What is a radical neck dissection? when is it done?

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What is a radical neck dissection? The surgeon removes a block of tissue from the collarbone to the jaw and from the front to the back of the neck. The large muscle on the side of the neck that is used for rotating, flexing or extending the neck is also taken out, along with the major vein on the side of the neck. Sometimes, a less drastic operation, called a supraomohyoid neck dissection is done. This takes out only the lymph nodes, the tissue surrounding the nodes and a muscle at the front of the neck. Another technique, called a functional neck dissection, saves the muscles of the neck, taking out only the lymph nodes and tissues surrounding them.
What kind of incision is made with a radical neck dissection? The incision depends upon what the surgery is for. It can run from below the ear to the collarbone. Everything in the front of the neck on one side or on both sides may be removed. This may include the lymph nodes, blood vessels, nerves, and the salivary gland under the jawbone.

Rectal cancer how fast does it grow? How is rectal cancer diagnosed?

Rectal Cancer

This is one cancer which doctors can readily diagnose. The majority of these growths are within easy reach of the physician's examining finger. Rectal bleeding can be an important symptom; it should never be passed off lightly. If the patient promptly sees a physician after the occurrence of this symptom and if the proper examination is done, diagnosis can be made early. Adequate medical attention demands that all patients with blood in or on the stool be examined to discover its cause. Usually there is a simple explanation.

What is the survival rate of rectal cancer?

In the collection of statistics relevant to cancer, the five and ten year results are the ones commonly used for reference. A five year or ten year cure means that the patient is alive for that interval without evidence of cancer. The term "five year survival" is also employed when the patient is alive but has residual or recurrent cancer.

Early rectal cancer offers an excellent chance for cure, with 80 percent alive and free of cancer five years later. If the tumor is encountered in a more advanced stage, when the lymph drainage areas are also involved, the survival figure falls to 25-40 percent. Because the symptoms may be regarded as trivial and because the examination requires exposure of the area, time to examine it, and appropriate instruments, diagnosis and treatment may be delayed. Sometimes these growths are less bloody than irritative, and they can produce diarrhea. Any change in bowel habits in the adult requires proper examination.

How is rectal cancer diagnosed?

A piece of tissue is removed at the time of the internal rectal examination. This specimen is examined microscopically.

Since this diagnosis is so serious, can this tissue examination be relied on? 

No pathologist will make the diagnosis unless he is positive. If there is any uncertainty, a second or even a third representative piece of tissue may be removed for further microscopic examination. In rare instances a second, a third or even a fourth pathologist is consulted. The operation is not done unless the diagnosis is unequivocally made.

What constitutes a favorable case?

 It is not possible to know this before the operation is performed. However, if examination does not suggest that the tumor has extended to the bone or to other parts of the lower body lining, if the X ray of the bladder area shows this to be normal and if the blood examination is normal except for some very mild anemia due to the blood the patient has been losing, there is good reason to be optimistic.

Must an operation be performed? 

This disease won't go away by itself or by any nonsurgical means. It will get bigger and spread and cause much misery. If the patient's condition at all permits it, we should make an effort to cure him.

What does the operation do? 

In general terms the cancer area is completely removed. In some circumstances we can sew the intestinal ends together again; under other conditions a permanent colostomy is required. It is hard to tell in advance which procedure will be possible and which will be the better method.

What makes it necessary to do a colostomy? 

Every effort will be made to save the rectum so that the bowels will move in a normal fashion. Sometimes the growth is so far down toward the anus that it is unwise, in terms of subsequent bowel control or in an effort to cure the disease, to bring the ends together. It's almost always possible to join the ends, but this obviously is not a wise approach if the cancer will probably reappear in the same area in a few months. The operation that removes all the tissue by the abdominal as well as the perineal route offers the best opportunity for total extirpation of the growth. The so called abdominoperineal procedure is the standard approach to this type of cancer.

Is my father too old to be operated on? 

In this regard an individual is not evaluated in terms of how old he is in years, rather in terms of how the years have affected his heart, lungs, kidney and brain. One may be older or younger than his chronological age. The family and the doctor are concerned not only with prolonging existence but also with providing a comfortable life. Thus the quality of survival must be considered. In broadest terms, an eighty year old bedridden, blind, senile individual should be managed differently from a person of the same age who functions completely and performs responsible daily activities.

Is there any other surgical method besides opening the abdomen? 

Another method is burning the tumor by special freezing or electrical techniques. This is done through the rectum without making an incision. It is one of the alternatives when for some reason the standard operation cannot be done. There is currently no long term information available about the cure rate or the salvage rate. It is viewed as a comparative method.

My father has already been operated on. At that time he refused a colostomy and the two ends were brought together. The cancer has recurred. What can be done now?

 If the examination shows that the cancer is still removable, a second operation should be done to excise it all. This will probably require a permanent colostomy. The chances the second time around are never as good as the first time. However, it is definitely the thing to do in an attempt to cure him. The discomfort and symptoms of a recurrent uncontrolled tumor are very disabling.

He had a cancer of the large intestine removed four years ago and appears to be OK from that. Isn't it surprising now to have a cancer of the rectum?

 It is not too common. About 5 percent have two intestinal cancers at the same time or get one after the other.

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