If the primary tumor is readily available, it also can be biopsied. Use an open biopsy only if diagnosis cannot be attained by FNAB and a lymphoma is suspected. Treat inoperable N3 metastases with concurrent radiation and chemotherapy. This has been found more effective than sequential therapy. If the patient has a partial response, salvage surgery is indicated if both the neck disease and primary lesion are resectable.
Surgery consists of treatment of the primary tumor and radical or extended neck dissection.
Extended neck dissection includes resection of muscle, nerve, or cartilage, in addition to structures encompassed by traditional radical neck dissection. Selective or functional neck dissections rarely are indicated in patients with N3 disease. Use radiation postoperatively. Preliminary studies indicate that chemotherapy may improve results in patients with advanced neck disease. Patients general condition limits routine use of chemotherapy with radiation, and many patients who are elderly, immunocompromised, or malnourished may not be candidates for adjuvant therapy.