Neck Dissection Lymph Node Removal/Sampling - Yes or No?

Posted by mamacatjane @mamacatjane, Jan 17 10:20pm

After being referred by my PCP, I saw an oral & maxillofacial surgeon on 10/21/22, who biopsied a small lesion on my tongue (which I initially thought was just a canker sore but became concerned when it wouldn't go away after a couple of months), and was subsequently diagnosed with SCC of the left lateral tongue on 10/25/22. Since examination by my surgeon, as well as my PET/CT scan on 11/17/22, showed no evidence of invasion, neck dissection lymph node removal/sampling at the time of my surgery on 11/19/22 was considered selective, and we made the decision to defer it at that time, pending final surgical pathology. My left partial glossectomy went well, and my recuperation has been going as well as can be expected.

Now I am faced with a very difficult decision about how to proceed with treatment, which I have discussed with my immediate family members and a few close friends, with mixed feedback and opinions, so I am turning to those of you who have actually experienced this. Although my tumor was only Grade 1 according to its small size (1.5 x 1.0 x 0.7 cm), its depth of invasion was 6 mm, which barely meets the criteria for Stage 2, since Stage 1 depth must be < 5 mm. My surgeon has discussed with me the potential risks associated with neck dissection – injury to the nerves of the tongue and lower lip, nerves to allow swallowing and movement of the neck muscles, vessel injury, and scarring, not to mention the long-term effects of anesthesia.

Alternatively, my option is a watchful waiting approach, having PET/CT scans as often as possible – probably every three months – with ultrasounds in between. He says that based on the literature, there is a 15-20% chance that there is lymph node invasion, even though nothing is visible on the scans – meaning that there's an 80-85% chance that there is not. I am currently scheduled for my next PET/CT scan on 2/17/23, which will be exactly three months since my last one, but I wonder whether we should be scheduling surgery instead. Thinking about all the potential injury risks truly scares me, and I don't know whether it's worth taking those risks, especially since I am barely a candidate for neck dissection surgery at all – by only 1 mm! That's what makes this decision so difficult for me and keeps me up at night. I would love to hear from those of you who have had this surgery, as well as any of you who have decided against it. HELP!!

Interested in more discussions like this? Go to the Head & Neck Cancer Support Group.

@mamacatjane, although my cancer was in the throat area, I can empathize with this decision you have to make. Before undergoing radiation, chemotherapy was also on the list of to-dos. After researching the odds of chemotherapy helping me (as you have done) and speaking with the oncologist in an up-front manner, I decided against the chemotherapy. This is because having the chemotherapy would have increased my odds of survival by 1-2%, yet there was a greater chance of hearing loss, plus other negative consequences. The decision was very troublesome for a few weeks, before making up my mind. After you explained it, the odds are in your favor…not by the margin of 1-2%, but 80-85%. I cannot tell you what to do. Being an older person, I would not elect for the surgery with those odds. Pray about it, in the quiet of the morning. Listen to the still, small voice inside!

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hi mamacatjane, i can sure understand where your coming from as far as decision making. i thought about the thyroidectomy i am suppose to have and ev en though i listened, the words: total radical nect dissection are such scary words and when i looked at some pictures, even more so. i'm an octogenarian, i am however uncomfortable in my condition as of now, still do not like the thoughts of what's to come. so i agree with thomason. lots to think about, i love the quiet of the morning to pray like thomason said. i'm sure you will make the best decision. blessings

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I had a radical neck surgery as a teenager in the 1970s. It’s definitely life-changing. If you have a good support system and good coverage, that helps. I was an Air Force dependent in San Antonio and the Air Force had a pretty good system that followed up thoroughly. You will need lots of physical therapy.

I don’t know a lot about geriatric cancer. I have heard that older patients might be at reduced risk of metastasis due to their circulatory systems being less efficient. It’s not an easy decision.

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