Lymph Node Surgery

What is Lymph Node Surgery?

Lymph node surgery is a procedure commonly used in the treatment and staging of various cancers, including breast cancer, melanoma, and certain types of head and neck cancers. The surgery involves the removal of lymph nodes to determine if cancer has spread beyond its original site and to help guide further treatment decisions.

Who is Suitable for Lymph Node Surgery?

The suitability for lymph node surgery largely depends on several factors related to the individual’s cancer diagnosis and overall health:

Type and Stage of Cancer: Lymph node surgery is most often performed for cancers where there is a concern about the spread through the lymphatic system. For example, in breast cancer, if a tumour is invasive and of a certain size or grade, a sentinel lymph node biopsy may be recommended. In cases of more advanced or aggressive cancers, an axillary lymph node dissection might be considered.
Results of Imaging and Biopsy: Pre-operative imaging and biopsy results also influence the decision. If imaging suggests lymph node involvement, lymph node surgery can help confirm the extent of cancer spread.
Overall Health and Medical History: The patient's overall health, including any pre-existing conditions that might affect surgery risks or recovery, is also considered. For instance, patients with a history of significant infections or lymphatic issues might face higher risks of complications from lymph node surgery.
Patient’s Preference and Understanding: The decision also involves a detailed discussion with the patient about the surgery's potential benefits, risks, and recovery implications. Understanding the patient's preferences and comfort with the proposed surgical plan is crucial.

Benefits of Lymph Node Surgery

Accurate Staging of Cancer: Lymph node surgery is crucial for accurately determining the cancer stage. Cancer cells in the lymph nodes often indicate that the cancer has spread beyond the original tumour site. Accurate staging is essential for planning the appropriate treatment regimen and predicting the likely outcome or prognosis.
Guiding Treatment Decisions: The results from lymph node surgery can help oncologists decide whether additional treatments, such as chemotherapy or radiation therapy, are needed. For instance, if cancer is found in the lymph nodes, it may suggest a higher risk of recurrence, and more aggressive treatment might be recommended.
Improving Survival Outcomes: In some cancers, such as breast cancer and melanoma, lymph node surgery has improved survival rates. By effectively removing cancerous lymph nodes, the surgery can potentially reduce the risk of cancer spreading to other parts of the body.
Targeted Therapy Approaches: The information from lymph node surgery can also help select targeted therapies. Certain types of cancer treatments are more effective when specific characteristics of cancer (like genetic markers found in lymph node metastases) are known.
Reducing Recurrence: Removing lymph nodes that may contain cancer cells can help reduce the risk of cancer coming back (recurrence). This is particularly true in cases where the lymph nodes are the first and potentially only sites of metastasis.
Psychological Impact: Knowing the exact extent of cancer can provide psychological benefits to patients by reducing uncertainty and allowing them to make more informed decisions regarding their treatment options.
Minimally Invasive Options: Techniques such as sentinel lymph node biopsy (SLNB) involve fewer risks and complications than more extensive surgeries. SLNB can significantly reduce the chances of developing lymphedema (a common and challenging complication characterised by swelling due to lymph fluid buildup) and other complications associated with traditional lymph node dissections.

Preparation Before Lymph Node Surgery

Medical Evaluations: Undergo necessary pre-surgical evaluations, including blood tests, imaging studies, and physical examinations, to assess your overall health and readiness for surgery.
Medication Review: Discuss with your doctor any medications you are currently taking, including over-the-counter drugs and supplements. You may need to stop or adjust certain medications, especially those that can affect blood clotting, such as aspirin or blood thinners.
Fasting: Follow the instructions regarding fasting before the surgery. You may be asked not to eat or drink anything after midnight on the night before the procedure.
Consent and Discussions: Ensure you understand the procedure, potential risks, and benefits. Sign any necessary consent forms.
Arrangements for Recovery: Arrange for someone to drive you home after the surgery and help around the house as you recover.

Lymph Node Surgery Procedure

The specifics will depend on the type of lymph node surgery being performed.

Sentinel Node Biopsy (SNB)

Sentinel Node Biopsy (SNB) is a surgical procedure used primarily in breast cancer and melanoma patients to determine if cancer has spread to lymph nodes near the primary tumour. It involves the following steps:

Tracer Injection: Before the surgery, a radioactive substance and/or a blue dye is injected near the tumour site.
Node Identification: The substances travel the path that cancer would take to spread to the lymph nodes. The first lymph node(s) to pick up the tracer is identified as the sentinel node(s).
Node Removal: The sentinel lymph nodes are surgically removed and sent to a laboratory for examination.
Pathological Examination: If cancer cells are found in the sentinel node, additional treatment might be necessary. If no cancer is found, further lymph node removal may be unnecessary, thus sparing the patient potential side effects.

SNB is preferred for its minimal invasiveness compared to more extensive lymph node surgeries, significantly reducing the risk of complications like lymphedema.

