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Neck Cancers

Understanding the Anatomy

The neck is the connection between the head and the body and is a very complex anatomic region. In the front, the neck goes from the bottom part of the mandible (lower jaw) to the bones of the upper chest and shoulder (including the sternum and collar bones). In the back of the neck, there is mainly muscle and of course the spine.

Basically, the neck is a passageway for air, food, liquids, blood and more to travel from the head to the body and vice versa. This includes blood vessels, nerves, lymphatics and pathways for functions of breathing and eating. The neck is more than just a passageway, though; it contains organs such as the voice box (larynx), thyroid gland and parathyroid glands as well. The submandibular salivary glands and the tail of the parotid salivary glands are also located in the neck.

There are many different ways to classify and analyze the anatomy of the neck. A few major structures to know about include:

  • Sternocleidomastoid muscle: This is the big muscle on either side of your neck. This muscle protects many important deeper structures such as the carotid artery and jugular vein (in addition to many other structures). This muscle goes from the skull just behind the ear (mastoid bone) all the way down to the sternum (breastbone) and clavicles (collarbones). You can feel this large muscle in your neck, especially when you turn your neck side to side.
  • Salivary glands: The submandibular salivary glands and tail of the parotid salivary glands are located in the neck. If you have cancer in one of these glands, see Salivary Gland Cancer.
  • Carotid sheath and major arteries and nerves: This is an envelope of tissue that includes three major structures: the carotid artery, internal jugular vein and vagus nerve. Just behind the carotid sheath sits the sympathetic nerve plexus, which helps with blood pressure control and other important functions. There are also other major nerves such as the hypoglossal nerve (which controls tongue movement) and the spinal accessory nerve (which controls neck and shoulder movement).

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  • Thyroid gland: This organ is located at the midline of your neck, under the skin and a few layers of thin muscles. This gland secretes a hormone that is important in regulating many functions of your body. The thyroid gland has a right and left lobe as well as an isthmus (and occasionally a prominent pyramidal lobe). Also, next to the thyroid gland are four parathyroid glands, which are critical to your body to regulate levels of calcium in your blood.

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  • Trachea and esophagus: These structures are passageways for breathing and eating. The trachea sits in front of the esophagus. It starts below the voice box at the level just below the cricoid cartilage. The esophagus is hidden behind the trachea, and it is the tube through which food and liquids travel from your mouth into your stomach.
  • Lymph nodes: Lymph nodes are located throughout your body, including your neck. Lymph nodes filter fluid accumulated from a nearby part of the body and help your body fight infections and cancers. Cancers from one site in the head and neck can drain into lymph nodes and lead to growth of cancer within the lymph node (called metastatic lymph nodes). The lymph nodes in the neck are classified into different regions. This helps doctors talk about and research spread of cancer into the neck.

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References

1 Gurney JG, Young JL, Roffers SD, Smith MA, Bunin GR. SEER pediatric monograph – soft tissue sarcomas. National Cancer Institute. Page 111. http://seer.cancer.gov/publications/childhood/softtissue.pdf.

2 Fletcher CDM, Rydholm A, Singer S, Sundaram M, Coindre JM. Soft Tissue Tumours. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours: pathology & genetics WHO Classification. Lyon: IARCPress; 2005.

3 Zhang MQ, El-Mofty SK, Dávila RM. Detection of human papillomavirus-related squamous cell carcinoma cytologically and by in situ hybridization in fine-needle aspiration biopsies of cervical metastasis: a tool for identifying the site of an occult head and neck primary. Cancer. 2008;114(2):118-23.

4 Cunningham MJ, Myers EN, Bluestone CD. Malignant tumors of the head and neck in children – a 20 year review. International Journal of Pediatric Otorhinolaryngology. 1987;(13)3:279-292.

5 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Page 611.

6 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed June 20, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

7 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Soft Tissue Sarcoma V.1.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed July 17, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

8 Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.