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.

What tests are done to check for cancer? How do I get a second opinion for cancer treatment?

What are the kinds of tests used to help detect cancer?

The tests used to detect cancer depend upon the kind of cancer and the degree to which it has spread.

They fall into the following categories:

• Clinical history and physical examination, including routine blood and urine analyses, heart exams, and chest x-ray.
• X-ray examinations
• Optical instruments (endoscopy)
• Examination of sloughed off cells (cytology)
• Radioactive scans
• Ultrasound
• CT scans (also called CAT or ACTA scans)
• MRI (magnetic resonance imaging)
• Monoclonal antibodies
• Biopsies

Do doctors do too many diagnostic tests? 

Sometimes, but in the area of cancer, it seems that the problem is that too few diagnostic tests are done before operating rather than too many. Laboratory tests are a vital part of any diagnostic workup, but especially so in the treatment of cancer. It is of major importance for the doctor to determine ifthe cancer has spread to other areas from the primary site of the growth. If it has already spread from the primary site, in some cases an operation may not be advisable. Instead chemotherapy or radiation treatment may be used.

The treatment for cancer which has spread, therefore, is different from the treatment for cancer which is located only in the primary site. A good, thorough workup is vital before any surgery at all is done for cancer.

Are the risks great in waiting to do the surgery while spending time to do the diagnostic tests? 

There is very little conclusive evidence to show that there is harm in delaying a short time (such as two weeks) while you are having the diagnostic tests. Occasionally, of course, rapid treatment is necessary for some specific problems of cancer patients. It is also harmful to delay seeing the doctor if you have suspicious symptoms such as a lump in your breast or blood in your stool.

What are some of the things the doctor should tell me about the tests he is going to do or going to order? 

The doctor should tell you what the test is for, what the procedure will be like, what he feels he will learn from the test, why it is important in light of your symptoms, what the risk of the test is, whether you need to be hospitalized,how much it will cost to do the test, and when you can get the results. If the doctor does not offer this information, ask for it.

What kind of risks are there in the tests done for cancer? 

The risks depend upon the test and on the condition of the person on whom the test is being done. Certainly the more simple ones, such as blood counts, involve little or no risk. X-rays which involve small amounts of radiation are lowrisk tests. However, some of the x-rays, as well as some of the procedures, do involve quite a bit of risk. Risks are discussed in this chapter, along with the procedures. You should ask the doctor to discuss the risk versus the benefit of the tests he recommends. Generally in the area of cancer, the benefits of the tests are worth the risks.

What is the best place to go for laboratory tests? 

In general, the most reliable laboratories are in the hospitals. However, there are many independent labs (independent of doctors' offices or hospitals) which also do an excellent job. Many small independent laboratories do so few of some tests that the results may be questionable. The results are only as accurate as the person or laboratory doing them.

Is it all right for me to ask for information about testing, test results, and other procedures?
It certainly is. You are entitled to all information that the doctor has about your case.

How long does it take to establish a diagnosis? 

Ask your doctor about the time it will take. It will depend upon several factors and the slightest delay will seem like an eternity because you will be living with the fear of the unknown. A full evaluation can take from several days to several weeks or may even have to be postponed because a decision cannot be made for any of a number of reasons. Don't be in a rush for that final diagnosis. Allow time for as many diagnostic procedures, additional consultations, and reviews as you can. This is the point in your treatment that is most important to you because what happens at this point sets the stage for determining much of the future course of your disease.

It is at this point that you must evaluate the following:

• Is this the doctor I want to handle my case?
• Do I have enough information about my case to make a judgment?
• Am I comfortable with the doctor?
• Is he someone who understands how I feel and is sensitive to my needs?
• Whom do I want with me when I receive my diagnosis?
• Should I have a second opinion?
• Should I go to one of the large medical centers for more complete diagnosis and treatment?
• What hospital will I go to for my surgery and treatment?

Cancer Diagnosis: initial tests, biopsy and tissue diagnosis, staging and the MDT

Won't my doctor be offended if I ask for another opinion? 

If he is, you should find yourself another doctor. The important thing to remember is that most doctors welcome a second opinion. Because the public has held doctors in reverence for so long, many people think that the doctor will be upset if they ask for a second opinion. But a second opinion does not mean you are questioning your doctor s competence. If you have cancer, a decision about how you proceed with treatment is probably the most important decision you will make in your life. You need the best advice you can get before proceeding with a course of treatment. You don't hesitate to check out various makes and models of cars when you are making a decision about buying one. Certainly you should not hesitate to check out all the possible angles when making a decision about your health.

