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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.

33_front_larynx (1)

  • 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.

 07_neck_levels73_lymph_nodes_neck

References

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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 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.

7 Yuek B. Measuring and Reporting Quality of Life in Head and Neck Cancer. mcLEan, Virginia; 2002.

8 Arens C. Transoral treatment strategies for head and neck tumors. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2012;11:Doc05.

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10 Li Y, Taylor JM, Ten haken RK, Eisbruch A. The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2007;67(3):660-9.

11 Garden AS, Morrison WH, Wong PF, et al. Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2007;67(2):438-44.

12 Eisbruch A, Levendag PC, Feng FY, et al. Can IMRT or brachytherapy reduce dysphagia associated with chemoradiotherapy of head and neck cancer? The Michigan and Rotterdam experiences. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S40-2.

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15 Beadle BM, Liao KP, Giordano SH, et al. Reduced feeding tube duration with intensity-modulated radiation therapy for head and neck cancer: A Surveillance, Epidemiology, and End Results-Medicare Analysis. Cancer. 2017;123(2):283-293.

16 Pfister DG, Cassileth BR, Deng GE, et al. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol. 2010;28(15):2565-70.

17 Scarantino C, Leveque F, Swann RS, et al. Effect of pilocarpine during radiation therapy: results of RTOG 97-09, a phase III randomized study in head and neck cancer patients. J Support Oncol. 2006;4(5):252-8.

18 Holliday EB, Frank SJ. Proton radiation therapy for head and neck cancer: a review of the clinical experience to date. Int J Radiat Oncol Biol Phys. 2014;89(2):292-302.

19 Miller RC, Lodge M, Murad MH, Jones B. Controversies in clinical trials in proton radiotherapy: the present and the future. Semin Radiat Oncol. 2013;23(2):127-33.

20 Zenda S, Kawashima M, Nishio T, et al. Proton beam therapy as a nonsurgical approach to mucosal melanoma of the head and neck: a pilot study. Int J Radiat Oncol Biol Phys. 2011;81(1):135-9.

21 Fukumitsu N, Okumura T, Mizumoto M, et al. Outcome of T4 (International Union Against Cancer Staging System, 7th edition) or recurrent nasal cavity and paranasal sinus carcinoma treated with proton beam. Int J Radiat Oncol Biol Phys. 2012;83(2):704-11.

22 Demizu Y, Fujii O, Terashima K, et al. Particle therapy for mucosal melanoma of the head and neck. A single-institution retrospective comparison of proton and carbon ion therapy. Strahlenther Onkol. 2014;190(2):186-91.

23 Fuji H, Yoshikawa S, Kasami M, et al. High-dose proton beam therapy for sinonasal mucosal malignant melanoma. Radiat Oncol. 2014;9:162.

24 Allen AM, Pawlicki T, Dong L, et al. An evidence based review of proton beam therapy: the report of ASTRO's emerging technology committee. Radiother Oncol. 2012;103(1):8-11.

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