Lymphadenectomy Health Article

Definition

Lymphadenectomy, also called lymph node dissection, is a surgical procedure in which lymph glands are removed from the body and examined for the presence of cancerous cells. A limited or modified lymphadenectomy removes only some of the lymph nodes in the area around a tumor; a total or radical lymphadenectomy removes all of the lymph nodes in the area.

Purpose

The lymphatic system is responsible for returning excess fluid from body tissues to the circulatory system and for defending against foreign or harmful agents such as bacteria, viruses, or cancerous cells. The major components of the lymphatic system are lymph capillaries, lymph vessels, and lymph nodes. Lymph is a clear fluid found in tissues that originates from the circulatory system. Lymph capillaries are tiny vessels that carry excess lymph to larger lymph vessels; these in turn empty to the circulatory system. Lymph nodes are small, oval- or bean-shaped masses found throughout the lymphatic system that act as filters against foreign materials. They tend to group in clusters in such areas as the neck (cervical lymph nodes), under the arm (axillary lymph nodes), the pelvis (iliac lymph nodes), and the groin (inguinal lymph nodes).

The lymphatic system plays an important role in the spread of cancerous cells throughout the body. Cancer cells can break away from their primary site of growth and travel through the bloodstream or lymphatic system to other sites in body. They may then begin growing at these distant sites or in the lymph nodes themselves; this process is called metastasis. Removal of the lymph nodes, then, is a way that doctors can determine if a cancer has begun to metastasize. Lymphadenectomy may also be pursued as a cancer treatment to help prevent further spread of abnormal cells.

Demographics

The American Cancer Society estimates that approximately 1 million cases of cancer are diagnosed each year. Seventy-seven percent of cancers are diagnosed in men and women over the age of 55, although cancer may affect individuals of any age. Men are more often affected than women; during his lifetime, one in two men will be diagnosed with cancer, compared to one in three women. Cancer affects people of all races and ethnic backgrounds, although cancer type does vary somewhat depending upon these factors.

Description

Although the specific surgical procedure may differ according to which lymph nodes are to be removed, some steps are common among all lymphadenectomies. General anesthesia is usually administered for the duration of surgery; this ensures that the patient remain unconscious and relaxed, and awaken with no memory of the procedure.

First, an incision is made into the skin and through the subcutaneous layers in the area where the lymph nodes are to be removed. The lymph nodes are identified and isolated. They are then carefully taken out from surrounding tissues (that is, muscles, blood vessels, and nerves). In the case of axillary node dissection, the pad of fat under the skin of the armpit is removed; generally, about 10 to 20 lymph nodes are embedded in the fat and separately removed. The incision is sutured (stitched) closed with a drain left in place to remove excess fluid from the surgical site.

Alternatively, laparoscopy may be used as a less invasive method of removing lymph nodes. The laparoscope is a thin, lighted tube that is inserted into the abdominal cavity through a small incision. Images taken by the laparoscope may be seen on a video monitor connected to the scope. Certain lymph nodes, such as the pelvic and aortic lymph nodes, may be removed using this technology.

Diagnosis/Preparation

Lymph nodes may become swollen or enlarged as result of invasion by cancer cells. Swollen lymph nodes may be palpated (felt) during a physical exam. Before lymph nodes are removed, a small amount of tissue is usually removed. A biopsy will be performed on it to check for the presence of abnormal cells.

The patient will be asked to stop taking aspirin or aspirin-containing drugs for a period of time prior to surgery, as these can interfere with the blood's ability to clot. Such drugs may include prescription blood thinners (for example, Coumadin—generically known as warfarin and heparin). However, patients should discuss their medications with regard to their upcoming surgery with their doctors, and not make any adjustments or prescription changes on their own. No food or drink after midnight the night before surgery will be allowed.