Post chemorads, will I need a neck dissection, when would they do it?

RogerRN43
RogerRN43 Member Posts: 185
in Head and Neck Cancer #1
I finished treatment almost 2 weeks ago and still have a hard palpable 1/3-1/2 lengthwise peanut sized node deep in the corner under my left jaw beside my carotid. Of course with all the possible side effects, and due to it's challenging location, I rather not need any sort of dissection.

Can I still expect it to dissolve?

Have any of you had your affected node as scar tissue and left alone, nothing done with it?

My regional cancer center does not do PET scan followups, in fact I'm not sure if they do them in Canada.
How would they followup my progress, contrast CT/MRI?

Did anyone have a neck dissection after chemorads? When did they do it?

(Sorry for the multiple questions)

Comments

  • soccerfreaks
    soccerfreaks Member Posts: 2,788 Member
    #2
    Questions
    Roger, only your doctors can truly answer your questions, as they have presumably seen 'the pictures' and know what it is there, OR are waiting an appropriate length of time before doing another scan to determine whether there has been any growth (and thus a presumption, perhaps, of a tumor of some kind).

    However, I can say with certainty that radiation can indeed cause scarring, that some of it may go away on its own, and that some of it may be permanent. In between, if the scarring (if that's what it is) in impacting swallowing, you may be a candidate for dilation, where they try to expand the dilation and try to break up some of the scarring (perhaps) while not breaking the esophagus. I have had five of these now, and am finally meeting with some really fine results.

    In my experience, the MRI has only been used to scan the brain when a particular cancer is known to go there on occasion. Otherwise, I have had only CT and PET scans.

    I had my neck dissection at the same time I had tongue surgery, because they found cancer in a few lymph nodes. They recommended the surgery first in my case (probably because they were transplanting nerves along with the flesh from the left arm) because the chemo and rads reportedly would degrade the tissue to the point of making a later surgery much more difficult.

    I'm not sure if any of this helps, but please do not be reluctant to ask as many questions as you like in the forum. There are plenty of knowledgeable and kind people prepared to help if and as they can.

    Good luck!

    Take care,

    Joe
  • sweetblood22
    sweetblood22 Member Posts: 3,228
    #3
    I know there are some that
    I know there are some that still have the scar tissue or lump in their neck, and didn't have a neck dissection.

    There is a poster here from Canada, and with the advice of their physician, paid for a pet scan out of pocket, and traveled to go get it in another city, a few hours away. Maybe they will chime in, and can talk more about that.

    I think Pam and Hal have have neck dissections after, maybe they can help with that.
  • ratface
    ratface Member Posts: 1,337 Member
    #4
    sweetblood22 said:

    I know there are some that
    I know there are some that still have the scar tissue or lump in their neck, and didn't have a neck dissection.

    There is a poster here from Canada, and with the advice of their physician, paid for a pet scan out of pocket, and traveled to go get it in another city, a few hours away. Maybe they will chime in, and can talk more about that.

    I think Pam and Hal have have neck dissections after, maybe they can help with that.

    I was post radiation
    Hi Roger, yes I had a selective disection at about 3 months after rads and chemo. It took that long to find a surgeon, go for the consult, schedule the surgery and just generally be healed enough physically to undergo the operation. My hospital also does not use PET but contrast CT/scanning. Not a big deal for either of these two issues.
  • Pam M
    Pam M Member Posts: 2,196
    #5
    Post Rads DIssection
    Three months after rads, my scans showed what looked to be a node that did not respond fully to treatment. The node was smaller than it had been, and showed less PET activity, but was still larger and more active than normal. My doc advised we do a "wait and see" since there was every chance the cancer was just not finished "dying". My next scans showed physical growth and increased activity, so the modified radical neck dissection was scheduled. My surgery was nine months after the radiation ended. All nodes on the right side of my neck were removed. For me, this was only five nodes - my ENT confirmed that he took them ALL, and that I just had fewer nodes than I thought I would have had.

    Hoping your case is what my docs expected mine to be - very common for people to have "dirty" scans early after treatment, followed by "clean" scans later out with no additional treatment.
  • Hal61
    Hal61 Member Posts: 655
    #6
    Dissection after chemo and rads
    Hi Roger, my case was similar to Pam's. My rad onc had of course hoped that chemo and concurrent radiation whould fix me. Three months post treatment I still had borderline radiance in my left neck/node are, site of original node spread (SCC primary BOT).

    Two docs said, no big, scar tissue, still healing, and a low number on the radiance, just a fraction over borderline (I forget the numbers, I think it wa 3.9 or 4.3, but it was just a bit over what was considered still safe to wait). So I said o.k., and waited for the next scan at six months, and still the nagging just-over-the-border number. Now the ENT sided with my medical onc in urging me to get the dissection. My rad onc was mum, which meant she was for waiting a bit longer, but didn't want to commit.

    So I had a partial neck dissection on the left side. 15 or 16 nodes removed, two came back cancerous.

    So I guess my answer to your question is, you'll need it when scans or biopsies conclude (in yours and the docs' estimations) it's warranted, and you'll do it soon possible at that time.

    best, Hal
  • Goalie
    Goalie Member Posts: 184
    #7
    Hal61 said:

    Dissection after chemo and rads
    Hi Roger, my case was similar to Pam's. My rad onc had of course hoped that chemo and concurrent radiation whould fix me. Three months post treatment I still had borderline radiance in my left neck/node are, site of original node spread (SCC primary BOT).

    Two docs said, no big, scar tissue, still healing, and a low number on the radiance, just a fraction over borderline (I forget the numbers, I think it wa 3.9 or 4.3, but it was just a bit over what was considered still safe to wait). So I said o.k., and waited for the next scan at six months, and still the nagging just-over-the-border number. Now the ENT sided with my medical onc in urging me to get the dissection. My rad onc was mum, which meant she was for waiting a bit longer, but didn't want to commit.

    So I had a partial neck dissection on the left side. 15 or 16 nodes removed, two came back cancerous.

    So I guess my answer to your question is, you'll need it when scans or biopsies conclude (in yours and the docs' estimations) it's warranted, and you'll do it soon possible at that time.

    best, Hal

    cut it out
    Well, we started out with the tonsillectomy and followed that with nine weeks of rads and chemo. Right from the start the ENT said that a follow-up neck dissection was always a possibility if everything didn't disappear... but that we would cross that bridge when we came to it. By "everything" he meant the known large lymph node tumor whose presence was what started the whole process (though the tonsil was the primary).

    Well, at the end of the treatment we still had a good-sized mass. They did the scans two months later and there seemed to be no activity but the real purpose of the scans was to get the exact size and position of the lingering mass so that the surgeon could confidently go in for it. While there he took all the rest of the nodes that cascade down the neck to be sure. As it turned out, the big one was indeed dead and was just a lifeless mass that had died from the inside from the radiation but there was no way to tall this without taking it out and, frankly, I would rather have had it out anyway. Perhaps over the coming years it might have gone away but perhaps not and I didn't need the constant reminder either. And all the others were clean and never cancer.

    Frankly, not only was a neck dissection a good idea for me but I have had the fewest continued problems from this. The scar is almost invisible unless I really stretch out and point to it and it is really the only outward sign of my cancer. But, I admit, I was lucky in that the dissection was very modified and he could very carefully work around nerves and muscles and nothing was cut. As a result, I just ended up with a little numbness and stiffness. Your mileage may vary considerably.

    So, to sum up, for me it was well worth it. Doug

Discussion Boards