes when there is a high chance cancer will spread to them
• reduce the chance that the cancer will come back (recur)
• remove cancer that is still in the lymph nodes after radiation therapy or chemotherapy
• help doctors plan further treatment

A neck dissection is done under general anesthetic in a hospital operating room. In head and neck cancer, you will have lymph nodes removed on one side of the neck (ipsilateral neck dissection) or both sides of the neck (bilateral neck dissection). This is done for tumours that are very likely to spread or have already spread to one or both sides of the neck.

You may have a neck dissection at the same time as surgery to remove the main tumour or as a separate surgery. The surgeon makes a cut (incision) in the neck to remove the lymph nodes. Depending on the type of neck dissection surgery, the surgeon may also remove other tissue in the area.

Selective neck dissection removes only those lymph nodes where cancer is very likely to spread. How many and which lymph nodes are removed is based on the size and location of the primary tumour. The muscle and nerve tissue around the lymph nodes are not removed to maintain proper function of the neck and shoulder. A selective neck dissection is also called a functional neck dissection.

Modified radical neck dissection removes lymph nodes from levels I to V, but keeps one or more of the following – internal jugular vein, sternocleidomastoid muscle or spinal accessory nerve.

Radical neck dissection removes nearly all lymph nodes on one side of the neck as well as the internal jugular vein, sternocleidomastoid muscle and spinal accessory nerve.

After removing the lymph nodes, the surgeon places a small tube (drain) in the wound and closes the cut with stitches or staples. A drainage bag is attached to the end of the tube to collect fluid draining from the area. This reduces the chance of fluid building up in the tissue and improves healing. The drain is left in place for a few days or until there is little drainage.

After a neck dissection, you may need to stay in the hospital for a few days. You may be given:

• antibiotics to prevent infection (if the primary tumour is removed at the same time)
• pain-relieving medicine
• instructions on caring for and dressing the wound
• advice on how much and which types of activity you can do after surgery
• advice on body positions that may help reduce swelling
• a follow-up appointment to see the surgeon in 1–2 weeks
• information about which symptoms and side effects you should report

The lymph nodes and any other tissue removed during surgery are sent to a lab to be examined by a doctor who specializes in the causes and nature of disease (pathologist).

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after a neck dissection. Sometimes late side effects develop months or years after a neck dissection. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Tell your healthcare team if you have these side effects or others you think may be from a neck dissection:

• pain and stiffness
• bruising
• signs of infection, such as pain, redness, yellow discharge (pus) or fever
• a collection of fluid under the skin (seroma) in the neck near the cut
• swelling due to a buildup of lymph fluid in the soft tissues ( lymphedema)
• changes in the shape of the neck
• shoulder pain and a change in the normal shape, with some weakness on the side of the surgery

The healthcare team may give you antibiotics to prevent or treat an infection, or they may drain a buildup of fluid. Lymphedema treatment may include massage therapy and exercises.

Each lymph node removed is examined to see if it contains cancer.

• A negative lymph node has no cancer cells.
• A positive lymph node has cancer cells.

The pathologist’s report includes the type of cancer, the number of lymph nodes removed and the number of lymph nodes that have cancer cells. The report may also say if the cancer has grown through the outer covering of the lymph node (the capsule).

Doctors use the number of positive lymph nodes to help stage the cancer. They use the stage along with other information about the type and grade of the cancer to make treatment decisions and give a prognosis.

Depending on the result, your doctor will decide if you need more tests, any treatment or follow-up care.

In rare cases, a neck dissection may be done in children to treat cancers that may spread to lymph nodes in the neck, such as melanoma or thyroid cancer.

Preparing children before a test or procedure can lower anxiety, increase cooperation and help them develop coping skills. Preparation includes explaining to children what will happen during the test, including what they will see, feel, hear, taste or smell.

Preparing a child for a neck dissection depends on the age and experience of the child. Find out more about helping your child cope with tests and treatment.