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15.01.2016
Lighting, Sound, Stagecraft CD's work on both PCs and Macs - featuring dozens of animations, video, color photos and more to help make learning fun and engaging. Lymph is the fluid that flows out from capillary walls to bathe the cells in the tissues of the body.
Cancer can appear in the lymph nodes in two ways: it either starts there or spreads there from somewhere else. In order for cancer cells to spread to new parts of the body, they have to go through several changes.
Normal lymph nodes are tiny and so can be hard to find, but when there is infection, inflammation, or cancer, the nodes can get larger.
When a surgeon operates to remove a primary cancer, one or more of the nearby (regional) lymph nodes may be removed as well. Under the microscope, any cancer cells in the nodes look like cells from the primary tumor. Doctors may also use scans or imaging studies to look for enlarged nodes around a cancer if the nodes are deep in the body. More cancer in the nodes may mean that the cancer is more aggressive or that it is more likely to spread to other places in the body. Cancer that has spread to nodes further away from the cancer is more likely to require extra treatment with chemotherapy or radiation. Treatment of cancer is based on the type of cancer a person has, and the stage of that cancer. A cancer with lower TNM numbers is usually easier to treat and has a better outlook for survival (prognosis).
Nodes that have been removed during cancer surgery can leave the part of the body without a way to drain off excess fluid in the affected area. Parotidectomy is a major surgical procedure to remove the parotid gland .The most common reason to remove this gland is due to an abnormal mass contained within. Most masses that develop in the parotid gland are due to benign tumors such as a pleomorphic adenoma and warthin’s tumor. Rarely cancerous growths like mucoepidermoid carcinoma and acinic cell carcinoma can occur. Some tests that may be performed include computed tomography (CT) scan, magnetic resonance imaging (MRI), and fine-needle aspiration biopsy (using a thin needle to withdraw fluid and cells from the growth).
This surgery requires both highly technical micro-dissection as well as facial nerve monitoring and as such, is not just simply cutting the skin and removing the mass without regard to surrounding structures.
If facial nerve is damaged, the person will potentially be unable to close the eye, smile, close the lips, kiss, etc. Temporary facial paralysis may occur and is not unusual which will recover in few days time.
Rarely, 1-2 weeks after surgery, a salivary fistula may develop between the residual gland and the skin resulting in saliva coming out the skin, usually somewhere along the incision or at the drain site.
Although not considered a complication, the patient should be forewarned that the ear very often is numb as the great auricular sensory nerves to the ear do get cut during surgery. Depending on how the surgery goes and how healthy the patient is to begin with, the patient may be able to go home the same day or the next day.
The patient is able to eat whatever they want but is forbidden from any exercise or heavy lifting the first 1-2 weeks after surgery. However, the left facial region will appear somewhat sunken in compared with the normal opposite side, especially behind the jawbone, below the ear.


Dr Paulose FRCS, DLO is a Consultant ENT Plastic & Laser Surgeon with over 38 years of world class experience in Ear, Nose, Throat and Laser Surgery treating patients across the world from UK, US, Middle East to Asia. Tara Maginnis (of costumes.org fame) putting makeup on herself as she talks and walks you through the process of becoming a character!
This network collects fluid, debris, and other things that are in the body’s tissue, outside the bloodstream. You can read more about lymphoma in our documents Hodgkin Disease and Non-Hodgkin Lymphoma. When cancer cells break away from a tumor, they can travel to other areas of the body through either the bloodstream or the lymph system. They have to be able to break away from the original tumor and attach to the wall of a lymph vessel or blood vessel. For instance, when breast cancer spreads to the lymph nodes, the cells in the nodes look like breast cancer cells.
Sometimes there are so few cancer cells in the node that the pathologist must use special tests to find them. If the cancer is growing out of the lymph node through the layer of connective tissue on the outside (call the capsule), it is called extracapsular extension.
But if nearby lymph nodes are the only other place cancer is found beyond the main (primary) site, surgery to remove the main tumor and the nearby lymph nodes may be able to get rid of it all (and cure it).
For instance, if nodes are affected on the other side of the body, the cancer may need more aggressive treatment. For example, a cancer with T1, N0, M0, would be a cancer that was found very early, before it spread.
Many of the lymph vessels now run into a dead end where the node used to be, and fluid can back up. The clinical significance of lymph node micrometastasis in stage I and stage II colorectal cancer.
There are two parotid glands, one on each side of the face, just below and to the front of the ear. If there is pain, numbness over the face, or facial paralysis, the likelihood of being cancerous growth is there. This complication can be reduced if the surgeon makes every attempt to make the skin flap over the parotid gland as thick as possible. Fortunately, the ear numbness does very slowly resolve over 9-12 months, though it may never go quite back to normal. The surgical drain is removed usually within 3 days and the sutures 5-7 days after surgery. Furthermore, the bigger the parotid mass is to begin with, the more asymmetric the appearance will be after the surgery. They contain immune cells that can attack and destroy germs in the lymph fluid to help fight infection.
Then they must move through the vessel wall to flow with the blood or lymph to a new organ or lymph node. In the case of a very few cancer cells in a lymph node, it may not change the recommended treatment at all. The T1 would mean a small tumor, the N0 means that no nodes are involved, and the M0 means that no metastases were found.
In DeVita VT, Lawrence TS, Rosenberg SA (Eds) Cancer Principles and Practice of Oncology 8th ed.


The Stenson’s duct through which saliva is secreted runs from each gland to the inside of the cheek.
Pain is not that bad in the vast majority of patients after this surgery with most people requiring narcotics only during the first week.
To prevent this the digastric muscle flap can be mobilized during surgery and sutured over to cover the defect. When cancer grows inside lymph nodes, it usually affects the lymph nodes near the tumor itself. When cancer has spread to lymph nodes, it often affects the risk that the cancer might come back after surgery. The tissue that is removed is looked at under the microscope by a pathologist (a doctor who diagnoses illness using tissue samples) to find out if there are cancer cells there. The T in TNM stands for tumor, and the M stands for metastasis, and the N stands for lymph nodes. For more information on staging, see information about your cancer, or read our document, Staging.
The extra temporal facial nerve and its branches pass through the parotid gland and supply motor innervations to the muscles of facial expression, as well as to the post auricular muscles, the posterior belly of the digastric muscle, and the stylohyoid muscles. The various facial nerves are identified and protected during the surgery so as to avoid permanent facial paralysis or numbness. Lymph fluid from the fingers, for instance, works its way toward the chest, joining fluid from the arm. Either way, most of the escaped cancer cells die or are killed before they can start growing somewhere else.
This information helps the doctor decide whether more treatment might be needed after surgery. If there is no cancer found in the lymph nodes near the cancer, the N is assigned a value of 0.
A superficial or total parotidectomy is then performed, depending on the type and location of the tumor. If nearby or distant nodes show cancer, the N is assigned a number such as 1, 2 or sometimes 3, depending on how many nodes are affected, their size, and where they are.
If the tumor has spread to involve the facial nerve, the operation is expanded to include parts of the bone behind the ear (mastoid) to remove as much tumor as possible. Before the incision is closed, a drain is inserted into the area to collect any leaking saliva, if a superficial parotidectomy was performed. Eventually, lymph collects into a large vessel that drains into a blood vessel near the heart. Some lymph nodes are deep inside the body, such as between the lungs or around the bowel, to filter fluid from those areas. The procedure typically takes from two to three hours to complete, depending on the extent of surgery and the skill of the surgeon.
At the end of its journey, the filtered fluid, salts, and proteins are dumped back into the bloodstream.



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