Hi, I have a question about surgery. Richard's doctor said that they would only do surgery to remove the lymph node if they found no primary. Otherwise he would have TX and chemo and that the node would shrivel up. I'm reading much about neck dissection and I'm unclear as to why that would be necessary if the TX and chemo eliminates the cancer. Sorry ahead of time if this is a lame question, but I know I'll get an answer here. Thanks, Geri

Neck dissections are a matter of some controversy in treatment of OC. Your husband's diagnosis seems similar to mine. I called mine T2, but it was 2 cm, right on the border of T1 and T2. I had 1 obvious node, but when they did the neck dissection, they found a second node with a microscopic trace of cancer.

There appear to be two distinct schools of thought on neck dissections. Probably more, but these are the ones I have discerned. First is the school that your husband's doctors appear to follow -- ND is unnecessary where N0 or N1 and primary is small. Radiation will kill the cancerous cells in the lymph nodes. Neck dissection is reserved for situations where there is an incomplete response to the radiation/chemo regimen, or where recurrence arises.

The second school, which my doctors followed, is more of a "belt and suspenders" approach, relying on both surgical removal of the lymphatic pathways that OC uses to spread, and the radiation/chemo to kill any stray cells. Of this school, some prefer to do the surgery after treatment, while others do it before radiation and chemo. I had the latter.

There are pluses and minuses to both approaches, so tough to say that one is "better" than the other. Becaues neck dissections can and do have residual effects on shoulder and neck function and sensation, many doctors prefer to hold that surgery in reserve. I have ongoing shoulder and neck pain/stiffness, but it is very manageable. Would I have obtained the same results without the ND? Maybe yes, maybe no. Cancer free and doing pretty much anything I want today, so I will thank my lucky stars.

Hope this helps.

I did not opt for a ND and Moffitt gave me the choice and were leaning towards the no ND as well saying they could always pop it out post Tx but they strongly felt the chemo/rad would take care of my cancer. So far, I'm very glad I didn't have the surgery.

Has he been tested for HPV?

JeffL spelled out the opposing positions in a very evenhanded manner. While not as HOT button an issue as the PEG debate, Neck dissections decisions are similar in that the medical treatment team usually has a strong point of view. My RO felt strongly that neck dissections were "insurance". My ENT surgeon saw neck dissection as much more of an risk analysis issue. Like David, I was very grateful they took my concerns into account and we decided NOT to have one. My admittedly non expert research had indicated that approximately half of the neck dissections were "unnecessary' in that no cancer was found in the lymph nodes. Those figures may be changing now as more and more doctors opt out of rigid treatment protocols. No body wants a neck dissection but in some cases they are necessary.

Jeff and Charm have really hit the nail on the head. My ENT surgeon didn't hesitate once the biopsy came back "suspious" of SCC. Once you're opened up, they can immediately run tests on the lymph nodes to see if cancer is present and go from there. In my case it was so they took them, got a more complete report a week or so thereafter, then set up the program with my RO. As Charm, notes there are lingering ramifications of surgery but I think this path was the right one for me. One thing's for sure for all of us . . . you'd better feel real good about the hands you're putting yourself in.

I had a right side neck dissection. I have had a lot of pain and stiffness form the surgery and radiation but in the lastf ew months I've finally turned the corner. I've done lots of physical therapy to break up the scar tissue and strengthen the muscles.Yoga and different excercises I've been taught have made a huge difference. My neck is uneven too but all this is fine with if it means that I am cancer free and hopefully will continue to be for the rest of my life.

I had a right side neck dissection in December 06 even though I was T1N0M0. The only explanation I was given was that even though the lymph nodes were clean there was a higher chance of recurrence if the lymph nodes were not removed. Didn't work for me. I had a recurrence in Sept 08.

I like the way you are asking questions. I was a little too accepting of my surgeons recommendations. Another good reason for a CCC.

I had a bilateral neck disection had 54 nodes removed. I am not sure if that was the best route for me. I guess I will find out when I do the wash...My doctor also knew how I felt about radiation and I am still terrified about the thought of having to have it. But then he didn't know that till after they decided surgery was the way to go. I got a clear bill when it was over with all nodes removed were clear it is just getting clear margins that we had to worry about. I am still in process of healing painful yes sometimes. Stiffness yes...MissKate it would be nice to know what exercises worked for you...at present I do some but always feels like I have pulled muscles...and a great deal of headaches

I have had 2 bilateral neck dissections. The first was in April 07 to remove several nodes - 1 being positive. The second was 12 months later in April this year when they cut my neck open again to replace and reconstruct my lower jaw bone with new bone.

Following the first dissection my neck healed up really well, but then the radiotherapy certainly tightened up my neck alot, especially seeing there had been alot of muscle removed.

Now 8 months on after the second dissection it is still really tight and stiff but some physiotherapy/massage seems to be helping a little.

In my situation having to have another neck dissection following radiotherapy obviously has made the healing process take twice as long as what the first one did. The radiotherapy just shrivelled everything up.

Karen

I'm sitting here reading this and rubbing my neck dissection scar and edema right now! I had one positive node and had a bunch of other swollen ones so I had a neck dissection. Being as young as I am, I wanted the best chance at getting rid of all the cancer so I opted to have the book thrown at me in a sense. Also, since I had the neck dissection, I did not have to have my jaw cracked or whatever because they went through the area under my chin to do my tongue reconstruction and stuff. So I guess that was a bonus for me.