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Lymph node removal (lymphadenectomy)

Lymph nodes (or glands) are part of your body’s natural defence system called the lymphatic system. If you’re having surgery for cancer, your doctor may need to remove one or more of your lymph nodes in order to find out if your cancer has spread and to help plan further treatment.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Lymph nodes are small kidney bean-shaped organs located throughout your body, particularly in your armpits, neck and groin. Their main function is to fight infection and filter lymphatic fluid. You may be able to feel swollen nodes in your neck if you have a throat infection or tooth abscess.

Cancer may start in other parts of your body and spread to your lymph nodes. Occasionally, cancers called lymphomas may also start in your lymph nodes.

If you have cancer, for example, breast cancer or melanoma (skin cancer), your surgeon may remove lymph nodes closest to the tumour. This is to find out if the cancer has spread. This will help your doctors to plan the best course of treatment for you.

Depending on the size and location of your cancer, your surgeon may remove the lymph nodes at the same time as removing the primary tumour. For example, in some types of breast cancer, the surgeon removes the lymph nodes in the armpit at the same time as the breast tumour.

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An image showing the lymphatic system

Details

  • Preparation Preparing for lymph node removal

    Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

    Lymph nodes are usually removed under general anaesthesia. This means you will be asleep during the procedure. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s advice.

    Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

    Your nurse will prepare you for theatre. He or she may ask you to wear compression stockings to help prevent blood clots forming in the veins in your legs.

  • Alternatives What are the alternatives to lymph node removal?

    Your surgeon may suggest having a sentinel lymph node biopsy. This is a procedure that can help identify the lymph nodes closest to the cancer (the sentinel nodes) and test them to see if they contain cancer cells. If no cancer cells are found in the sentinel nodes, it means it’s less likely that the cancer has spread.

  • The procedure What happens during lymph node removal?

    There are two main surgical methods for removing lymph nodes – 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. He or she will then carefully remove the lymph nodes. Your surgeon will close the cut with dissolvable stitches.

    Keyhole surgery is done through small cuts to reach lymph nodes deeper inside your body. Your surgeon will use special instruments to pass through these cuts and look at a monitor to see your lymph nodes. Keyhole surgery isn’t suitable for everybody – your surgeon will advise you if it’s appropriate for you.

    Your surgeon will send your lymph nodes to a laboratory to look at the cells to see if these are benign (not cancerous) or cancerous.

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  • Aftercare What to expect afterwards

    You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

    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 will have a dressing covering your wound, and will be told when you can remove this.

    If your surgeon has used dissolvable stitches, they will not need to be removed but will dissolve completely when the area is healed.

    If you have lymph nodes removed from under your armpit or groin area, a physiotherapist will teach you exercises to help you recover. A physiotherapist is a health professional who specialises in maintaining and improving movement and mobility.

    You will 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 home.

    General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon’s advice.

    Your nurse will give you some advice about caring for your healing wounds before you go home. You will be given a date for a follow-up appointment.

    Results

    Your results will be ready several days later and will usually be sent in a report to the doctor who requested your procedure. Your doctor will review the results and discuss them with you at your follow-up appointment.

  • Recovery Recovering from lymph node removal

    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 and if you have any questions, ask your pharmacist for advice.

    Remember to do the exercises your physiotherapist showed you to keep the affected area (your arm or leg) mobile. This will reduce the risk of fluid building up in your arm or leg (lymphoedema). It’s also important not to do any strenuous exercise or heavy lifting for several weeks.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with having lymph nodes removed. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure – for example, feeling sick as a result of the general anaesthetic. Side-effects of having lymph nodes removed include:

    • pain, swelling and bruising
    • stiffness
    • loss of sensation

    Complications

    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, usually in a vein in the leg (deep vein thrombosis, DVT).

    Specific complications of having lymph nodes removed can include:

    • an infection – you may need antibiotics if you develop an infection
    • a build-up of fluid in the lymph node area (seroma)
    • a build-up of fluid in the affected arm or leg (lymphoedema)

    You will continue to be at risk of developing lymphoedema for the rest of your life after you have had your lymph nodes removed (see our FAQs for more information about lymphoedema). The following measures can help to reduce your risk.

    • Keep the 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 – this means wearing suitable clothing and shoes, wearing insect repellent and being careful if shaving.
    • Avoid extreme heat and don’t get sunburnt.
    • Keep mobile by continuing with the exercises recommended by your doctor or physiotherapist.
    • If you notice signs of an infection, such as redness, warmth, swelling, pain or discomfort, see your GP straight away.
  • FAQs FAQs

    For which types of cancer is it necessary to remove the lymph nodes?

    Answer

    It's usually necessary to remove lymph nodes in malignant cancer. Malignant cancers have the potential to spread to other parts of the body.

