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Author |
Topic: Neck Dissection |
molly
Contributing Member (25+ posts)
Member # 64
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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?
Posts:
28 | From: Winter Springs FL | Registered:
Mar 2002 |
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Joanna
"Above & Beyond" Member (200+ posts)
Member # 41
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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
Posts:
161 | From: Pacific Northwest | Registered:
Mar 2002 |
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youngerag
"Above & Beyond" Member (200+ posts)
Member # 12
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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.
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Anne G.Younger
Life has never been better.
Posts:
152 | From: Wilmington, Delaware | Registered:
Mar 2002 |
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Brooke
Supporting Member (50+ posts)
Member # 104
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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!
--------------------
Hope is the one thing no one can take away from you!!!
Posts:
52 | From: Toms River, NJ, USA | Registered:
Apr 2002 |
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youngerag
"Above & Beyond" Member (200+ posts)
Member # 12
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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.
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Anne G.Younger
Life has never been better.
Posts:
152 | From: Wilmington, Delaware | Registered:
Mar 2002 |
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Joanna
"Above & Beyond" Member (200+ posts)
Member # 41
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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
Posts:
161 | From: Pacific Northwest | Registered:
Mar 2002 |
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Donna
Platinum Member (100+ posts)
Member # 33
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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
Posts:
128 | From: Plymouth, Minnesota | Registered:
Mar 2002 |
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Brian
Hill
Administrator
Member # 4
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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.
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Brian, stage 3 oral cancer survivor. OCF Founder and Director.
"The first responsibility of a leader is to define reality.
The last is to say thank you. In between, the leader is a
servant."
Posts:
364 | From: Laguna Beach, CA | Registered:
Mar 2002 |
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Ilene
Supporting Member (50+ posts)
Member # 116
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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
Posts:
50 | From: Duluth, Minnesota | Registered:
Apr 2002 |
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Brian
Hill
Administrator
Member # 4
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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.....
Posts:
364 | From: Laguna Beach, CA | Registered:
Mar 2002 |
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Midwest
Gal
Member
Member # 121
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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.
Posts:
22 | From: Des Moines, IA | Registered:
Apr 2002 |
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Midwest
Gal
Member
Member # 121
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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.
Posts:
22 | From: Des Moines, IA | Registered:
Apr 2002 |
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