Cancer in the Neck: Evaluation and Treatment

Abstract

Physicians dealing with head and neck cancer have puzzled about the best management of cancer in the neck for many years. Crile, in 1906, is credited with defining the operation most commonly used today, the radical neck dissection. This consisted of removing all cervical lymph nodes and nonvital structures in one or both sides of the neck, including the jugular vein, spinal accessory nerve, and sternocleidomastoid muscle. Before World War II, this procedure had a high level of morbidity and mortality, and many patients with cancer in cervical lymph nodes were treated with radiation therapy. Unfortunately, this, too, was not very good, and the appearance of cancer in the neck usually heralded a dismal outcome. With improved anesthesia, the introduction of blood or fluid replacement and antibiotic therapy just prior to World War II, the experience gained by surgeons, and increasing specialization, surgery, in the form of radical neck dissection,