Question:
What is the treatment for a cancer of the lateral border of the tongue with lower neck lymph node secondaries?
What is the treatment for a cancer of the lateral border of the tongue with lower neck lymph node secondaries?
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Node positive lower neck disease from tongue cancer needs a comprehensive radical neck dissection, not a selective one.
Updated On: Jul 8, 2026
- Radical neck dissection
- Supraomohyoid dissection
- Suprahyoid neck dissection
- Teletherapy
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The Correct Option is A
Solution and Explanation
Step 1: Understand the clinical situation.
The patient has a squamous cell carcinoma of the lateral border of the tongue that has already spread to lymph nodes in the lower neck. The disease is no longer confined to the primary site, the neck is clinically node positive, and the involvement is in the lower neck specifically.
Step 2: Recall the types of neck dissection.
A radical neck dissection removes all lymph node levels I to V on the involved side, along with the internal jugular vein, sternocleidomastoid muscle, and spinal accessory nerve. A supraomohyoid dissection is a selective dissection removing only levels I to III, used mainly for a clinically node negative neck as an elective, staging procedure. A suprahyoid dissection removes only the submental and submandibular nodes, level I, an even smaller field.
Step 3: Match the extent of disease to the extent of surgery.
Because this patient already has clinically proven secondaries in the lower neck, levels III to V, a limited selective dissection like supraomohyoid or suprahyoid would leave disease behind. The standard of care for a clinically node positive neck with lower neck involvement is a comprehensive dissection that clears all the at risk levels, which is the radical neck dissection, or a modified version that spares an uninvolved structure such as the accessory nerve.
Step 4: Explain why teletherapy alone is wrong.
Teletherapy, external beam radiotherapy, is used as an adjuvant after surgery, or as a primary option in patients unfit for surgery, but it is not the first line answer when surgical clearance of bulky, lower neck nodal disease is feasible.
Step 5: Final answer.
\[ \boxed{\text{Radical neck dissection}} \]
The patient has a squamous cell carcinoma of the lateral border of the tongue that has already spread to lymph nodes in the lower neck. The disease is no longer confined to the primary site, the neck is clinically node positive, and the involvement is in the lower neck specifically.
Step 2: Recall the types of neck dissection.
A radical neck dissection removes all lymph node levels I to V on the involved side, along with the internal jugular vein, sternocleidomastoid muscle, and spinal accessory nerve. A supraomohyoid dissection is a selective dissection removing only levels I to III, used mainly for a clinically node negative neck as an elective, staging procedure. A suprahyoid dissection removes only the submental and submandibular nodes, level I, an even smaller field.
Step 3: Match the extent of disease to the extent of surgery.
Because this patient already has clinically proven secondaries in the lower neck, levels III to V, a limited selective dissection like supraomohyoid or suprahyoid would leave disease behind. The standard of care for a clinically node positive neck with lower neck involvement is a comprehensive dissection that clears all the at risk levels, which is the radical neck dissection, or a modified version that spares an uninvolved structure such as the accessory nerve.
Step 4: Explain why teletherapy alone is wrong.
Teletherapy, external beam radiotherapy, is used as an adjuvant after surgery, or as a primary option in patients unfit for surgery, but it is not the first line answer when surgical clearance of bulky, lower neck nodal disease is feasible.
Step 5: Final answer.
\[ \boxed{\text{Radical neck dissection}} \]
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