There are lots of articles and research on the site and on the internet about handling of potential cervical lymph node metastasis.

If there is any clinical indication of lymph node involvement, I think the prevailing view is to do a neck dissection of some sort. These vary from a radical neck dissection, which customarily involves removal of lymph nodes at levels I through V, the Internal Jugular Vein, the Spinal Accessory Nerve and the Sternocleidomastoid muscle. These are done less frequently today, as effort is made to preserve as many of the non-lymphatic structures as possible. Names for other neck dissections short of radical include Modified Radical, Functional, and Selective. The primary difference between the various types is the number of non-lymphatic structures involved and the number of lymph node levels removed.

It is a misnomer to say that all of the lymph nodes are removed. They remove quite a few, but rarely, if ever, is every single lymph node in the neck removed.

In my case, I had a Modified Radical Neck dissection on both sides, where they removed a number of lymph nodes from all 5 levels, as well as the submandibular glands on each side. I had 1 clinically positive node that was enlarged to just under 3 cm, and another that showed some microscopic involvement. My neck dissection came first, followed 4 weeks later by the radiation and chemotherapy. Our CCC has had good results with that protocol, though others have had equally good results by doing chemo/rad first, then the neck dissection.

The type of neck dissection depends upon the clinical findings and where you want to fall on the risk/side effect matrix. The more levels of lymph nodes removed, the greater chance that all of the involved nodes are gone, but also a greater chance of long term side effects.

The neck dissection surgery is the easiest part of the whole process, by far. I had three drains installed after surgery, and was home, without drains, 4 days later. Other than looking like Frankenstein for awhile, it is really not a big issue. I have some stiffness and nerve issues today, but am willing to accept those.

Good luck!