My husband has 4 radiation treatments to go, just finished last chemo yesterday.

Consulted with ENT today to see about neck dissection. First of all, my husband will not have achieved a complete response by the end of radiation, as there is still a lump to some degree on the left side of his neck, though not even close to the size it started out, which was huge. We knew the ENT was going to recommend neck dissection following chemo/radiation regardless of response, but thought it would (should?) be 4 to 6 weeks following chemo/radiation. ENT is going to be out of the office during the month of May, as we found out today, to have surgery on himself. Subsequently, he suggested that my husband have a modified radical neck dissection, removing nodes on left side only, and proposed that the surgery take place on April 13, which will be only 9 days after his last radiation treatment. He said that this would not be a problem, that he would much prefer to do it now rather than later anyway, since my husband has an open wound still on his neck from initial biopsy in January, and it is still seeping to some minor degree, which he said may (or may not) indicate that there is still active cancer. Also, he said he will not try to spare the spinal accessory nerve since my husband already has damage evident and he "doesn't think" it will come back.

Could anyone who has had neck dissection after radiation/chemo give me your thought about having this done so soon after? And also, what about not removing any nodes on right side? (Keeping in mind that my husband did not have an identified primary site, so that all areas were treated, with more focus on shrinking the mass on the left side where it was considered to be metasticized)

I realize these are just your opinions based on your experience and particular situation, which is not the same for everyone, but I would appreciate hearing anyone's thoughts about this, as I feel the ENT may be "hurrying" the surgery since he is going to be away.
Thanks so much. Michele

Hi Michele,

I think you need a second opinion. My MRN disection was done 7 weeks after treatment. I'm note sure I could have handled it after one week. How is your husband's stength?

Steve

Michelle,
With my unknown primary, they did the neck disection BEFORE the radiation but only did the one side with the enlarged lymph node. That may depend on what node(s) are affected.

I'd vote for a second opinion also, especially on the nerve and problems that can lead to. I have no clue.

Take care,
Eileen

hello Michelle,
I just recently had a partial neck dissection on the right side(jan.11) and had finished 33 IMRT radiation and three chemo sessions on Dec. 16, my surgeon (ENT DR.) wanted to schedule surgery 1 week after end of radiation my radiologist balkeds and with scheduling problems it ended up being 25 days after the end of treatment. Everything went well (22 lymph nodes removed as well as some muscle and jugular vain). I still have quite a bit of numbness from my ear to my shoulder and my neck is pretty stiff and hard, but I did have my feeding tube removed three weeks after surgery and am doing very well in many aspects, but I am having some problems with some teeth anf my sinus and they cannot seem to find the source of this pain and discomfort, more tests tomorrow. I would ask your surgeon a bit more as to why he wants this so soon. I felt like shit for a good 10-14 days after treatment ended, but by 3 1/2 weeks not bad, and I was out of the hosp[ital in 3 days. Best of luck, if you want to talk more send me a private message and I will send along my phone #.
Always lenny

Generally these are done 7-8 weeks after the end of radiation, if they are done at all (controversial at many CCCs). The fact your husband has a residual tumor (not a complete response to treatment) is a good reason to have the surgery, which many have said is not the worst part of the treatment!

However it does sound pretty soon -- what does your RO think about this?

Gail

It is not uncommon that the nerve has to be sacrificed, in fact most that I talk to have had it cut. It is almost impossible to dissect around it and still get all the tissues that need to be removed. (They will remove the fatty tissues of the neck as well as the nodes.) The life long numbness as a result of this has not been a significant issue to me since treatment.

I also had what appeared to be an incomplete response to the radiation treatments (after having the maximum dose that my spinal cor could endure), but when the nodes were examined by the pathologist they were completely clean. This is not an uncommon issue/outcome when reading scans taken at the end of treatment. I do not regret getting the surgery, as I wanted to be sure that we had gotten it all. However any fistula which is still draining is not a good sign that the cancer has been completly eliminated. This is a gray area, as necrotic tissues left as a by-product of treatments can be producing some type of discharge or even infectious process. My surgery was 5 weeks after the end of radiation treatments.

Brian, to clarify your comment regarding the open area on my husband's neck that is still draining - this can be a sign that there is still cancer, right? But it could also be something else. Do you think that if there is still cancer there, that it is a good idea to have the surgery 9 days after the radiation ends? Otherwise, I would assume it might start to spread again, right? Because first the ENT said the radiation continues to work for awhile after treatments end so that it shouldn't spread, but then when he decided to go ahead and do surgery before he leaves (going to be out of the office for the month of May) as opposed to waiting until June, which would be about 7-8 weeks after radiation, then he said he was concerned about the seeping still being cancer. My other concern is that he said he would not remove the nodes in the right side. When would it be advisable to remove nodes from both sides?
Thanks.
Michele

I cannot speculate on what your ENT is thinking. Certainly it is correct that radiation's effects continue after treatment ends. He may consider doing surgery to remove what he considers a still active malignancy as a salvage (a terrible bit of medical phrasing, but what they call it) method. Your original post says that he had a left neck mass, so a unilateral dissection would seem appropriate. I can't say any more about the draiinage, like my previous post stated, it could be a sign of continuing maliganancy, or it could be drainage from the sluffing of tisssues related to treatment and even an infectious process combined with that. None of us here can really tell you more from our distant perspective and lay person's knowledge.

Thanks Brian. I understand that you cannot provide anymore than your perspective, which is what I was seeking. I am just looking to clarify in my mind what the ENT has alreaady told us. I guess knowing that there are many on this site that have been there, I tend to want them to "chime in" on what we have been told, like a sounding board. It helps me to formulate other questions for the docs.
Thanks everyone.
Michele