Can I do this tactfully? 

Yes. Often it is easier if you ask your husband, wife, sister, or whoever usually accompanies you to help you with this. He or she can simply explain to your doctor that before going any further you would like to have a confirming opinion. This is not an unusual or unreasonable request. It is a very necessary step for you to take. The doctor may explain that the x-rays and tests are conclusive as far as he is concerned. Don't let that put you off or pressure you to agree to go along with his treatment. A second opinion will strengthen his conclusions and set your mind at ease.

Who will recommend a specialist to me? 

Usually your primary doctor will make the recommendation. Sometimes he will give you more than one name. You should ask questions about the specialist's credentials, such as:

• Why do you recommend this particular doctor?
• Is he a specialist in the operation (or field)? How often does he perform this particular operation (or service)?
• Is he board certified?
• Is he on the staff of an accredited hospital?

There are some competent doctors who are not boardcertified, but your doctor should be able to tell you why he has chosen the specific specialists he is recommending.

What do I tell the doctor who is doing the consulting? 

Sometimes the doctor who refers you will make the appointment. If you are calling yourself, explain that you have already had a diagnosis and are coming to him for a consultation. Don't make the mistake of trying to let him think you haven't been to another doctor. Using him on a consulting basis means that you will get a straight answer, since he has nothing to gain from recommending one treatment over another.

How do I go about finding the right doctor for a second opinion? 

• You can ask your own doctor to suggest the name of someone to see for a second opinion.

• You can make the appointment yourself, or you can ask the doctor to make the appointment for you.

• You should always discuss your plans for consultation with your doctor. He has your original x-rays and tests, which the other doctor will need in his deliberation. If your doctor is uncooperative, then you have other decisions to make about continuing your relationship with him.

• You can call the nearest cancer center (many of them are affiliated with the 1-800-4-CANCER number) and ask for names of doctors who are specialists in your kind of cancer. If there isn't a cancer center close to you, you can call the toll free 1-800-4-CANCER and ask for names of physicians in your area.

• You can call your nearest medical school and ask for suggestions.

• You can call the nearest unit of the American Cancer Society or state or local medical society.

• You can check the Directory of Medical Specialists at your library and call the specialist directly.

• You can check the Directory of Medical Specialists, get the names of two or three top notch doctors in the area, and ask your doctor to suggest which one he thinks you should see.

Is a medical school's outpatient clinic a good place to go for a second opinion? 

Yes. This is probably one of the better places to turn for a second opinion. Physicians who practice there are on the faculty of the medical school and are usually using the latest methods of treatment. Because most outpatient clinics are divided into specialties, this is where some of the top specialists in the country are practicing. You can contact the clinic by calling the medical school and explaining that you are interested in contacting a doctor at the clinic who specializes in the area of your specific problem. Don't be afraid to explain that you want to get a second opinion and what your experience has been to date. Each clinic, of course, has its own setup but most have appointment secretaries who are very knowledgeable about the clinic and the doctors in their service and will be most helpful in making arrangements for a consultation.

What will such a consultation cost? 

You will be amazed to find that some ofthe finest physicians in the country charge no more and sometimes less than doctors with far less experience and expertise. Part of the reason is that medical school faculty clinic physicians are often salaried and their fees returned to the medical school.

Does such a consultation mean I have to go to that institution for my treatment? 

No. You have free choice in this matter and the decision should be yours. Sometimes people shy away from getting expert advice from doctors at a large medical center because they feel this will mean that they will have to return to the medical center for their treatments. However, this is not the case. Many medical and cancer centers diagnose and recommend treatment for patients to be followed by doctors in local communities. If the medical center is a long distance from your home and you do not want to be bothered with the expense and inconvenience of returning there each time you need treatment, you can take advantage of a consultation and continue to be treated at your local hospital by your own doctor but with the added experience and continuing advice of the specialist at the medical center.

Genetic Testing For Inherited Risk For Cancer


Who pays for a second opinion? 

Many insurance companies now pay for second opinions. Even if your particular insurance company does not, the cost should be less than for the first consultation, because all of the test results and x-rays are available to the second doctor.

