Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you’ll be asked to make every effort to stop. This is because smoking increases your risk of getting a chest and wound infection, which can slow down your recovery.
The anaesthetic you have will depend on exactly what procedure you’re having. Although you can have a local anaesthetic for some procedures, if you’re having many lymph nodes removed (clearance or dissection) you’ll probably have general anaesthesia. This means you’ll be asleep during the procedure. A general anaesthetic can make you feel sick, so it’s important that you don’t eat or drink anything for six hours before your procedure. But check this with your anaesthetist or surgeon and follow their advice.
Your nurse or surgeon will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you’re happy to give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.
Your nurse will prepare you for your operation. You may be asked to wear compression stockings which help prevent blood clots forming in the veins in your legs.
Your lymph nodes can be removed in two different ways – open or keyhole surgery.
In open surgery, your surgeon will make a small cut in the affected area and identify the lymph nodes to be removed. They will then carefully remove these and close the cut with dissolvable stitches.
In keyhole surgery, your surgeon will make several small cuts to reach lymph nodes deeper inside your body. They will pass surgical instruments through these cuts and use images on a computer screen to see your lymph nodes. Keyhole surgery isn’t suitable for everybody – talk to your surgeon about whether it’s an option for you.
After surgery, your lymph nodes will be sent to a laboratory to see if the cells are benign (not cancerous) or cancerous.
If you had a procedure under local anaesthetic, you’ll need to take it easy until feeling returns to the area. Be careful not to bump it particularly during this time. Similarly if you had a general anaesthetic, you’ll need to rest while all the effects wear off. You might have some discomfort as this happens but you’ll be offered pain relief as you need it.
You may have fine tubes running out from your wound. These drain fluid into a bag and are usually removed after a few days. You’ll have a dressing covering your wound. Your nurse or surgeon will tell you when you can remove this.
If your surgeon has used dissolvable stitches, these won’t need to be removed but will dissolve completely when the area is healed.
Definitely if you had general anaesthesia, and ideally if you had local, you’ll need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after you get back.
Having a general anaesthetic affects everyone differently and in ways you may not expect. You might find that you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your surgeon’s advice.
You’ll be given advice about caring for your healing wounds before you go home, as well as a date for a follow-up appointment.
Your results of whether or not the cells were found to be cancerous will be ready several days later. These are usually sent to the doctor who requested your procedure. Your doctor will talk you through them at your follow-up appointment.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine. If you have any questions, ask your pharmacist for advice.
If you have lymph nodes removed from under your armpit or groin area, you may feel stiff or sore afterwards. It’s possible that you’ll be seen by a physiotherapist who can give you exercises to do to help the area mobile. Doing these will also reduce the risk of fluid building up in your arm or leg. This fluid build-up is called lymphoedema. Make sure you don’t do any strenuous exercise or heavy lifting for several weeks as this could also lead to lymphoedema.
All medical procedures come with some risks. But how these apply to you will be different to how they apply to other people. Be sure to ask for more information if you have any concerns.
After having the procedure, you may get some side-effects, which are mostly temporary. For example, you may feel sick after a general anaesthetic. After having your lymph nodes removed, you may have:
- pain, swelling and bruising
- stiffness and reduced movement
- loss of sensation (numbness)
Complications are when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot.
Specific complications of having your lymph nodes removed can include:
- an infection, which may mean you’re prescribed antibiotics
- a build-up of fluid in the lymph node area (seroma)
- a build-up of fluid in the affected arm or leg (lymphoedema)
You’ll continue to be at risk of developing lymphoedema for the rest of your life after having lymph nodes removed (see our FAQ 'What is lymphoedema?' for more information about this). But there are many things you can do to keep this risk as low as possible – we’ve put together some suggestions here.
- Keep your skin in the area where you had your lymph nodes removed clean and well moisturised. This can reduce your risk of an infection, which can cause lymphoedema.
- Take care not to get cuts, grazes, bites and stings. So wear suitable clothing and shoes (don’t go barefoot, for example), wear insect repellent and be careful if you’re shaving.
- Avoid extreme heat and don’t get sunburnt.
- Although gentle exercise can help to keep you mobile and it’s important to continue with your physiotherapy exercises, don’t do anything too vigorous.
- Don’t wear tight clothes over the area where you had lymph nodes removed.
- Discuss with your doctor whether it’s safe for you to have vaccinations, blood tests and intra-venous (IV) catheters in your affected arm or leg. These could make you more likely to develop an infection, which can cause lymphoedema. You may also be advised not to have your blood pressure taken with a cuff around your arm.
If you notice signs of an infection, such as redness, warmth, swelling, pain or discomfort, contact your GP straight away.
FAQ: For which types of cancer is it necessary to remove the lymph glands? FAQ: For which types of cancer is it necessary to remove the lymph glands?
If you have cancer, the lymph nodes closest to the tumour may need to be removed. This may be to find out if the cancer has spread or because it already has. Cancers for which this is most often done include cancer of your skin (melanoma), breast, lung, colon or cervix.
Cancer usually spreads to other parts of your body via your lymphatic system and lymph nodes, or through your blood. It’s often useful to remove lymph nodes in some cancers to help find out if it’s spread (called cancer staging) and plan appropriate treatment.
