Lymph nodes are small, bean-shaped glands that serve as filters within the lymphatic system, a part of the body’s immune defenses. These nodes cleanse lymph fluid, trapping foreign particles, damaged cells, and cancer cells. They also house immune cells, such as lymphocytes, which identify and destroy harmful substances like bacteria and viruses. Lymph nodes can be surgically removed in a procedure called lymphadenectomy.
Reasons for Removal
Lymph node removal is often performed to assess and treat the spread of cancer. This procedure helps determine if cancer cells have spread from their original site to the lymphatic system, which influences treatment planning. For example, in breast cancer, melanoma, or head and neck cancers, surgeons remove lymph nodes to check for cancerous cells and remove affected nodes.
A less extensive method, sentinel lymph node biopsy (SLNB), involves removing only the “sentinel” node, the first node where cancer cells might spread. If clear, it often suggests cancer has not spread further, potentially avoiding more extensive removal. If it contains cancer, additional nodes may be removed.
While cancer is the main reason, lymph nodes may also be removed in less common situations involving severe infections. If a lymph node becomes heavily infected or develops an abscess and does not respond to antibiotic treatment, surgical removal might be considered. A single lymph node biopsy can also be performed for diagnostic purposes, helping to diagnose conditions like lymphoma, tuberculosis, or sarcoidosis.
Surgical Procedures
Lymph node removal involves different surgical approaches based on the medical reason and disease extent. A common, less invasive technique is the sentinel lymph node biopsy (SLNB). This procedure begins with injecting a special dye or radioactive tracer near the tumor site. The tracer travels through the lymphatic vessels to highlight the sentinel lymph node, which is then surgically removed for examination under a microscope. This targeted approach aims to minimize the removal of healthy tissue.
When cancer has spread more extensively, lymph node dissection (lymphadenectomy) is performed. This involves removing a larger group of lymph nodes from a specific region, such as the armpit (axillary dissection), groin (inguinal dissection), or neck (cervical dissection). This comprehensive surgery removes all potentially cancerous nodes in the area.
For diagnostic purposes, an excisional biopsy may be performed, involving the complete removal of a single, suspicious lymph node. Regardless of the specific procedure, lymph node removal typically involves general anesthesia, an incision near the affected area, careful removal of the targeted nodes, and then closure of the incision. Sometimes, a small drain might be placed temporarily to manage fluid accumulation.
Immediate Post-Surgical Considerations
Following lymph node removal surgery, patients are typically monitored in a recovery room as they awaken from anesthesia. Pain management is provided with medication to control discomfort, though the level of pain can vary.
Care for the surgical wound promotes healing and prevents complications. Patients receive instructions on how to clean the incision site and identify any signs of infection, such as increased redness, swelling, warmth, or discharge.
Activity restrictions are commonly advised during the initial recovery period to prevent strain on the surgical area. This often includes limitations on lifting heavy objects or engaging in strenuous physical activities. Patients may also experience common side effects such as temporary numbness, bruising, or swelling in the area where the lymph nodes were removed. These effects usually subside as the healing process progresses.
Living Without Lymph Nodes
Living without some lymph nodes, particularly after extensive removal, can lead to long-term implications, with lymphedema being a main concern. Lymphedema is a chronic condition characterized by swelling, typically in an arm or leg, due to impaired lymphatic fluid drainage. This occurs because the removed lymph nodes are no longer available to filter and move lymph fluid, causing it to accumulate in the tissues.
Management of lymphedema often involves a combination of strategies, including the use of compression garments to reduce swelling, specialized physical therapy techniques like manual lymphatic drainage, and meticulous skin care to prevent infections. Exercise is also often recommended to help promote lymphatic flow. While treatment can help manage symptoms, lymphedema can be a persistent condition for some individuals.
Beyond lymphedema, individuals may experience long-term numbness or altered sensation in the surgical area. This can result from nerve disruption that occurs during the removal of lymph nodes. While the body’s immune system has numerous components, extensive lymph node removal can slightly affect local immune surveillance in the affected region. However, the body typically compensates over time by rerouting lymphatic pathways and utilizing other immune resources. Ongoing medical follow-up is advised for monitoring any potential long-term effects, including the risk of cancer recurrence and the effective management of lymphedema.