Surgery to remove the lymph nodes in your neck

Cancer of the larynx sometimes spreads to the lymph nodes in the neck. Surgery to remove lymph nodes from your neck is called a neck dissection.

When you might have surgery to remove lymph nodes in the neck

Your doctor needs to find out if lymph nodes in the neck contain cancer. It is important to know this to work out the stage of the cancer and plan treatment.

Lymph nodes are often the first place cancer cells spread to when they break away from a primary cancer.

You might have lymph nodes removed from one side of your neck or from both sides. Removing the lymph nodes reduces the chance of the cancer spreading or coming back.

You might have this surgery after radiotherapy if your cancer comes back.

About lymph nodes

Lymph nodes are small bean shaped glands. We have them throughout our bodies including the head and neck area. They are part of the lymphatic system that filters body fluid and fights infection.

Lymph nodes also trap damaged or harmful cells such as cancer cells. They are often the first place cancer cells spread to when they break away from a tumour.

Diagram showing the lymph nodes in the head and neck

Your surgeon might not know if there are cancer cells in your lymph nodes before you have surgery. In this case, they will suggest removing the lymph nodes closest to the cancer.

If there is cancer in the lymph nodes you might need to have more surgery to remove more nodes. Or have radiotherapy in that area.

Surgeons don't do a neck dissection on everyone because it can have long term side effects. They have to consider who will benefit from it.

The number of lymph nodes removed depends on:

how many lymph nodes are cancerous
the size of the lymph nodes
if the cancer has spread beyond the lymph node (extra nodal extension)

How you have surgery to remove lymph nodes in your neck

Your surgeon will check that you are fit and well enough for a general anaesthetic Open a glossary item . They will talk to you about the operation and answer any questions you might have.

Having a neck dissection

There are different levels of neck dissection. The most common are levels 1 to 5. For each, your surgeon makes a cut (incision) in the neck and removes some or all of the lymph nodes. This may be on one or both sides of your neck.

Your surgeon may only remove a group of lymph nodes close to the cancer or they may need to remove all the lymph nodes, including those that are around the nerves, blood vessels or muscles.

Sometimes, the surgeon may have to remove other structures in the neck close to the nodes. These include:

a major nerve (accessory nerve) or branches of nerves
a major blood vessel (internal jugular vein)
muscle (sternocleidomastoid muscle)

Diagram showing the muscle, nerve and blood vessel sometimes removed with a lymph node dissection of the neck

You usually have surgery to remove the cancer at the same time as your neck surgery.

After surgery to remove lymph nodes

After the operation, you may have one or more tubes (drains) coming from the wound. These drain any blood that may collect in the wound.

How long you’ll stay in hospital will depend on the type of surgery you’ve had. Your surgeon will give you more information about this.

You usually get the results up to 2 weeks later.

You might have radiotherapy Open a glossary item or chemoradiotherapy after your surgery.

Possible Problems after having a neck dissection

There is a risk of problems or complications after any operation. Many problems are minor but some can be life threatening. Treating them as soon as possible is important.

The side effects often depend on the number of lymph nodes removed during your surgery.

Pain

You usually have some pain and discomfort for the first week or so. But it is possible to control your pain. There are different painkillers you can have.

Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

Immediately after surgery you might have painkillers through a drip into the bloodstream that you control. This is called patient controlled analgesia (PCA). Analgesia is another word for painkillers.

You get painkillers to take home. Your nurse will talk to you about:

how often to take them
when to take them
what side effects you may get

Contact your doctor if you still have pain or if it gets worse.

Infections

You are at risk of getting an infection after an operation. This includes a wound, chest or urine infection. You may have antibiotics to reduce the risk of developing an infection after surgery. Tell your doctor or nurse if you have any symptoms of infection.

They include:

a change in your temperature - 37.5°C or higher or below 36°C
shivering
feeling generally unwell
feeling sick
swelling or redness around your wound and your wound might feel hot
a strong smell or liquid oozing from your wound

Blood clot

Sometimes the tubes of the drain that the surgeon puts in during surgery can become blocked. This can cause blood to collect under the skin and form a clot (haematoma). If this happens, you might need to go back to the operating theatre to have the clot removed and the drain replaced.

Chyle leak

Chyle is milky fluid carried around the body by the lymphatic system. Rarely one of the lymph channels (called the thoracic duct) leaks after a neck dissection. This may cause chyle to collect under the skin. You are usually on bed rest in hospital until it stops.

Some people may have to go back to the operating theatre if the leak continues.

Stiff neck

You may have a stiff neck after a neck dissection. Your physiotherapist will show you some exercises that will help improve this. It can take a few weeks or longer for your neck to be less stiff. You may need to continue the exercises after you go home.

Shoulder stiffness and arm weakness

The accessory nerve controls shoulder movement. If the surgeon removes it during a neck dissection, your shoulder will become stiffer and more difficult to move. Raising your arm over your head on that side can also become more difficult.

Depending on the surgery you have, the weakness in your arm usually lasts only for a few months. But if the surgeon completely removes your accessory nerve, the changes can be permanent. Usually, you see a physiotherapist, who teaches you exercises to help improve the movement in your neck and shoulder. It is important to do these exercises regularly.

Some people may have problems with pain and movement for several months after surgery, despite doing their exercises. If this happens, your surgeon may refer you to a shoulder surgery specialist.

A thinner and shrunken neck

Your neck will look thinner and shrunken if you have had the sternocleidomastoid muscle removed.

Swelling (lymphoedema)

After surgery to remove some or all of the lymph nodes in your neck, the area can be swollen. This can be due to general swelling around the surgical wound. This usually goes down within a couple of weeks. But it can also be a sign of lymphoedema, this swelling doesn’t go away.

Lymphoedema means a build up of lymph fluid that causes swelling. It can develop because surgery interferes with the normal flow of lymph in the lymphatics.

Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. This may include swelling of your tongue and other parts of your mouth.

Tell your surgeon or nurse straight away if you:

have any swelling
find it difficult to swallow
have a feeling of fullness or pressure

They will refer you to a lymphoedema specialist if they think you might have lymphoedema. It’s important to start treatment early to stop the swelling from getting worse.

Scarring

Your scar may look red soon after surgery. Over time this fades and becomes less noticeable. After a few months you may only have a thin white line. Some people may develop a thicker looking scar called keloid scarring. It might take a year or longer for this to improve.