As there may be complications linked to having your lymph nodes removed, your surgeon may recommend having a sentinel lymph node biopsy beforehand. This helps to identify the first lymph node that the tumour cells drain into (called your sentinel lymph node). Your surgeon will then need to remove only your sentinel lymph node to test it for cancer. If the results come back as negative, it means the cancer hasn’t spread to your lymph nodes and they don’t need to be removed.
FAQ: I’ve had swollen lymph nodes for several months. Do I need to have them removed? FAQ: I’ve had swollen lymph nodes for several months. Do I need to have them removed?
No, having swollen lymph nodes doesn’t automatically mean that you need to have them removed. But it’s a good idea to see your GP if they stay enlarged for more than three or four weeks.
Lymph nodes (or glands) are found throughout your body. Their main role is to fight infections and filter the lymph fluid that travels through them. Sometimes your lymph nodes may get bigger and you or your doctor may be able to feel them in your armpit, neck and groin.
There are many reasons why you might have enlarged lymph nodes. The most common cause is an infection, for example:
- a genital or pelvic infection, which may cause lymph glands in your groin to swell
- a breast infection, which may lead to swelling in lymph glands in your armpit
- glandular fever, which affects your whole body and may cause swollen lymph glands in your neck, armpit and groin
If the infection is caused by bacteria, you’ll probably be offered antibiotics to treat it. If your swollen lymph nodes are caused by something else, your treatment will be different and sometimes you may not need any treatment at all.
Lymphoedema is a build-up of fluid that causes swelling. If you have lymph nodes removed, it can develop in the area they were taken from. It can affect any part of your body but is most often seen in your arm or leg.
Your lymphatic system is made up of glands (such as tonsils and lymph nodes), your bone marrow, thymus and spleen. A network of lymphatic vessels connects it all together, in a similar way to the arteries and veins in your blood system. But whereas your arteries and veins carry blood, your lymphatic system drains away extra fluid, including waste products, from your tissues.
If your lymphatic system is blocked or damaged, fluid isn’t removed from your tissues. This causes swelling (lymphoedema), usually in an arm or leg. If you have lymph nodes removed, there’s a risk that you may develop lymphoedema. You’re more likely to develop lymphoedema if you have several lymph nodes removed and if you’ve had radiotherapy treatment for cancer.
Symptoms of lymphoedema may include:
- a feeling of tightness, fullness and heaviness in your arm or leg
- swelling in your arm or leg, which may be slight at first and make your skin pit when you press it
- restricted movement in your affected arm or leg
- skin changes, such as dry or tight skin
- aching of your arm or leg
These symptoms may get worse in warm weather or, in women, just before a period.
Wearing an elastic compression garment on your affected arm or leg and doing regular exercise can help reduce swelling and encourage the fluid to drain. Keeping your affected arm or leg raised, especially at night, can also help. Specialist nurses can advise you on how to prevent or treat lymphoedema. If the swelling becomes particularly severe, you may be advised to have further treatment, possibly an operation.
- Lymphatic system anatomy. Medscape. www.emedicine.medscape.com, published 19 September 2013.
- Axillary dissection. Medscape. www.emedicine.medscape.com, published 26 September 2013
- Secondary cancer in the lymph nodes. Macmillan Cancer Support. www.macmillan.org.uk, reviewed 1 January 2013
- Breast and endocrine surgery. OSH Operative Surgery (online). Oxford Medicine Online. www.oxfordmedicine.com, published October 2011
- Dixon J. Intraoperative assessment of axillary lymph node in patients with breast cancer. BMJ 2014; 349:g6803. doi:org/10.1136/bmj.g6803
- Perioperative anaesthesia care and practical procedures. OSH Operative Surgery (online). Oxford Medicine Online. www.oxfordmedicine.com, published October 2011
- Treatment of primary breast cancer. Scottish Intercollegiate Guidelines Network (SIGN), September 2013. www.sign.ac.uk
- Lymphedema. The Merck Manuals. www.merckmanuals.com, published October 2013
- Complications after breast surgery. OSH Post-operative Complications (online). Oxford Medicine Online. www.oxfordmedicine.com, published October 2011
- Lymphoedema. BMJ Best Practice. www.bestpractice.bmj.com, published 22 August 2014
- Lymphedema. Medscape. www.emedicine.medscape.com, published 8 January 2015
- Generalised lymphadenopathy. PatientPlus. www.patient.info/doctor, reviewed 24 March 2014
- Benign breast disease. PatientPlus. www.patient.info/doctor, reviewed 7 March 2013
- Endoscopic radical inguinal lymphadenectomy. National Institute of Clinical Excellence (NICE), June 2011. www.nice.org.uk
- Colon cancer. Medscape. www.emedicine.medscape.com, published 17 September 2014
- Sentinel lymph node biopsy in melanoma pathology. Medscape. www.emedicine.medscape.com, published 21 October 2013
- Cervical cancer clinical presentation. Medscape. www.emedicine.medscape.com, published 15 August 2014
- Lymphadenopathy. The Merck Manuals. www.merckmanuals.com, published September 2013
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