Radical Neck Dissection
As stated under my section on the Head and Neck Clinic treatment for head and neck cancer depends on several factors, including the type of cancer, the size and stage, its location, and your overall health. The most common approaches are:
- Surgery, radiation therapy and chemotherapy being the mainstays of treating head and neck cancer
- For many head and neck cancers, combining two or three types of treatments may be most effective.
- An important concept in treating head and neck cancer is organ preservation. Rather than relying on major surgery, an organ preservation approach first uses radiation and chemotherapy to shrink the tumour. This allows for a less extensive surgery and may even allow some patients to avoid surgery altogether
After consultation at the Head and Neck Clinic my specialists decided the best course of action was to undertake surgery prior to stating the course of radiation and chemotherapy. The reasoning behind this was that in my case they believed that the removal of the majority of the cancer prior to starting treatment would provide better chances overall than leaving the surgery as the last option if the radio/chemo did not kill all the cancer. As I have stated before each case is different and you should weigh up all the available information prior to making any decision on treatment, for me it was simple get rid of as much of Herbert as I could then have a reduced radiation/chemo program to remove what was left.
A Radical Neck Dissection (I love this term) involves the removal of the cancer and associated lymphatic tissue in all levels of the neck (upper, mid and lower). To optimise the chances of completely removing the cancer, a radical neck dissection is often the best course of treatment.
The specific risks of a radical neck dissection depend on the number of neck levels that are operated on and the precise location of the operated area. In my case the outcomes were:
- loss of a lot of tissue that makes my neck look thinner (a hollow on the left side of my neck)
- loss of feeling (at least for the time being) from the tip of my left ear down to my left shoulder due to the removal of various nerves.
- A little loss of function in my left shoulder due to the removal of the main muscle at the front of my neck ( I now look very strange when I shrug).
I was scheduled to go in for surgery on 22 January 2009 to have the radical neck dissection. The ENT surgeon advised me that I would be in hospital for about a week (until all the relevant drains, tubes etc were removed) after surgery. I arrived at St Andrews Hospital at the appointed 12PM ready for the scheduled start of surgery at 1700. The process on arrival was much the same as the "exploratory" surgery I had the week before, that is report to the Cardiac reception area, fill out the obligatory paperwork, say goodbye to H, go up to the Surgical Preparation area (SPA), do the height and weight checks then sit around for four and a half hours until the wards man comes and collects you for transporting down to surgery.
I was summoned about 1640, jumped on the gurney and was whizzed down to the operating theatre. The first surgeon to get a shot at me was to be the maxillo-facial surgeon who was to remove the eight molars. After she was done with me the ENT was to get to removing Herbert. In all I spent about six hours on the table, 1.5 hours for the teeth and 4.5 for the radical neck dissection. At about 2300 I was taken to ICU for an overnight stay.
Straight after finishing with me in surgery my ENT specialist gave H a ring to let her know how things went.
I awoke (that I can first remember) at about 2315-2330 to see a nurse sitting at the end of my bed (we had one nurse for two patients in ICU and they were never more than a few steps away at any time). I was instructed that they had given me a "self-administering" morphine device and that if I was in any pain to give the button a press. By the time I was taken up to the ward later on 23 January 2009 I had had no need to use the morphine at all.
At about 0540 I was awoken for a wash and a shave and given a soft breakfast. My face was numb from the top lip down so I must have been some sight trying to eat. In fact later that afternoon, up in the ward, one of the nurses brought me a face washer to clean up the bake-bean juice (from breakfast) off my chin. I had gone most of the day with no one telling me I had a dirty face. At about 0700 the ENT visited and gave the ICU staff the go ahead to send me up to the ward for the rest of my week-long stay.
At this point I must say that I was feeling remarkably well, I had no pain from surgery, I could move freely (well as freely as you can with the restriction of massaging leggings, drains in your neck and drips in your left arm). The left side of my face was completely numb from my left ear down to the suture line on my left shoulder, my lower jaw was numb and my upper lip was pins & needles as the aesthetic wore off from the oral surgery. It took until about lunchtime on 24 January 2009 for my lower jaw to get feeling back.
The rest of my stay in the ward was pretty standard with two hourly observations, plenty of attention (in the early days until I was mobile) from the nurses and plenty of time to read and watch what wasn’t on TV.
On 24 January 2009 I had my massage leggings removed which meant I could get up and walk around.
On 26 January 2009 I had my drip removed along with the upper of my two drains which meant I was only restricted in movement by one drain. It was also this day that I went onto oral antibiotics. On 27 January 2009 I was taken of Heprin (an anti-clotting agent) because my moving around reduced the risk of clots forming.
On 29 January 2009 I had my lower drain removed along with half the 60 odd staples in my neck. On 30 January 2009 I had the rest of the staples removed and was allowed to go home. H came and picked me up at about 1500. it was good to get home, and when I slipped into my own dear little bed that night it was one of the best night sleep I had had in a while, except I could not feel my left ear when I slept on it – it seemed like I was lying on a lump which was a little disconcerting.
Over the weekend I got back to normal activities such as housework, driving etc and had no real side-effects from the surgery with the exception of a little stiffness in the left shoulder.
On 03 February 2009 I returned to work. The major side affect I ahd at work from my surgery was every time the phone would ring (it is on the left side of my desk) I would almost knock myself out when I put it to my left ear (due to it being numb). I vowed I would get a telephone headset.