Neck Dissection for Thyroid Cancer


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Neck Dissection for Thyroid Cancer

  1. 1. Dorset Cancer Network Patient Information Neck Dissection for Thyroid Cancer How do thyroid cancers spread? All thyroid cancers have the ability to spread to other parts of the body producing metastases (“mets”) or “secondaries”. Thyroid cancers can spread in a number of different ways, including by the lymph system to lymph nodes and by the blood to distant organs like the liver, bones and lungs. In certain types of thyroid cancer (papillary and medullary) lymphatic spread is common. Lymph nodes or “glands” are like sieves which catch cancer cells which have spread away from the thyroid. What is a neck dissection? Neck dissection is an operation to remove lymph nodes from the neck. It is an important part of the operation to treat certain types of thyroid cancer. By removing the lymph nodes that are related to the thyroid, the surgeon can maximise the chances of removing all thyroid cancer cells. Also, knowing whether or not there has been spread of thyroid cancer cells to the lymph nodes helps the surgeon and oncologist to make decisions about whether or not other thyroid cancer treatments are needed. There are 2 types of neck dissection: A radical neck dissection: This is an operation which aims to remove all the lymph nodes in the neck between the jaw and the collarbone. This operation may be carried out if there is evidence that there are one or more nodes affected with cancer in the neck. The nodes are often small and stuck to structures in the neck, so it may be necessary to remove other tissues as well as lymph nodes to ensure complete clearance of the cancer. Only structures which you can safely do without are removed. A partial neck dissection: This is performed when there is a possibility that there may be tiny amounts of cancer cells in the nodes in the neck. In this case only those groups of nodes which are most likely to be affected are removed. In both types of neck dissection all the tissues removed are sent away to the laboratory to be fully analysed and determine the extent of spread of cancer cells. What can I expect from the operation? In most cases neck dissection is performed at the same time as removal of the thyroid gland (thyroidectomy), but it may be performed as a separate operation. The operation is performed under general anaesthetic which means that you will be asleep throughout. There may be one or more cuts made in the neck. At the end of the operation you will have one or more drain tubes and stitches or skin clips to the skin. On occasions some of the muscle of the neck is removed, in which case the neck may look flatter on the side of the operation. © Poole Hospital NHS Foundation Trust
  2. 2. Dorset Cancer Network Patient Information Possible Complications All operations carry risks, including postoperative infections (e.g. in the wound or chest), bleeding beneath the wound, which occasionally requires re-operation and miscellaneous problems due to the anaesthetic. There are some complications which are more specifically associated with neck dissection: Scar: Most incisions in the neck heal to produce a very satisfactory scar. The scar may become thick and red for a few months after the operation before fading to a thin white line. Some patients develop a thick exaggerated scar but this is uncommon and unpredictable. Numb skin: The skin of the neck will be numb after surgery. This will improve to some extent but it is unlikely to return to normal. Stiff neck: Most patients find that their neck is stiffer after the operation. Bleeding: If bleeding is excessive or the drain tubes which are put in during surgery become blocked, blood may collect under the skin and form a clot (haematoma). If this occurs it may be necessary to return to the operating theatre to remove the clot, stop the bleeding and replace the drains. Chyle leak: Chyle is the tissue fluid which runs in lymph channels. Occasionally one of these channels, called the thoracic duct, leaks after the operation. If this occurs, lymph fluid or chyle can come out of the drain in large volumes or collect under the skin. If this occurs you will need to stay in hospital longer and you may need another operation to seal the leak. Nerve damage: There are a number of nerves in the neck which can be damaged during neck dissection. The surgeon tries hard to preserve these nerves but they may be inadvertently damaged or need to be removed because they are too close to the tumour to leave behind. Nerve damage may be temporary or permanent. If the damage is temporary some improvement can be expected over a period of a few months. If the damage is permanent the resulting changes will also be permanent. Injury to the Accessory Nerve: This is the nerve to one of the muscles of the shoulder. If it is damaged you will find that your shoulder is stiff and that it may be difficult to lift your arm above the shoulder. Also lifting heavy weights like shopping bags can be difficult. Injury to the Hypoglossal Nerve: This is the nerve which makes your tongue move. If it is damaged movement of the tongue is weakened and you will find it difficult to clear food from the side of the mouth. Injury to the Marginal Mandibular Nerve: This nerve makes the muscles of the mouth move. If it is damaged you will find that the corner of your mouth will be weak. This is most obvious when smiling. © Poole Hospital NHS Foundation Trust
  3. 3. Dorset Cancer Network Patient Information Will I need any other sort of treatment? This will depend upon the type of tumour you have, how extensive it is, whether it has spread to your lymph nodes and what treatment you have had already. Sometimes radio-iodine treatment or a course of radiotherapy is recommended. Your surgeon will discuss this with you after your operation. I confirm that I have read and understood the above information and have discussed any queries with the surgical team. Name ………………………… Signature ……………………. Date …………………………. Written by: Dorset Cancer Network Endocrine Site Specific Group Date: October 2008 Review date: October 2009 Contact Details Telephone: 01202 2365 for Claire Clark – Macmillan Head & Neck Clinical Nurse Specialist Bleep: 0166 or Karen Roberts & Heidi Trotman – Head & Neck Clinical Nurse Specialists Bleep: 0967 Further Information British Thyroid Foundation: Cancer Backup: For further health-related information, please contact: The Health Information & Resource Centre Poole Hospital NHS Foundation Trust Longfleet Road Poole BH15 2JB Telephone: (01202) 448003 We can supply this information in larger print, on audiotape, or have it translated for you. A member of staff will be happy to discuss this with you. Please call PALS on 01202 448499 or the Health Information Centre on 01202 448003 for further advice. © Poole Hospital NHS Foundation Trust
  4. 4. Dorset Cancer Network Patient Information © Poole Hospital NHS Foundation Trust