Axillary Lymph Node Dissection (ALND)

Axillary Lymph Node Dissection (ALND) involves the removal of many lymph nodes from the axillary area (underarm) to check for the spread of cancer. It is typically recommended when:

Cancer in Sentinel Nodes: Cancer has been found in the sentinel lymph nodes during an SNB.
Clinical Evaluation: There is clinical or imaging evidence of extensive lymph node involvement.

The procedure typically involves:

General Anesthesia: The patient is put under general anaesthesia.
Incision: A larger incision is made in the underarm area.
Node Removal: Numerous lymph nodes are removed from the area around the breast and under the arms.
Pathological Analysis: Removed lymph nodes are examined for cancer cells.

ALND is more invasive and has a higher risk of complications, such as lymphedema, but it may be necessary to effectively manage cancer spread in some patients.

Targeted Axillary Dissection (TAD)

Targeted Axillary Dissection (TAD) is a newer approach that combines the principles of sentinel node biopsy with axillary lymph node dissection but aims to be more conservative and targeted. It is generally used in patients who have had chemotherapy before surgery (neoadjuvant chemotherapy) and initially had cancer in their lymph nodes. The steps include:

Marking: Before the patient begins chemotherapy, a marker (such as a clip) is placed in the lymph node that initially tested positive for cancer.
Chemotherapy: The patient undergoes chemotherapy intended to shrink the tumour and affected lymph nodes.
Re-evaluation and Surgery: Post-chemotherapy, a sentinel lymph node biopsy is performed. The marked lymph node and any sentinel lymph nodes are removed and analysed.
Assessment: If the marked lymph node is cancer-free, it may suggest that the other nodes are also clear, potentially avoiding a full axillary dissection.

This method aims to minimise surgical intervention while still effectively managing cancer, based on the response to chemotherapy.

What to Expect After Lymph Node Surgery?

You may spend several hours in a recovery room as the anaesthesia wears off. Nurses will monitor your vital signs, pain levels, and any signs of complications.

Pain and swelling at the incision site are common. Pain relief medications will be provided.

If drains were placed to help remove fluid buildup, you'll be taught how to care for them.

The removed lymph nodes are sent to a laboratory for analysis to determine if cancer cells are present, which usually takes several days to a week.

Lymph Node Surgery Recovery Plan

Recovery from lymph node surgery varies but typically involves:

Activity Restrictions: Avoid strenuous activities and heavy lifting for several weeks as recommended by your surgeon.
Wound Care: Keep the surgical site clean and dry. Follow instructions for showering and changing dressings.
Lymphedema Prevention: Physical therapy may be recommended to prevent lymphedema, especially in cases of ALND. Exercises to improve drainage and maintain range of motion are important.
Follow-Up Appointments: Attend follow-up appointments to monitor your recovery and discuss the pathology report results.
Emotional Support: Recovery can be both physically and emotionally challenging. Support from family, friends, or professional counsellors can be beneficial.

Lymph Node Surgery Prognosis

If cancer has not spread beyond the sentinel lymph nodes, the prognosis is generally more favourable, and the cancer is often more manageable with a higher likelihood of successful treatment. Conversely, if multiple lymph nodes are involved, it might indicate a more advanced disease, which could potentially lower the survival rate and complicate treatment.

The prognosis also depends on how well the cancer responds to subsequent treatments like chemotherapy or radiation therapy. Lymph node surgery itself doesn't cure cancer but is a crucial step in staging the disease and planning the most effective treatment strategy.

Lymph Node Surgery Risks

Infection: Any surgery can introduce the risk of infection at the incision site.
Lymphedema: Particularly after ALND, there's a significant risk of developing lymphedema, where lymph fluid accumulates in the arm or leg, causing swelling and pain.
Seroma: A build-up of fluid in the place where the lymph nodes were removed. It may require drainage if it does not resolve on its own.
Nerve Damage: Nerves in the surgical area can be injured during the operation, potentially causing numbness, pain, or weakness.
Blood Vessel Damage: There is a risk of damaging blood vessels near the lymph nodes, which can lead to bleeding and bruising.
Limited Range of Motion: Some patients may experience a limited range of motion in the affected area, which can usually be improved with physical therapy.

What if Lymph Node Surgery is Delayed?

The primary risk of delaying lymph node surgery is the potential for cancer to spread to other parts of the body. This can make the cancer more difficult to treat and potentially worsen the prognosis. Delays can affect staging accuracy, which is crucial for planning the appropriate treatment strategy. Without accurate staging, treatments may be less targeted and, consequently, less effective.

For many patients, any delay in cancer treatment can lead to increased anxiety and stress, which can affect overall well-being and mental health. Particularly in aggressive cancers, delays can directly impact survival rates, as the opportunity to control the cancer at an earlier stage is lost.