    Explanation

    Cancer usually spreads to other parts of your body via your lymphatic system and lymph nodes, or via your bloodstream. It's often useful to remove lymph nodes in malignant cancers to help find out if the cancer has spread (called cancer staging) and plan appropriate treatment. This includes cancer of the skin (melanoma), breast, thyroid, mouth, colon or cervix.

    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 (the sentinel lymph node). Your surgeon will then only need to remove the sentinel lymph node to test it for cancer. If the results come back as negative, it means the cancer hasn't spread to the lymph nodes and they don't need to be removed.

    I've had swollen lymph nodes for about four months. Does this mean I need to have them removed?

    Answer

    No, having swollen lymph nodes doesn't automatically mean that you need to have them removed. However, you should see your GP if your lymph nodes remain enlarged for more than a week or two.

    Explanation

    Lymph nodes (or glands) are located throughout your body and may be felt in your armpit, neck and groin. Their main function is to fight infection and filter lymphatic fluid that travels through them.

    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 cause lymph glands in your armpit to swell
    • glandular fever, which affects your whole body and may cause lymph glands in the neck, armpit and groin to swell

    If you have swollen lymph nodes, it's important that you see your GP. He or she will ask about your symptoms and examine you. If he or she suspects an infection, you may be offered blood tests to identify it.

    If your GP can't find an obvious reason for the swelling, he or she may refer you for a fine-needle biopsy. This procedure involves using a fine needle to collect cell samples from your lymph nodes. The sample is then sent to a laboratory for testing. Alternatively, you may have the whole lymph node removed for testing.

    What is lymphoedema?

    Answer

    Lymphoedema is a swelling caused by a build-up of fluid in the area where you have had a lymph node removed. It occurs when the lymphatic system doesn't work properly. It can affect any part of your body but is most often seen in your arm or leg.

    Explanation

    Your lymphatic system is made up of glands (such as tonsils and lymph nodes), your bone marrow and thymus, your spleen and a network of lymphatic vessels.

    The lymphatic system is similar to your blood system, connected by a network of tiny lymphatic vessels. But whereas your blood system supplies oxygen to your tissues, your lymphatic system drains away extra fluid from your tissues, including waste products, back into your blood.

    If the lymphatic system is blocked or damaged, fluid isn't removed from your tissues and this causes swelling. If you have lymph nodes removed, there is a risk that you may develop lymphoedema. The swelling can occur immediately after surgery or several weeks or months later.

    Symptoms of lymphoedema may include:

    • a feeling of tightness and heaviness in your limb
    • swelling in your limb, which may be slight at first and make your skin pit when you press it
    • skin changes, such as dry or tight skin
    • aching of your limb

    Wearing an elastic compression garment on the affected leg or arm and doing regular exercise can help reduce swelling and encourage drainage. Specialist nurses can advise you on how to avoid or treat lymphoedema. If the swelling becomes particularly severe, you may need to have the fluid drained.

  • Resources Resources

    Further information

    Sources

    • Secondary cancer in the lymph nodes. Macmillan Cancer Support. www.macmillan.org.uk, published 1 January 2013
    • Lymphatic system anatomy. eMedicine. www.emedicine.medscape.com, published 28 June 2011
    • The lymphatic system. Cancer Research UK. www.cancerresearchuk.org, published 9 November 2011
    • Lymphadenopathy. eMedicine. www.emedicine.medscape.com, published 4 May 2012
    • Sentinel lymph node biopsy. National Cancer Institute. www.cancer.gov, published 11 August 201
    • Types of breast cancer surgery. Cancer Research UK. www.cancerresearchuk.org, published 16 October 2012
    • Mediastinal lymphadenectomy. eMedicine. www.emedicine.medscape.com, published 12 July 2012
    • Axillary dissection. eMedicine. www.emedicine.medscape.com, published 14 October 2011
    • Surgery. Macmillan Cancer Support. www.macmillan.org.uk, published 1 January 2013
    • Salvat J. Endoscopic lymphadenectomy. Geneva Foundation for Medical Education and Research. www.gfmer.ch, published 17 August 2012
    • Lymphoedema. Macmillan Cancer Support. www.macmillan.org.uk, published August 2010
    • Personal communication, Dr Adam Dangoor, Medical Oncologist, University Hospitals Bristol, 23 January 2013
    • Lymphoedema after breast cancer treatment. Cancer Research UK. www.cancerresearchuk.org, published 17 October 2012
    • After surgery for breast cancer. Macmillan Cancer Support.www.macmillan.org.uk, published 1 August 2010
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010:936
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    Produced by Pippa Coulter, Bupa’s Health Information Team, May 2013.

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