Hi all
I have noticed that some folks have had radiation after neck dissection and some have had it before. Is there
a reason why or is it the decision of the doctor?

Well, Molly, I can only speak for me, but when the surgery showed one positive lymph node, the next stop was radiation. If the lymph nodes had all been negative, radiation would not have been ordered. Hope this helps.

Joanna

Molly, I had a radical neck dissection and did not have to have RAD, as all of my lymph nodes were clear of cancer. Your question is a very good one, and I'm not sure of the answer. However, it seems that sometimes they will use RAD before surgery to try to shrink a tumor. I don't know the answer and it was a topic of discussion with Donna and I earlier this week. Perhaps, Brian get put us on the path to find this answer.

Anne.

Molly,
my mother had RAD before her neck dissections, and they told us it was because when she was diagnosed, her tumors were too big for surgery. She had 35 RAD treatments, to shrink the tumors, so they would be operable. Her chemo was for cancer on the tongue, and the RAD greatly reduced the tumors in the lymph nodes...they also removed other nodes, and they tested negative. I'm not certain, but I think that is the main idea of RAD pre-op.....possibly the RAD after an operation would be to get rid of any remnants?? Not sure!

Brooke,

Thanks for the information. I think we are on the same tract.

How are you doing? Thanks so much for all of your replies. Thinking of you.

Anne.

Brooke is exactly correct. My post-dissection radiation is to take care of anything that MIGHT be there. (And considering the price that radiation extracts, there better darn well be something there to kill. )

Joanna

Hi Guys/Gals.........Ok, this has always puzzled me. I understand that the use of RAD and Chemo is sometimes used to shrink the tumor so that it is more operable, and that makes sense to me. What I don't understand is why the Doctors sometimes refuse to do surgery after RAD when clearly it CAN be done, but perhaps with some risk. So, is it all about the risk factor? Not sure if I am quite able to articulate the right question, but do you catch my drift---or maybe my question is just a silly one. Brian, can you help?? Sincerely, Donna

Hi everyone, this is Ingrid, Brian's wife typing for him. Brian just came home from a week in the hospital having abdominal surgery and is a little under the weather, hence his absence from the boards, emails, etc. for the last 10 days. While he is dictating this to me he wants you to know that he is under the influence of some drugs that make his thought processes a little choppy so please bear with it all.

As to the question of surgery coming before or after radiation, there are several factors which determine this. One has been mentioned above, and that is the desire for the treatment team to reduce the overall volume of tumor mass to an operable size. This is not to say that a tumor the size of a football could not be surgically removed, as we all have no doubt seen the tabloid stories of these enormous basketball-sized tumors removed from people who thought they were pregnant, fat, or whatever. Oral and head and neck cancers frequently come in close proximity to vital structures such as the primary arteries of the neck, and other significant neuro-vascular bundles, which are delicate to cut around. A smaller object to remove, in theory would make damage to adjacent structures less likely. There is a problem with surgery following radiation however, and that is that the tissues of all types, muscular, fatty, lymphatic, become thick, stringy, and extremely gooey/sticky as surgeons "technically" refer to the radiated tissues. Post radiation surgeries are a pain in the rear to surgeons and most given a choice would prefer to cut normal density tissues. In Brian's case, during his radical neck dissection, this was a particular problem as the surgeon had to spend many hours literally scrapping these gooey tissues from around locations such as his carotid artery. This type of surgery requires supreme skill and the best hands which he was lucky to have working on him. There is also an issue of the tissues ability to heal post radiation as most of you know. Even years after radiation treatments the healing process for those irradiated can be significantly longer for a simple cut or bruise compared to normal people.

All this goes back to the type of center at which you are being treated. At a multidisciplinary facility you will find the debate of what is convenient for the surgeon, less important than what will have the maximum impact on the cancer at the earliest possible time.

Lastly, as to chemotherapies, as a primary treatment for cancer they are normally reserved for use in only those patients which have the worst and most advanced oral cancers. For those with stage two's and early three's chemotherapy is thought of in most circles as a general area/and systemic "wash" to catch errant cancer cells which may have micro-metastasized away from the immediate location of the oral cancer. In the absolute worst scenarios, chemotherapy is sometimes only prescribed as a palliative treatment to extend the life and comfort of someone whose disease is beyond the realm of cure.

This maybe should be a new topic but I wasn't sure. I am curious from those who have had surgery of any kind after head and neck radiation - was there any concern about getting a breathing tube down for the surgery? Ingrid or Brian, was this a problem in the recent surgery? I had my tongue and neck surgeries prior to radiation but then need surgery for a feeding tube. Because of previous stomach surgery and scar tissue this was a major operation. Minutes before taking me to surgery the anesthesiologist (I hope my spelling is close) said that because of radiation they might not be able to get a breathing tube down. In that case they would wake me up and numb my throat and try to do it with me awake (not a fun thought). There was even some possibility that they couldn't do it at all. The surgery scheduled right before mine was cancelled due to that reason. Mine turned out ok and the surgery was uneventful. However I wonder if the tissue gets harder to deal with as time passes. My surgery was 2 months after radiation. There is a good chance I will face more surgery in the next year (its now a year after radiation - the next surgery is not related to the cancer but to female issues). I am concerned about difficulties of having surgery.
ilene

Intubation problems are related to an issue of the diameter of the structures after irradiation. Sometimes they are filled with scar tissue making them less flexible, or depending on what type of neck treatments were used, slightly diminished in size. My intubation last Tuesday was uneventful according to the anesthesiologist, although for several days afterwards I was coughing up blood... obviously from some physical damage in their getting the tube down. I came out of surgery without any significant throat pain related to all this. I just feel like a 2000 pound stallion kicked me in the chest, and I'm back to having drains dangling out of me, and of course the obligatory new Frankenstein look to my abdomen. I think at this stage of things I was pretty well past taking my shirt off at the pool anyway.....

In my case I had the neck dissection 3 months after the radiation. My ENT said that sometimes the radiation shrinks the lymph node down to normal, making the surgery unnecessary. A radiologist at the Univ of Iowa was bragging that he shrunk a 9 centimeter lymph node down to nothing. That didn't happen to me. My lymph node stayed the same size all the way thru. My ENT said that if it still shows up 2 months after the radiation, then he orders the surgery.

I was told that I had a small airway which caused a need to intubate me awake before the surgery. It was no big deal. They give you major sleepy drugs that make you think the whole thing is one big party. I remember coughing the tube back out during one attempt and laughing about it like it was the funniest thing in the world. I don't think anyone else in the room was pleased with it not going in right, but it must of later. The last thing I remember is a man saying 'That's it, I'm In." The nurse leaned over me saying "You did good, honey" Then it was lights out!

My ENT suggested that I wear a medical alert bracelet saying 'small airway'. The anetisegolists (you know I can't spell) warned me that I should never let anyone put me out without doing the intubation first. He said that would be very bad. I believed him and didn't ask him what very bad might mean.