What if the second opinion differs from the first doctor's advice? 

Second opinions can sometimes be confusing. If the first doctor recommends a course of treatment different from the second, you are left more confused than when you started. You have three alternatives in this case: Ask the two doctors to discuss the case to see if they can resolve the conflict, ask for a third opinion and accept the majority decision (two out of three), or follow your own instincts about what is best for you.

What is the difference between a referral and a consultation? 

If your doctor decides that your illness requires the attention of a specialist, he will recommend the names of one or several specialists for you to see. This is called a referral and differs from a consultation. A referral means that once you see the specialist you become his patient. For a consultation, a consultant is called in to advise you and your doctor but does not take over responsibility for treating you.

If I am unhappy with my doctor, should I ask him for a referral or a consultation? 

When you are satisfied with your doctor but want to get a second opinion because you want confirmation of a diagnosis, you should ask for a consultation. However, if you are really unhappy with your doctor and the kind of treatment he has been giving you and if you really feel that someone else should be handling your case, what you want is not a consultation but a referral. Ask your doctor to refer you to the top specialist in the area dealing with your condition. Many times, this is a step that may be difficult for the patient to take and can be more easily handled by a family member or a friend. The important thing to remember is not to waste time trying to be patient about the treatment being received when in your own mind you know that things are not going as well as they should. Be bold and ask the doctor for a referral or take steps to find a new doctor on your own.

Can I take advantage of a comprehensive cancer center or research center while using my own local hospital? 

Yes, you can, and it is wise to do so. You can make an appointment to be seen by the specialists at the cancer center or research center for a consultation. Your doctor can call for information on getting a consultation with a doctor on the staff to discuss a case, or you can call for information. As stated before, these centers are designed for treatment of cancer patients and most have up to date cancer information available.

What do I do if I want a second opinion and I am already hospitalized? 

It is a little more difficult to arrange unless your doctor is agreeable to your having it. Explain to your doctor that before you go ahead with any treatment you would like to have another consultation. If there is a specialist on the hospital staff who is qualified, arranging a consultation will be easier than if the specialist is located at another hospital. However, don't allow difficulties to deter you from seeking a consultation that will give you further insight into what alternatives are open to you. Even when you are hospitalized, it is still your right to demand that your doctor find another physician even one from another hospital to give you an independent opinion. Some hospitals have patient advocate services which can be helpful in this kind of situation.

Is it a good idea to get a second opinion on a pathology report? 

The kind of treatment you will get and the outlook for your future are often based on the pathology report. Pathologists are human and pathology is not an exact science. The diagnosis of cancer sometimes requires more than just the examination of a very thin slice of tissue through a series of lenses which magnify the tissues several hundred times. Question the pathology report. Ask your doctor whether he has consulted personally with the pathologist. Many doctors do this as a routine matter. If the doctor has not already done so, indicate that you would like the opinion ofa second pathologist to confirm the first report. In most large hospitals where several pathologists are employed, consultations are routine, assuring the patient that the report is the consensus of a number of trained pathologists.

How are clinical histories taken? 

First, the physician or a trained medical assistant takes a family history, exploring the kinds of illnesses and diseases you have had, whether or not there has been a history of cancer in your family, and the kinds of medication or radiation administered to your mother during pregnancy and to yourself during your lifetime. He asks questions about your body's organs and any suspicious symptoms you may have noticed. You may be asked about your work area, whether or not you are exposed to carcinogens such as asbestos or vinyl chloride, and your smoking habits.

If I have no cancer symptoms and I go to a doctor for a complete cancer detecting physical, what should that physical consist of? 

There is certainly not full agreement on what a comprehensive cancer detecting physical should consist of. Here are some of the items a complete checkup for detecting hidden cancer could involve:

• Complete medical and family history

• Complete blood count

• Complete urinalysis

• Digital rectal exam

• Proctosigmoidoscopy for persons over 50

• Pelvic exam and Pap test for women

• Chest x-ray

• Manual examination of the abdomen, thyroid gland

• Examination of the prostate gland in men and breasts in women (mammography according to age and risk guidelines)

• Check of all skin areas

• Mouth check using a mirror to see into throat and larynx

• Eye exam with a lighted instrument

• Test for occult blood in the stool

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