Question:medium
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: Restate the problem in plain terms.
A tongue cancer has already thrown secondaries down into the lower part of the neck. The surgeon has to decide how wide a net to cast when clearing the neck nodes.
Step 2: Line up the options by how much tissue they remove.
Suprahyoid dissection clears only level I. Supraomohyoid dissection clears levels I through III and is meant for a neck that looks node negative on exam, done as a precaution. Radical neck dissection clears levels I through V plus the jugular vein, sternocleidomastoid muscle, and accessory nerve, the widest of the three.
Step 3: Match the extent to a node positive lower neck.
Once nodes are already involved, and specifically in the lower neck, levels IV and V, a selective operation like supraomohyoid or suprahyoid will simply miss disease, since those procedures were designed for a clinically clear neck, not one with confirmed secondaries.
Step 4: Place radiotherapy correctly.
Teletherapy has a role after surgery or in patients who cannot undergo an operation, but it does not replace surgical clearance when the nodal disease can be resected.
Step 5: Conclude.
\[ \boxed{\text{Radical neck dissection}} \]
A tongue cancer has already thrown secondaries down into the lower part of the neck. The surgeon has to decide how wide a net to cast when clearing the neck nodes.
Step 2: Line up the options by how much tissue they remove.
Suprahyoid dissection clears only level I. Supraomohyoid dissection clears levels I through III and is meant for a neck that looks node negative on exam, done as a precaution. Radical neck dissection clears levels I through V plus the jugular vein, sternocleidomastoid muscle, and accessory nerve, the widest of the three.
Step 3: Match the extent to a node positive lower neck.
Once nodes are already involved, and specifically in the lower neck, levels IV and V, a selective operation like supraomohyoid or suprahyoid will simply miss disease, since those procedures were designed for a clinically clear neck, not one with confirmed secondaries.
Step 4: Place radiotherapy correctly.
Teletherapy has a role after surgery or in patients who cannot undergo an operation, but it does not replace surgical clearance when the nodal disease can be resected.
Step 5: Conclude.
\[ \boxed{\text{Radical neck dissection}} \]
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