Surgery to remove the lymph nodes in your neck

Cancers of the mouth and oropharynx can spread to lymph nodes in your neck. Your surgeon might remove some or all of the lymph nodes in your neck.

Why you might have surgery to remove lymph nodes

Lymph nodes are small bean shaped glands found throughout the body, including the head and neck. They are part of the lymphatic system that filters body fluid and fights infection. They 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 primary cancer.

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.

What happens?

Neck dissection

Before your operation, your surgeon might know that there is cancer in your lymph nodes. In this case, the surgeon removes your lymph nodes during your surgery to remove the cancer. 

Surgery to remove the lymph nodes in the neck is called a neck dissection. Surgeons don't routinely do a neck dissection on everyone because it can have long term side effects.

Sometimes your surgeon doesn't know if there are cancer cells in your lymph nodes before you have surgery. In this case, your surgeon might remove the lymph nodes closest to the cancer. They send the nodes to the laboratory to check them for cancer cells.

You might need to have lymph nodes removed from just one side of your neck, or you might need to have them removed from both sides. This will depend on the stage of your cancer.

Sentinel lymph node biopsy (SLNB)

For an early stage cancer your doctor might suggest a sentinel lymph node biopsy(SLNB). This is a test to find the first lymph node or nodes to which a cancer may spread. The doctor then checks to see if this lymph node contains cancer cells.

You might have a sentinel node biopsy at the same time as your operation to remove the cancer.

How you have surgery to remove lymph nodes in your neck

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

Having a general anaesthetic means you won’t be able to eat or drink for several hours beforehand. You usually stop eating at least 6 hours before the procedure. You can usually drink water up to 2 hours beforehand. Your nurse will give you instructions about this.

Sentinel lymph node biopsy

Before your sentinel lymph node biopsy

The day before or morning of your operation, you have a scan to show where the sentinel nodes are. You usually have this in the nuclear medicine department in the hospital. This scan shows the surgeon which lymph nodes to remove but doesn’t tell them whether the nodes contain cancer.  

You have an injection of a small amount of mildly radioactive liquid into the area close to the cancer. The radioactive liquid is called a tracer.

Then you have a scan. This picks up the radioactive liquid and traces it as it moves through the lymphatic vessels and into the lymph nodes. The first nodes that the tracer drains into are the sentinel nodes. The radiographer might mark where these nodes are on your skin.

The scan can take up to 2 hours, but this time may vary. Afterwards you might go straight to the ward to prepare for surgery. Or you may go home and return the following day for your surgery. 

Having a sentinel lymph node biopsy

Your surgeon removes the sentinel lymph nodes during your operation to remove the mouth cancer. During the operation, your surgeon also injects a small amount of blue dye around the cancer. The dye and the tracer help the surgeon identify the sentinel node.  

Your surgeon usually removes 1 to 3 nodes. They send the lymph nodes to the laboratory to be checked for cancer cells. 

After the sentinel lymph node biopsy

You usually get the results about 2 weeks after your surgery. A positive result means there are cancer cells in the sentinel nodes. This means the cancer has started to spread. Your doctor will talk to you about further treatment. They might recommend that you have:

• surgery to remove all the lymph nodes in your neck (a neck dissection)
• radiotherapy to the neck area

A negative result means there are no cancer cells in the sentinel nodes. This means it is unlikely the cancer has spread to the other lymph nodes.

Neck dissection

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)

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

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

After a neck dissection

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; they are usually removed prior to being discharged from hospital.

You usually get the results up to 2 weeks later.

After surgery

How long you’ll stay in hospital will depend on the type of surgery you’ve had.

You may go home on the same day or the following day after a sentinel lymph node biopsy. If on the same day, you will need someone to take you home and stay with you for 24 hours after the operation. This is because of the general anaesthetic.

You may be in hospital for up to 3 days after a neck dissection.

Problems after lymph node removal surgery

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.