Lymphatic System and Lymph Nodes

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Many different causes of a lump in the neck exist, including infections, cysts, saliva gland swelling, as well as tumors, both benign and malignant. When a lump in the neck is the first problem noticed by a patient or their physician, evaluation involves sorting out what it is and whether further testing, such as a scope, a biopsy, or imaging is needed. When biopsy is needed, a needle biopsy usually has significant advantages over a biopsy through an incision.

• Link to Neck Mass in Adults article on the ENTHealth website.

Removal of neck lymph nodes (cervical lymphadenectomy or neck dissection)

When lymph nodes of the neck are either definitively involved with cancer or are at high risk of involvement with cancer, treatment typically includes the lymph nodes in that region. This can be done with radiation (± chemotherapy) or surgery. When the lymph nodes are surgically removed, the specimen is sent for pathology, allowing us to learn more about the cancer, such as how many lymph nodes were involved, and whether aggressive and high-risk features are present, such as when a tumor grows beyond the capsule of the lymph node. This additional information on the lymph nodes factors into any recommendation for possible additional treatment after surgery, such as radiation.

The technical goal of surgery to remove the lymph nodes is to thoroughly remove the lymph nodes in the area at risk, while preserving normal structures. Having said this, the surrounding structures are at some risk, and some numbness to the skin of the neck and ear, some weakness of the lower lip, and some weakness in raising the arm above the head in a jumping jack position may occur and typically improve with time.

• Link to a well-written article on the American Head and Neck Society website explaining the purpose and risks of removing lymph nodes in the neck,

sentinel node biopsy (sentinel lymph node biopsy)

The sentinel lymph node is the hypothetical first lymph node or group of nodes draining (filtering fluid from) a cancer. It is postulated that the sentinel lymph node is the most likely lymph node to be involved by a cancer if spread has occurred. Therefore, removing and testing a sentinel lymph node can indicate whether spread has occurred, even if too small to be felt on exam or seen on x-rays or other imaging. The sentinel node biopsy is the identification, removal and analysis of the sentinel lymph node (or sentinel lymph nodes if a few good candidates are apparent) of a particular tumor.

• Link to the National Cancer Institute webpage on sentinel node biopsy.

Lymphedema

Lymphedema is the condition of swelling (edema) of tissue relating to insufficient clearance by the lymphatic system. It can occur after treatment, either surgical, radiation, or both. New drainage pathways develop over time, but treatments such as manual lymphatic drainage performed by a physical therapist or a home-use device speed up and improve clearance of lymphedema. When severe and untreated, lymphedema can constrain movement, which can allow scar tissue to develop and limit movement permanently.

• Link to an article for patients explaining lymphedema and its treatment on the American Head and Neck website.

tracheostomy

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