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 is the most common treatment for stomach cancer?

Stomach Cancer

Where is the stomach located? 

The stomach is a pouchlike organ which makes up a relatively small part of the intestinal tract. It lies below the diaphragm in the left upper part of the abdomen, crossing over to the right below the liver. The stomach hangs comparatively free in the abdominal cavity and moves with breathing.

What symptoms indicate the possibility of stomach cancer? 

Unfortunately, the symptoms of stomach cancer are often vague and nonspecific. The most common symptom of stomach cancer is indigestion. This may consist of a sense of discomfort or mild pain, fullness or bloating, burping, slight nausea, heartburn, or loss of appetite. Of course these are signs which we find easy to ignore, but if they persist even intermittently for a period of 2 weeks, your doctor should be consulted. Later signs might include blood in the stools or vomiting, rapid weight loss, and severe pain. These symptoms may also indicate the presence of an ulcer.

Symptoms of Stomach Cancer


How is the diagnosis made? 

A careful history and physical and rectal examination come first. Laboratory tests such as red and white blood cell count and analysis of the acidity of stomach contents will be ordered. The most important of all diagnostic methods is the x-ray examination, with the radiologist observing the flow of barium under the fluoroscope with x-rays of various areas of the stomach taken from different angles with the patient in various positions. Gastroscopy, in which a flexible instrument is passed into the stomach for viewing, along with a diagnostic procedure known as exfoliate cytology, is sometimes used. Cytology allows the examination through a microscope of cells shed by the lining of the stomach. In order to collect the cells, a gastric washing is done. An abrasive brush or balloon is introduced into the stomach and the stomach lining is gently scraped. The material collected is studied by a pathologist to determine if malignant cells are present.

What is Stomach Cancer?

How is cancer of the stomach usually treated? 

The usual treatment for cancer of the stomach is prompt surgical removal ofthe malignant tumor. The operation usually involves the removal of a part or all of the stomach, depending on the location of the malignancy. Sometimes parts of other abdominal organs, such as spleen and pancreas, are removed if they are in the area of the tumor and are believed to be affected.

Stomach (Gastric) Cancer Most Common Treatment


Is any other treatment recommended? 

It depends upon the location and extent of the tumor. Sometimes chemotherapy is used following surgery. Some experimental work is being done with implantation of radioactive sources into the malignant stomach tumor to give relief from pain in patients whose cancers are inoperable. Stomach cancers usually are considered resistant to x-rays, since a radiation dose safe for the surrounding normal tissues is not strong enough to destroy the cancer.

Do doctors sometimes suspect cancer of the stomach and find a benign tumor? 

Yes. Preoperative x-ray examinations cannot always distinguish a malignant tumor from a harmless benign tumor. Furthermore, x-rays occasionally will give the appearance of a tumor but an ulcer may be discovered at surgery.

Is the same operation performed for ulcer of the stomach and stomach cancer? 

This depends on the extent ofthe stomach cancer. The same procedure removal of the stomach is usually performed for either condition.

Do stomach ulcers lead to stomach cancer? 

This is a question over which there has been much speculation. Most doctors feel that the danger of stomach ulcers rests not so much in the possibility that an ulcer may lead to malignancy, but rather that it may be cancerous even while being treated as an ulcer.

What is the difference in the usual treatment between a stomach ulcer and a duodenal ulcer? 

A duodenal ulcer can be treated conservatively for long periods of time without the fear of cancer. A stomach ulcer must be followed closely. A patient is usually put on a strict diet, given appropriate medication, and subjected to further x-ray examination every 2 to 4 weeks. If a clean x-ray picture does not result from this treatment within a few weeks, an exploratory operation is usually performed to determine whether there is a malignancy.

How can a person live without a stomach? 

Quite successfully. Sometimes, only a section of the stomach is removed. However, when necessary, the entire stomach is removed. The patient is required to eat smaller, more frequent meals perhaps half as much food at each meal as previously. The patient learns to eat more often and more slowly and adjusts to this way of life quite easily.

What must be done to prepare for stomach surgery? 

Patients are usually admitted to the hospital a few days before the scheduled operation. They are put on a liquid diet and the stomach is washed out with a stomach tube once or twice daily. Often intravenous medications, vitamins, and blood transfusions are given prior to the operation.

Can the doctor tell immediately if there is a malignancy? 

It is usually necessary to wait several days for the pathological examination of the stomach to determine if cancer is present.

Is the postoperative period for a stomach operation uncomfortable? 

There is likely to be discomfort caused by the use of stomach tubes, intravenous feedings, and injections. Food and drink is usually withheld for 2 to 4 days. For at least the first 3 to 4 months, small, frequent feedings are recommended. The patient can then gradually return to a normal diet of bland foods. Spicy foods and alcohol should be avoided. The doctor may prescribe the addition of iron and liver extract to the diet.

What is the dumping syndrome? 

Following gastrectomy, some patients develop what is known as the "dumping syndrome" weakness, dizziness, sweating, nausea, vomiting, palpitation which occurs when the remnant of the stomach empties itself of food too quickly. This can usually be controlled by frequent small feedings and by a high protein diet with the addition of dry foods and fluids between feedings.

How long is the convalescence period following extensive stomach surgery? 

The patient will usually be able to return to normal activity after about 2 months.

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