SENTINEL NODE LOCALIZATION FOR TUMORS OF THE HEAD AND NECK

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This research project involves a test that tries to detect if there is any spread of cancer to the lymph nodes from where the cancer started. It is difficult to diagnose early signs of cancer spread to the lymph nodes in patients who have squamous cell carcinoma of the mouth and throat. Spread of squamous cell carcinoma to the lymph nodes may not be detected by physical exam or even CAT scans. The goal of this study is to use lymphoscintigraphy, a test specifically for finding lymph nodes. A special probe (gamma probe) is used during surgery to locate lymph nodes that are most likely to contain cancer. This test has been used for breast cancer and melanoma (a type of skin cancer) and has worked very well. This research project will be offered to patients with squamous cell cancer in their mouth or throat that are less than 4 centimeters who have no indication of enlarged lymph nodes and have never had another mouth or throat cancer. To do the test, the cancer in the mouth or throat will be injected with a temporarily radioactive protein. The probe that is used during surgery uses the radioactivity to locate the lymph nodes that are most likely to contain cancer. The radiation will be gone by one week and should not have side effects. After the nodes that are most likely to contain the cancer are removed, then all the remaining nodes in the neck are removed. The total lymph node removal is the current standard surgery. The lymph nodes will be examined with a microscope to see if there was cancer in the nodes that were found with the probe. If the probe can find the cancerous lymph nodes, then the total lymph node removal (selective neck dissection) may not be necessary in the future. This is important because selective neck dissection can cause problems such as shoulder weakness, some pain, and a neck scar. If smaller operations can be used in the future, it will be easier for patients with cancer to receive treatment.