Calverley was one of those select patients. To eliminate the cancer, one-quarter of her tongue would need to be removed. When doctors at another medical center initially recommended having all of levels 1-4 removed – which could consist of 30-60 nodes in her neck – and grafting donor tissue onto her tongue, she sought a second and third opinion.

“Dr. Chang was the only one who offered to do the sentinel node biopsy and to have my tongue heal on its own,” says Calverley, a 72-year-old Rochester resident.


When Dr. Chang explained that the sentinel node biopsy is also done for women having a mastectomy, it was an easy decision for me, she said.

“I went home and prayed and spent two days talking to people about my decision,” she says. “Friends in the medical field agreed with me and asked, ‘Why would you have all the lymph nodes in your neck removed if they aren’t cancerous, and then deal with all the repercussions? It’s not necessary.’”

“I had my surgery in November, and my tongue is healing beautifully,” says Calverley.

“Only three nodes were removed, and my scar is only about two inches. It’s right in line with a wrinkle on my neck, and you can barely see it,” she says.

“Within three days, I was up and making pumpkin rolls for Thanksgiving,” says Calverley. She spent only one night in the hospital after the surgery.

The benefits of the biopsy are important. Compared to surgery that removes all the lymph nodes, sentinel lymph node biopsy lowers the risk of lymphedema, which causes a buildup of fluid and swelling in the body. Additionally, the biopsy involves mapping lymph nodes in the lower neck and opposite side of the neck – areas not typically included in the traditional approach. For cancer in the middle area of the head or neck, patients can avoid surgery on both sides of the neck.

The sentinel node biopsy procedure involves injecting into the oral cancer site a weak radioactive substance that marks white blood cells. The substance acts as a tracer and is picked up by the lymph vessels, travelling along the path most likely used by any cancer cells that might drain from the tumor to the lymph nodes. Depending on the patient, cancer cells may travel in different paths or patterns. The first lymph node that the substance goes to is called the sentinel lymph node. Imaging will find it and any other nodes containing the tracer.

The surgeon will remove the suspected lymph nodes along with the oral cancer, and a pathologist will immediately examine the tissue to determine if cancer is actually present in the nodes. If it is, the surgeon will perform a neck dissection to remove the diseased lymph nodes.

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