Neck Dissection

One of the most complex aspects of head and neck cancer is that it can often spread to the surrounding lymph nodes in the neck. Of the 600 lymph nodes in the human body, there are 200 nodes in the head and neck region.

These lymph nodes are an important part of the body’s immune system. They filter and trap infected material.

If cancer of the head and neck region has spread to the surrounding lymph nodes, they must be removed in a surgical procedure called neck dissection.

Lymphatic system

Cancer grows in a specific area in its earliest stages. As it grows, some forms can travel to other parts of the body via the lymphatic system.

The lymphatic system is similar to the vascular system of blood vessels, but instead of transporting blood, the lymphatic system transports lymph, a liquid that carries white blood cells, which fight infection.

When cancer spreads through the lymphatic system is it called lymph node metastasis.

When this happens, neck dissection is performed to remove both the cancer and the lymph nodes. The lymph nodes are then examined by a pathologist, who can determine the extent and severity of the cancer.

Removing these lymph nodes and the surrounding tissue can prevent the cancer from spreading to distant organs.

The procedure

During the neck dissection procedure, your head and neck surgeon will examine the larynx and surrounding tissues. Because lymph nodes are arranged in groups, a group of surrounding lymph nodes that the cancer might spread to may be removed in addition to any nodes that are enlarged.

There are different types of neck dissection that can be performed based on the severity of the cancer:

• Radical dissection: This form of neck dissection is performed if the cancer has spread widely. All of the nodes from zones I-V will be removed, as will the surrounding internal jugular vein, accessory nerve, and sternocleidomastoid muscle.
• Modified radical dissection: If one or more of the 3 main surrounding internal jugular vein, accessory nerve, and sternocleidomastoid muscle is left intact, the procedure is referred to as a modified radical dissection, which removes less tissue.
• Selective neck dissection: In this type of neck dissection, even less tissue is removed. This usually occurs when cancer is discovered early. The surgeon selects nodes to remove without removing nodes from all five zones.

 The different types of neck dissection are classified based on the where nodes are being removed from (zones I-V) and whether or not three important surrounding structures are removed:

• The internal jugular vein
• The accessory nerve (cranial nerve XI)
• The sternocleidomastoid muscle

The goal of neck dissection is to remove all of the cancer while preserving as much healthy tissue as possible. 

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