The neck contains the lymph nodes into which cancers of the head and neck drain, the great vessels to the brain, the nerves to the shoulder and tongue, and the muscles that turn the head. A lump in the neck therefore needs a clear diagnosis, and treatment of the lymph nodes is part of the treatment of most head and neck cancers.
What it is
A neck dissection is an operation that removes lymph nodes from the neck in groups (levels I to VI), so that cancer cells that have spread to them, or may have spread, are removed and examined. It is done together with the removal of the primary tumour or as a separate operation, for example after radiotherapy. Surgery for a neck mass is the removal of a lump for diagnosis or treatment: a cyst, a benign tumour, an enlarged lymph node, or a growth of the thyroid or salivary glands.
Who it is for
Adults with a head and neck cancer whose lymph nodes are involved or at risk; adults with a lymph node that contains cancer from a primary site that has not yet been found; and adults with a persistent neck lump for which a diagnosis is needed.
Symptoms and diagnosis
A lump in the neck may be felt by the patient or found on an examination or scan. Its position, size, consistency and how long it has been there all point towards its cause. Ultrasound is the first investigation, usually combined with a fine-needle biopsy of the lump. CT, MRI or PET scanning shows the extent and looks for a primary tumour when the lump is a lymph node containing cancer. Examination of the mouth, throat and larynx with an endoscope is part of the assessment in adults.
How the operation is done
Under general anaesthesia, the neck is opened through an incision placed in a skin crease. The lymph nodes are removed together with the surrounding fatty tissue, level by level, while the carotid artery, the jugular vein, the nerve to the shoulder muscle (accessory nerve) and the other nerves of the neck are identified and preserved whenever the cancer allows. For a single neck mass the incision is placed over the lump, and the mass is removed intact for examination. Small drains are left in place for a few days. The pathology report of the nodes guides whether radiotherapy or other treatment is needed afterwards.
Recovery
The hospital stay is a few days for a neck dissection and shorter for the removal of a single mass. The neck is stiff and numb at first; movement exercises and, when needed, physiotherapy for the shoulder start early. Sensation in the skin returns slowly. The scar lies in a crease and fades over months. Follow-up visits continue at intervals set by the diagnosis.
How Prof. Hafız works
Neck surgery is among the focus areas of Prof. Hafız’s practice, and his published research includes work on lymph node metastases in head and neck cancer and on the accessory nerve and quality of life after treatment for laryngeal cancer. The extent of the dissection, what will be preserved and the likely effect on the shoulder and neck are explained before the operation.