Some cancer patients may need lymph node surgery. Lymph node surgery is performed for staging purposes to find out whether the cancer has spread to nearby lymph nodes. One or more lymph nodes may be removed for examination under a microscope in one of two ways: axillary lymph node dissection or a sentinel lymph node biopsy.
Sentinel lymph node biopsy: A sentinel lymph node biopsy may be performed to see if the disease has spread to nearby lymph nodes at a microscopic level (i.e., the lymph nodes are not enlarged on the exam but contain small numbers of melanoma cells that have spread from nearby skin). Sentinel lymph nodes are the first nodes within a lymph node group in a region that drain fluid from the cancer site. The purpose of a sentinel lymph node biopsy is to find these nodes, remove them and check them for cancer cells. The surgeon injects a radioactive liquid and a blue dye into the melanoma site. The surgeon examines the lymph nodes for radioactivity to identify which are the first to drain fluid from the cancer site.
The surgeon makes a small incision in the area where the sentinel lymph nodes have been identified. The ones that have absorbed radiation and turned blue are the sentinel lymph nodes. They are removed and sent to the pathology lab for further examination under a microscope. If the sentinel nodes contain cancer, the surgeon will advise the removal of all other lymph nodes within the region. If there are no cancer cells present in the sentinel nodes, it is assumed there is no spread to the remainder of the lymph nodes in that region, and no further surgery is necessary. If a lymph node near the melanoma is enlarged, the test may be skipped altogether and the surgeon may simply remove the enlarged node (excisional lymph node biopsy).
Surgical (excisional) lymph node biopsy: The physician removes an enlarged lymph node through a small cut in the skin. If the lymph node is close to the surface of the skin, a local anesthetic will be used to numb the area being biopsied. If it is located deep under the skin, you may be given drugs to make you drowsy or be put to sleep (using general anesthesia). Surgical lymph node biopsies are generally performed if the lymph node’s size indicates the melanoma has spread, but an FNA was not performed or did not yield conclusive results.
Side Effects of Lymph Node Surgery
The possible side effects of lymph node surgery include
- Swelling
- Pain/tingling sensations/numbness
- Bleeding
- Infection
- Fluid collections
- Lymphedema
Lymphedema is more common in women who have undergone an axillary lymph node dissection than a sentinel lymph node biopsy. For some, the swelling may only be temporary, but for others lymphedema can cause long-term swelling, tightness, and/or pain. Patients experiencing any of the symptoms of lymphedema after lymph node surgery should notify their cancer care team immediately. Physical therapy can help lessen the symptoms of lymphedema.